Maternity Workforce Research Articles

Supporting Timor-Leste midwives and nurses through an educational program: An evaluative study

Little is currently known about the impacts of participation in a five-week Australian maternal and newborn health training program for Timorese midwives and nurses. BackgroundThe maternal mortality rate in Timor-Leste is estimated to be around 204 per 100,000 live births, and there is a correlation between safe and quality maternal and newborn health services. Hence, there is a need to develop the nation’s maternity workforce. Whilst numerous training programs have been geared towards improving the knowledge and skills of Timorese midwives and nurses, to date, no published study has evaluated their impact on participants. AimTo describe satisfaction of an Australian maternal and newborn health training program for Timorese midwives and nurses and its impact based upon the participants survey and qualitative evaluations. MethodsAn evaluative study was conducted using a survey to explore the impacts of a five-week Australian residential training program on 12 Timorese midwives and one nurse. FindingsThe survey data demonstrated an increase in the participants knowledge and skills required to provide enhanced maternal and newborn care; post-training, most participants demonstrated increased knowledge of obstetric emergencies. The participants showed the most pronounced increase in Advanced Clinical Skills in the subjects of fetal assessment, neonatal resuscitation and obstetric emergencies.The qualitative data identified two main themes and six subthemes related to professionalism, communication, and connections. ConclusionAn Australian residential training program, provided in collaboration with local Rotary clubs can enhance the development of maternal and newborn healthcare skills for midwives and nurses from Timor-Leste.

Maternity support workers’ experiences of workplace trauma and post-traumatic stress symptoms

BackgroundMaternity support workers (MSWs) are now a key part of the maternity workforce. They work in environments with potential exposure to traumatic events, but little is known about their rates of exposure or psychological responses. ObjectivesWe aimed to identify the proportion of MSWs reporting exposure to a traumatic work event and consequential rates of post-traumatic stress disorder (PTSD). We also aimed to identify factors associated with PTSD and to describe levels of burnout, empathy, and functional impairment, and to explore their potential associations with PTSD symptoms. MethodsMSWs were recruited via the Royal College of Midwives newsletter, which is sent to all MSW members, and via social media on the College MSW Facebook page. Participants completed an online survey. They provided information on demographic details, job role, and exposure to traumatic events, and completed questionnaires covering PTSD symptoms related to work events, related functional impairment, burnout, and empathy. Data were analysed via correlations and multiple regression. FindingsOf 98 respondents, 88 had been exposed to a traumatic work event; 79 of these through being present and nine through hearing about traumatic events. Of those exposed, 14.8% (n = 13) participants had probable PTSD, while a further 5.7 % (n = 5) met the subclinical threshold. Over a third (35.2 %) of the sample showed high levels of emotional exhaustion, a key feature of burnout, and 27.3 % reported functional work impairment. PTSD symptoms were associated with younger age, higher empathic concern, and direct exposure to traumatic perinatal events. Conclusions and clinical implicationsMSWs are routinely exposed to traumatic events at work and are at risk of work-related PTSD. Younger and more empathic staff appear more at risk, although our methods could not distinguish cause and effect. It must also be noted that the survey took place during the COVID-19 pandemic, and findings could be influenced by this context. MSWs need to be routinely included in programmes to support staff in relation to trauma exposure at work.

Sustainability of rural Victorian maternity services: ‘We can work together’

BackgroundRural maternity service closures and service level reductions are continually increasing across Victoria. There is limited understanding of how rural board members and executives make decisions about their maternity service’s operations and sustainability. AimTo examine perspectives of rural Victorian board members and executives on the sustainability of rural maternity services. MethodsThis was a qualitative study. Interviews were conducted via Zoom™ with 16 rural Victorian hospital board members and executives. Data were thematically analysed. FindingsSevere shortages in the rural maternity workforce, primarily midwives, have contributed to service sustainability decisions. Challenges in offering midwifery workforce incentives cause difficulty in overcoming workforce shortages. A rural maternity workforce strategy harnessing connection with regional services was called for. Innovative models of maternity care were often actioned at the point of service suspension or closure. Participants requested a government policy position and funding for innovative, safe, and sustainable models of care in rural settings. DiscussionThere is an opportunity for workforce planning to occur between regional and rural services to ensure the development of sustainable maternity models such as midwifery group practice and incentivise the workforce to address current deficits and sustain service provision. ConclusionModels of care developed with rural communities, in collaboration with regional services, have the potential to strengthen the delivery of safe, sustainable maternity services. Workforce modelling and centralised government policies aimed at arresting workforce deficits are suggested to provide rural health service leaders with strategic and operational directions to support the delivery of safe, sustainable maternity services.

