Abstract
BackgroundCaseload midwifery reduces childbirth interventions and increases women’s satisfaction with care. It is therefore important to understand the impact of caseload midwifery on midwives working in and alongside the model. While some studies have reported higher satisfaction for caseload compared with standard care midwives, others have suggested a need to explore midwives’ work-life balance as well as potential for stress and burnout. This study explored midwives’ attitudes to their professional role, and also measured burnout in caseload midwives compared to standard care midwives at two sites in Victoria, Australia with newly introduced caseload midwifery models.MethodsAll midwives providing maternity care at the study sites were sent questionnaires at the commencement of the caseload midwifery model and two years later. Data items included the Midwifery Process Questionnaire (MPQ) to examine midwives’ attitude to their professional role, the Copenhagen Burnout Inventory (CBI) to measure burnout, and questions about midwives’ views of caseload work. Data were pooled for the two sites and comparisons made between caseload and standard care midwives. The MPQ and CBI data were summarised as individual and group means.ResultsTwenty caseload midwives (88%) and 130 standard care midwives (41%) responded at baseline and 22 caseload midwives (95%) and 133 standard care midwives (45%) at two years. Caseload and standard care midwives were initially similar across all measures except client-related burnout, which was lower for caseload midwives (12.3 vs 22.4, p = 0.02). After two years, compared to midwives in standard care, caseload midwives had higher mean scores in professional satisfaction (1.08 vs 0.76, p = 0.01), professional support (1.06 vs 0.11, p <0.01) and client interaction (1.4 vs 0.09, p <0.01) and lower scores for personal burnout (35.7 vs 47.7, p < 0.01), work-related burnout (27.3 vs 42.7, p <0.01), and client-related burnout (11.3 vs 21.4, p < 0.01).ConclusionCaseload midwifery was associated with lower burnout scores and higher professional satisfaction. Further research should focus on understanding the key features of the caseload model that are related to these outcomes to help build a picture of what is required to ensure the long-term sustainability of the model.
Highlights
Caseload midwifery reduces childbirth interventions and increases women’s satisfaction with care
Caseload midwifery was associated with lower burnout scores and higher professional satisfaction
Further research should focus on understanding the key features of the caseload model that are related to these outcomes to help build a picture of what is required to ensure the long-term sustainability of the model
Summary
Caseload midwifery reduces childbirth interventions and increases women’s satisfaction with care. While some studies have reported higher satisfaction for caseload compared with standard care midwives, others have suggested a need to explore midwives’ work-life balance as well as potential for stress and burnout. This study explored midwives’ attitudes to their professional role, and measured burnout in caseload midwives compared to standard care midwives at two sites in Victoria, Australia with newly introduced caseload midwifery models. Caseload midwifery ( known as one-to-one midwifery, or Midwifery Group Practice (MGP)) offers benefits for women and infants, including a reduction in childbirth interventions [1,2,3], improved neonatal outcomes [1,2] and greater maternal satisfaction [2,4] compared with standard models of care. While a number of authors have discussed the possibility of burnout in the context of caseload midwifery [19,20], these concerns have not been substantiated in studies where burnout was measured [12,14,21]
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