112 | Chapter 5 I already thought things weren’t going very well. That was when I wanted to quit for a while...(P08) DISCUSSION This mixed methods study of midwives’ intentions and reasons for leaving the midwifery profession in the Netherlands reveals that one third (32.7%) of midwives considered leaving the profession. Split into newly qualified midwives and experienced midwives, we have revealed almost the same figures. Dissatisfaction with the organisation of midwifery care and family commitments were the main reasons for their intentions to leave the job. Reasons for actually leaving the job comprised an accumulation of qualitative and organisational demands combined with a lack of work resources. Conflicts between work and home life, problems with the length of shifts and on-call shifts, a lack of commitment within the team, a lack of social support from colleagues and a lack of work resources led them to leave the profession. Illness or physical limitations and the inability to change working conditions were also reasons for leaving the job as a midwife. Compared to international studies, it is remarkable that our findings indicate that fewer midwives intend to leave their jobs. Other studies reported rates ranging between 40% and 60%, whereas we found a rate of 34%. 2,9,10 This difference might be explained by the different work context of Dutch midwives. Previous research shows that working as an autonomous, self-employed midwife protects them from burnout symptoms, 28 and is associated with high work engagement. 16 Since most midwives in the Netherlands (about 66%) are self-employed in the community, 1 these working conditions might therefore be a reason for a substantial group of midwives to stay. The process of moving from the intention to leave to actually leaving the job seems, in our findings, to be the result of a process in which midwives first try to adapt to their working conditions, followed by feelings of frustration over the lack of opportunities to change their working conditions. Finally, they feel less engaged in their work. This process of decreasing engagement in their work is consistent with previous research findings: less engagement led to withdrawal behaviour and decreased performance. 8,29 Potentially, this process may indirectly affect the quality of care that midwives provide. Community midwives mentioned having problems in dealing with the changing demands of clients, which affect midwives’ work resources. In the Netherlands, women's demand for pain medication during childbirth often leads to an obligatory referral to the hospital, which results in the transfer of the responsibility for the care to mother and child to the hospital-based midwife or gynaecologist. These referrals lead to
RkJQdWJsaXNoZXIy MTk4NDMw