Contribution of Health Care Practitioner and Maternity Services Factors to Racial Disparities in Alabama: A Qualitative Study.

Black patients are three times more likely to die of pregnancy-related causes than White patients in the United States, and Alabama has the third worst maternal mortality rate in the nation. We sought to identify health care practitioner and maternity service factors contributing to disparities in Alabama, as well as potential strategies to address these contributors. We conducted key informant interviews with obstetricians, nurses, doulas, lactation counselors, health system administrators, and representatives of professional organizations who deliver maternity care to racially and ethnically diverse patients in Alabama. The interview guide was developed using Howell's conceptual framework on racial and ethnic disparities in severe maternal morbidity and mortality. Adopting a thematic analysis approach, we coded and analyzed transcripts using NVivo 12 software. Open coding and selective coding were conducted to identify themes related to health care practitioner- and maternity services-level determinants. Overall, 20 health care practitioners or administrators were interviewed. Primary themes related to health care practitioners included implicit bias and explicit racism, lack of communication and lack of positive patient-health care practitioner relationships, lack of cultural sensitivity, and variation in clinical knowledge and experience. Primary themes related to maternity services included lack of accessibility, inadequate quality and content of care, lack of continuity of care, discriminatory facility policies, and workforce shortages and lack of diversity. Strategies suggested by participants to address these factors included bias trainings for health care practitioners, improvements in racial and interdisciplinary diversity in the maternity workforce, and evidence-based interventions such as group prenatal care, disparities dashboards, simulation trainings, early warning signs criteria, and coordinated care. We gained diverse perspectives from health care practitioners and administrators on how maternity health care practitioner and maternity health services factors contribute to inequities in maternal health in Alabama. Strategies to address these contributing factors were multifaceted.

Growing the midwifery workforce

Claire Leader discusses the three-year delivery plan for maternal and neonatal services in England, focusing on the goal to grow the maternity workforce

Association between maternal employment and the child´s mental health: a systematic review with meta-analysis.

The recent rise in maternal workforce participation has led to more research regarding the role of maternal employment for (early) childhood mental health. This systematic review with meta-analysis covers new evidence on the association of both variables. A systematic literature search was conducted. Studies had to compare children 0-7years of age on the basis of their mothers' employment status, working amount, employment duration, i.e., how long the mother had been back at work after birth, or timing of return to work. Child mental health was operationalized as behavior problems and prosocial behavior. Narrative and meta-analytic syntheses of evidence were conducted. Maternal employment was associated with more conduct problems but less internalizing behavior problems and anxious/depressed behavior in children; full-time employment was linked to more externalizing behavior problems and more hyperactivity/inattention. Longer employment duration was related to less (internalizing) behavior problems and more prosocial behavior but also more externalizing behavior problems. Narrative syntheses indicated early maternal return to work to be associated with more child externalizing behavior problems and less prosocial behavior. Whether maternal employment is associated with child mental health strongly depends on both variables' operationalization. Especially part-time employment, longer employment duration, and return to work only after the first year postpartum may be beneficial for child mental health. Practical implications pertain to an expanded offer of family leave and the endorsement of maternal employment after the first year postpartum. Here, factors that may buffer the negative associations with full-time employment warrant consideration.

