gms | German Medical Science

Background: Midwives are qualified to provide maternity care independently but very often, they have limited opportunity to use their acquired qualifications and competences in clinical practice. This situation can affect the job satisfaction of midwives [1]. Midwife-led care models result in comparable obstetrical outcomes, lower intervention rates, lower costs, a higher satisfaction of cared women and an increased job satisfaction of midwives compared to usual care models [2], [3]. Little research was done about the professional situation of midwives working in Swiss maternity units.

Aim: The aim of this survey, which was part of a study investigating job satisfaction in association with midwifery-led care, was to gain an overview on the professional situation of midwives in the maternity units of a Swiss canton.

Methods: Online-survey, which was developed based on a literature search, the definition of midwifery-led care, actual state analyses of the hand book for midwifery-led maternity care units and the expert standard for the promotion of physiological birth [4], [3], [5]. All 17 institutions with maternity units in the canton of Zurich were eligible to participate in the survey. Descriptive analysis was done with Stata 13.

Results: 16 out of 17 maternity units (94.1%) participated in the survey: one university hospital, ten public hospitals, two private hospitals and two midwifery-led birthplaces. The maternity units had between 203 and 2,962 births in 2016 and the caesarean section rates ranged between 0% and 56.9%. A total of 25.0% (n=4) maternity units or birthplaces had a midwife-led maternity ward with 46 to 302 midwife-led births and n=1 (6.3) unit currently plan a midwife-led unit. There was no personal or spacial separation to the usual maternity ward, if available. In n=3 (18.8%) of the institutions, women were cared by a midwife which was part of a team which was known to the women before the admission, and in this n=4 (25.0%) institutions, women generally knew the midwife before the admission for giving birth. In the other maternity units (n=12, 75.0%), this rarely or never occurred. The following occupational activities are always or mostly conducted by midwives autonomously and independently: recording of medical history at the admission for giving birth in 81.3% (n=13), clinical assessment for admission in 87.5% (n=14), administration of alternative medicine in 100% (n=16), amniotomy in 86.7% (n=13), perineum protection in 93.8% (n=15), episiotomy in 43.8% (n=7), perineal suture in 6.3% (n=1), the evaluation of the Apgar score in 100% (n=16) and the health status of the new-borns in 53.3% (n=9) of the institutions.

Relevance: This study provides for the first time an overview on the professional situation of midwives in a Swiss canton and therefore a useful base for the future development of midwife-led projects.

Conclusion: Midwife-led maternity units or care models, which promote continuity of care provided by midwives, are rare in the canton of Zurich. Relevant differences were observed between the maternity units regarding the occupational activities which are conducted autonomously and independently by the midwives. There is a need to develop midwifery-led care models and this would have a positive impact on the professional situation and the job satisfaction of midwives.

Ethical criteria and conflict of interests: The research was submitted to an ethics committee. The work was financed by third party funds from Swiss State Secretariat for Education, Research and Innovation. There is no conflict of interest.

The PDF file of the poster submitted for the meeting is available in German as Attachment 1 [Attach. 1].