Staying or leaving: A telephone survey of midwives exploring the sustainability of their practice as lead maternity carers in one urban region of New Zealand

Abstract

The sustainability of Lead Maternity Carer (LMC) midwifery practice is the issue of concern. In one urban region of New Zealand there appeared to be a greater proportion of LMC midwives indicating that their way of working was unsustainable resulting in fewer midwives available to provide primary maternity care. This research was undertaken to identify reasons that support midwives to continue practising as LMC midwives and to identify reasons why midwives leave practice. A structured telephone survey of 94 LMC midwives in a large urban region who were currently working in community based midwifery practices, or who had left LMC practice within the last few years was undertaken. Continuity of care and relationships that are developed with women continued to be the main driving force for the midwives continuing to practise as LMC midwives. It was however, also causing midwives to leave. Collegial support was an important aspect and was evidenced through regular group meetings and providing back up or support when midwives were tired or having time off. Despite this however, structured time off was not as it appeared. Nearly half of the midwives who said they had time off were in actual fact still on-call for births. The difficulties associated with working within the current model included being on-call twenty four hours a day, seven days a week, (24/7) and interference with family and social life. A change to the structure of practice which would replace the current 24/7 on-call with a 12 hour system was suggested as a possible solution by the midwives themselves. This could help to minimize the interruptions to midwives' own family life as well as prevent midwives from working in an exhausted state. Exhaustion and having no time for self were the main reasons given by midwives who had left LMC practice. An increase in funding was one of the main reasons given by midwives considering a return to LMC practice. The current funding structure is such that it encourages midwives to work in a potentially unsafe way. Midwives are penalized financially when calling for back up or support from their colleagues if they are tired from having been awake for 24 hours or more. As well, it encourages midwives to remain on-call for births despite attempting to have some time off, as missing a birth means a loss of income. Nearly a third of midwives currently in practice are planning to leave within the next two years. The shortage of midwives in this particular area is therefore going to worsen. This will put more pressure on the remaining midwives to provide a service to women in our community. These issues need to be urgently addressed if LMC midwifery practice is to be sustainable. Several recommendations on sustaining LMC midwifery practice are made on the basis of this study.