First Nations doulas: Training needs and industry support in the Top End, Northern Territory, Australia

Problem and backgroundFirst Nations doulas offer an innovative approach for strengthening capacity and increasing the Australian First Nations maternity workforce to improve access to services that produce optimal outcomes. Currently, there is no published evidence on the training needs and health sector industry support for developing a First Nations doula workforce. Question/aimIn the context of the ‘Top End,’ Northern Territory, Australia, the aim of this article is to document Industry feedback on the training needs and support for developing a First Nations doula workforce. MethodsTen purposively recruited Industry representatives participated in a facilitated workshop using the Kaospiolit Vision Backcasting education design tool. FindingsParticipants identified and reached consensus on almost all the underpinning skills, knowledge, mindset, and attitudes required to work as a First Nations doula. Overall participants indicated strong Industry appetite and support for formally developing the doula role. DiscussionThere was participant consensus that accredited doula training would be a ‘game-changer’, addressing inadequacies and inequities in NT’s reproductive and maternal health services for remote-living First Nations women. ConclusionMore research is required to explore First Nations doula practice in addressing perinatal inequities and workforce issues. Investigation is required to identify funding and appropriate workforce models.

Supporting the midwifery workforce: An evaluation of an undergraduate midwifery student employment model at a large tertiary maternity service in Victoria, Australia

BackgroundIn 2020, in response to major maternity workforce challenges exacerbated by the COVID-19 pandemic, the Victorian Department of Health implemented a number of workforce maximisation strategies, one of which was employment of undergraduate midwifery students called ‘Registered Undergraduate Student Of Midwifery’ (RUSOM). AimTo evaluate the RUSOM model implemented in a tertiary maternity service in Melbourne, Australia. MethodsA cross-sectional online survey was distributed to all RUSOMs and midwives at the study site in August 2021. FindingsTwenty of 26 RUSOMs (77%) and 110 of 338 permanent midwives (33%) responded. Both groups considered the model to be a positive workforce strategy that contributed to work readiness of students, and increased confidence and competence to practise. RUSOMS and midwives reported positives for the organisation including improving workload for midwives on the postnatal ward, enhancing quality of care and outcomes for women and babies, and the value of RUSOMs as team members. RUSOMs felt well supported, supervised and clinically and theoretically prepared. Both groups considered RUSOMs were underutilised, and that they could undertake additional duties, and both thought that the RUSOM model should continue. ConclusionThe model was highly valued by both RUSOMs and midwives. There was strong agreement that the model should continue and that the list of duties could be expanded. Given these findings, further research should explore the expansion and sustainability of RUSOMs in the maternity workforce.

Frontline training in mortality reports

Does frontline training act on recurrent themes in mortality reports? Baby Lifeline's recent report identifies gaps in maternity training and calls for proper investment in the maternity workforce

Midwives’ experiences of providing maternity care during the COVID-19 pandemic in Australia

ProblemThe COVID-19 pandemic has required rapid and radical changes to the way maternity care is provided in many nations across the world. BackgroundMidwives provide care to childbearing women across the continuum and are key members of the maternity workforce in Australia. AimTo explore and describe midwives’ experiences of providing maternity care during the COVID-19 pandemic in Australia. MethodsA two-phased cross-sectional descriptive study was conducted. Data were collected through an online survey and semi-structured interviews between May-June 2020. FindingsSix hundred and twenty midwives responded to the online survey. Many reported a move to telehealth appointments. For labour care, 70% of midwives reported women had limited support; 77% indicated postnatal visiting was impacted. Five main themes were derived from the qualitative data including: coping with rapid and radical changes, challenges to woman-centred care, managing professional resilience, addressing personal and professional challenges, and looking ahead. DiscussionRestrictions applied to women’s choices, impacted midwives’ ability to provide woman-centred care, which resulted in stress and anxiety for midwives. Professional resilience was supported through collaborative relationships and working in continuity models. Midwives revealed ‘silver linings’ experienced in providing care during the pandemic. ConclusionFindings provide valuable evidence to understand the impact on midwives who have provided care during the COVID-19 pandemic. Knowledge will be useful for health leaders and policy makers as they consider ways to continue care during the pandemic and support the essential midwifery workforce. Recommendations are presented to improve preparedness for future pandemics.

Child Care During the COVID-19 Pandemic: A Bad Situation Made Worse.

