gms | German Medical Science

Background: The legal framework of midwives in Germany enables them to offer care in the full scope of practice. Midwives work in different settings (freelanced and/or employed). It is free and not State-regulated to work in the full scope of practice (from family planning up to the first birthday of the child) or fragmented [1]. Actually only few studies surveyed a shortage of midwives or a shortage of supply [2].

Aim/Research Question: The aim of the HebAB.NRW – Midwifery care in North Rhine-Westphalia (NRW) study (subproject B), is to generate reliable workforce data for NRW as work field, model of care and workload. The study also explores which factors influence the offer of midwifery care.

Methods: A quantitative cross sectional study design was chosen to ask practicing midwives in the German federal state NRW (written or online). Data was collected between February and July 2018 within the research project HebAB.NRW, funded by LZG.NRW (funding code LZG TG 72 001/2016). Uni- and multivariate analysis were carried out by SPSS 25.0.

Results: 1.924 questionnaires fulfilled the inclusion criteria and could be included in the analysis. 1.715 midwives report that they work in direct care. 36% of practicing midwives work employed as well as freelanced, 40.3% only freelanced and 23.4% only employed. The majority of freelanced midwives (95,3%) offer homebased postnatal care. However, they have a maximum utilization of 66.7% for six months and more and have to reject care requests of seeking women. Supply shortages are primarily found in maternity care and in outpatient postpartum care. There is a high proportion of midwives who wrote a hazard or overload report in the previous month (43.1%) or who could have written one (58.2%). In addition, 25.6% of clinically practicing midwives work in a delivery room that had to be closed temporarily in the previous month.

Relevance: For the first time, the survey generates valid data for the federal state of NRW, which can serve as a basis for the development of political measures to improve midwifery care. The study also shows in which areas access to and maintenance of care is particularly at risk.

Recommendations/Conclusion: Midwives have reached their capacity limits in the clinical and freelance sectors. In addition to a higher number of working midwives, other prevention measures are needed, such as new work structures and organizations that will enable midwives to carry out their occupation on a long-term basis. At the same time, there is a need for incentives for midwives to return to work or to full-time work in order to counter the shortage.

Ethics and conflicts of interest: A vote on ethics was obtained. The research was supported by external funding. There are no conflicts of interest.