* Abbreviation: COVID-19 — : coronavirus disease 2019 Pediatricians have long recognized that social determinants (the circumstances in which children live, learn, and play) influence the health and well-being of children and their families.1 The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of this broader scope of health care, which encompasses more than simply addressing a child’s medical conditions. Although the vast majority of COVID-19 cases in children have been mild, the secondary effects on the health of children have been profound. Downstream effects of the virus on a family’s social circumstances, including increased food insecurity, housing instability, school closures, and lack of child care, have exacerbated preexisting socioeconomic and racial disparities.2 Although it has often been overlooked, the need for safe and enriching child care that allows parents to be able to work, particularly for the most vulnerable children in our society, has become more acute over the last several months and requires urgent action. The pandemic has brought to light the lack of safe, reliable, and affordable child care options. Even before the closure of many facilities, child care was plagued by long waitlists, ballooning costs, and safety concerns. Child care costs for preschool-aged children can rival college tuition,3 making high-quality child care nearly inaccessible for many families, especially those experiencing material hardships. With recent school closures due to … Address correspondence to Nikita Kalluri, MD, Boston Medical Center, 801 Albany St, Boston, MA 02119. E-mail: nikita.kalluri{at}childrens.harvard.edu

The Global Alliance for Maternal and Child Health (GLAM): A Pioneer Organization for MCH Students.

Currently, there is an insufficient representation of racial/ethnic minority groups in the maternal and child health (MCH) workforce. A student-run outreach organization, the Global Alliance for Maternal and Child Health (GLAM), seeks to address this disparity by increasing the representation of racial/ethnic minority groups in MCH workforce. Founded by students at Texas Southern University in Houston, Texas, United States, GLAM, seeks to establish productive alliances and create programs that would help improve the well-being of mothers, infants, and children locally, nationally, and internationally by engaging an active cadre of students passionate about MCH. Through community outreach and global engagement using evidence-based strategies, GLAM is committed to the elimination of health disparities plaguing the MCH population.

Cultural respect in midwifery service provision for Aboriginal women: longitudinal follow-up reveals the enduring legacy of targeted program initiatives

BackgroundCulturally competent maternity care provision to Aboriginal and Torres Strait Islander women was identified as a priority area by Australia’s National Maternity Services Plan in 2011. While midwifery programs responded by including core Indigenous content and community placements in curricula, little is known about whether knowledge learned, and insights gained in response to these initiatives have endured and been applied in clinical practice. This follow-up study explores the impact of a compulsory Indigenous unit and a remote clinical placement on two cohorts of non-Indigenous midwives who were participants in an earlier 2012–14 study.MethodsFourteen non-Indigenous participants who were either students or recent graduates in 2012–14 were located and re-interviewed in 2019–20. In-depth interviews based on a semi-structured interview guide were conducted by telephone or face-to face; recordings were transcribed and thematically analysed using standard qualitative procedures.ResultsExposure to Indigenous content and settings during training had an enduring impact on participants’ midwifery practice; most felt better prepared to provide culturally safe care, build respectful relationships and advocate for improved services for Aboriginal women. Despite this positive legacy, they also expressed apprehension about causing offence and recognised their own knowledge deficits with regard to Aboriginal cultural practices. Organisational constraints, including restrictions on the number of family members accompanying a birthing mother were identified as barriers to optimal care; some positive organisational initiatives were also described.ConclusionsThis follow-up study provides encouraging evidence that well-designed and delivered Indigenous content and community placement opportunities in midwifery programs can have a lasting impact on service provision to Aboriginal women, contribute to a more informed, empathetic and culturally competent maternity workforce and help catalyse health service changes towards more culturally safe care.

Maternity connect: Evaluation of an education program for rural midwives and nurses

BackgroundRural and regional health services often find it difficult to maintain their maternity service and skills of their maternity workforce and enable women to give birth close to home. The Maternity Connect Program is a professional development initiative aimed at supporting and upskilling rural and regional maternity workforces to meet their maternity population care needs. AimTo evaluate the Maternity Connect Program from the perspectives and experiences of participating midwives/nurses and health services. MethodsA retrospective audit of data routinely collected as part of the Maternity Connect Program: initial needs assessments (baseline survey), and one month and six months post-placement surveys completed by participants, placement health services and base health services. The main outcome measures were: participants’ (midwives and health services) level of satisfaction with the Program; and changes in midwives’/nurses’ perceived level of confidence in performing key midwifery skills after participating in the program. ResultsRespondents (n = 97 midwives/nurses; n = 23 base health services; n = 4 placement health services) were satisfied with the program and there was an increase in midwives/nurses’ confidence when providing specific aspects of maternity care (birthing, neonatal and postnatal). Midwives/nurses report transferring skills learnt back to their base health service. ConclusionThe Maternity Connect Program appears to be a successful educational model for maintaining and increasing clinician confidence in rural and regional areas.

Health care service for families with children at early risk of developmental delay: an All Our Families cohort study.

AimThis study examined children’s health care service use, mothers’ workforce participation, and mothers’ community engagement based on children’s risk of developmental delay.MethodWe used data from the All Our Families study, a prospective pregnancy cohort. Ages and Stages Questionnaire (ASQ) scores at year 2 indicated risk of developmental delay. To investigate the impact of risk of developmental delay when children were not diagnosed, a sensitivity analysis excluded reports of neurodevelopmental disorder (NDD) diagnosis at year 3. Outcomes were maternal reports of children’s health and allied health visits (and estimated costs), and maternal workforce participation and community engagement from year 2 to 3.ResultsAmong 1314 mother–child dyads, 209 (16%) children were classified as being at risk of developmental delay by the ASQ, and 42 (3%) had a reported diagnosis of NDD. Risk of developmental delay was related to increased use of allied health care services (incidence risk ratio 5.04 [year 3]; 95% confidence interval 2.49–10.2) and health visits (incidence risk ratio 1.33 [year 3]; 95% confidence interval 1.14–1.54). The average expected allied health costs were greater for children at risk versus not at risk of developmental delay. However, when excluding children with reported diagnoses of an NDD from this analysis, increased service use and costs in the remaining at‐risk population were not observed. Community engagement and workplace participation among families did not differ on the basis of risk of developmental delay.InterpretationThese results suggest increased health care service use by families of children at risk of developmental delay is driven by those receiving a diagnosis of an NDD in the subsequent year.What this paper adds Early developmental delay risk was related to health care service use and costs.Diagnosis of neurodevelopmental disorder drove increased health care service use and costs.Early developmental delay risk did not relate to parental workforce participation.Early developmental delay risk did not relate to community engagement participation.

The effectiveness of an online module for midwives conducting antenatal pertussis vaccinations

Background An online education programme was developed to support midwives and maternity staff to implement the New South Wales antenatal pertussis vaccination programme from March 2015. Aims To determine if an educational programme met the needs of midwives and maternity staff to conduct an immunisation appointment confidently with a pregnant woman. Methods Pre- and post-surveys were conducted with learners completing the programme. Findings Before completing the programme, 57% of respondents reported feeling ‘confident’ or ‘very confident’ in conducting a vaccination encounter with a pregnant woman. This increased to 94.1% after completion of the programme. Conclusion The education programme met the needs of midwives and maternity staff in New South Wales. An informed and confident maternity workforce will increase vaccine uptake in pregnant women and ensure that pertussis vaccination is incorporated consistently into routine antenatal care, to protect vulnerable infants from life-threatening diseases such as pertussis and influenza.

Current and future availability of and need for human resources for sexual, reproductive, maternal and newborn health in 41 countries in Sub-Saharan Africa

BackgroundThe WHO African region, covering the majority of Sub-Saharan Africa, faces the highest rates of maternal and neonatal mortality in the world. This study uses data from the State of the World’s Midwifery 2014 survey to cast a spotlight on the WHO African region, highlight the specific characteristics of its sexual, reproductive, maternal and newborn health (SRMNH) workforce and describe and compare countries’ different trajectories in terms of meeting the population need for services.MethodsUsing data from 41 African countries, this study used a mathematical model to estimate potential met need for SRMNH services, defined as “the percentage of a universal SRMNH package that could potentially be obtained by women and newborns given the composition, competencies and available working time of the SRMNH workforce.” The model defined the 46 key interventions included in this universal SRMNH package and allocated them to the available health worker time and skill set in each country to estimate the potential met need.ResultsBased on the current and projected potential met need in the future, the countries were grouped into three categories: (1) ‘making or maintaining progress’ (expected to meet more, or the same level, of the need in the future than currently): 14 countries including Ghana, Senegal and South Africa, (2) ‘at risk’ (currently performing relatively well but expected to deteriorate due to the health workforce not keeping pace with population growth): 6 countries including Gabon, Rwanda and Zambia, and (3) ‘low performing’ (not performing well and not expected to improve): 21 countries including Burkina Faso, Eritrea and Sierra Leone.ConclusionThe three groups face different challenges, and policy solutions to increasing met need should be tailored to the specific context of the country. National health workforce accounts should be strengthened so that workforce planning can be evidence-informed.

The Effect of Childhood ADD/ADHD on Parental Workforce Participation

Objective: This research aimed to examine the impact of attention deficit disorder (ADD)/ADHD in children on parental labor force participation across different child age groups. Method: This study utilized a longitudinal, quantitative analyses approach. All data were collected from Wave 6 of the Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) survey. Results: After adjusting for various confounders, mothers whose children were 10/11 years old and had been diagnosed with ADD/ADHD were significantly more likely to be out of the labor force compared with those mothers whose child had not been diagnosed with ADD/ADHD. The impact was more pronounced for single mothers. No significant influence on paternal labor force participation was found. Conclusion: In assessing the cost-effectiveness of interventions for ADD/ADHD, policy makers and researchers must consider the long-term social and economic effects of ADD/ADHD on maternal workforce participation when considering costs and outcomes.

Improving maternity services for Indigenous women in Australia: moving from policy to practice.

The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality. Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have their genesis in utero and in early life. Applying interventions during pregnancy and early life that aim to improve maternal and infant health is likely to have long lasting consequences, as recognised by Australia's National Maternity Services Plan (NMSP), which set out a 5-year vision for 2010-2015 that was endorsed by all governments (federal and state and territory). We report on the actions targeting Indigenous women, and the progress that has been achieved in three priority areas: The Indigenous maternity workforce; Culturally competent maternity care; and; Developing dedicated programs for "Birthing on Country". The timeframe for the NMSP has expired without notable results in these priority areas. More urgent leadership is required from the Australian government. Funding needs to be allocated to the priority areas, including for scholarships and support to train and retain Indigenous midwives, greater commitment to culturally competent maternity care and the development and evaluation of Birthing on Country sites in urban, rural and particularly in remote and very remote communities. Tools such as the Australian Rural Birth Index and the National Maternity Services Capability Framework can help guide this work.

A wall of information? Exploring the public health component of maternity care in England

Backgroundmidwives have traditionally had an important role in providing public health messages to women. The range and diversity of the public health remit within maternity services has expanded rapidly over the past decade and maternity support workers as well as midwives are now engaged in public health work in many areas. Given these changes a review of current practice was indicated. Objectiveto identify student midwives׳, midwives׳ and midwifery support workers׳ current knowledge of and involvement in the public health agenda in England. Designdescriptive qualitative study using online discussion forums. SettingEngland, United Kingdom Participantsundergraduate student midwives, midwives and maternity support workers employed by the National Health Service in England and University employed Leads for Midwifery Education. Findingskey themes identified were: the scope of the midwives׳ public health role, training and support for public health role, barriers and facilitators, specific client groups, specialist referral services. Student midwives, midwives and maternity support workers view engagement with, and delivery of, public health initiatives as an integral component of their roles, but are on occasions frustrated by constraints of time, training and public engagement. Key conclusionsthe National Health Service in England aims to engage pregnant women and new mothers in a diverse range of population based and individualised, public health initiatives. Currently, there are high levels of involvement in the public health agenda from the maternity workforce across a wide range of activities. However, midwives and maternity support workers are restricted by barriers of time, training and resources. These barriers will need addressing for optimal maternity care engagement in public health to be realised. Implications for practicepolicy makers, commissioners and National Health Service providers need to provide clear guidance on the expectations of the public health remit of midwives and maternity support workers and ensure that such expectations are appropriately resourced to provide effective delivery.