General discussion | 197 environments, but in practice, this support is not always available – at least not formally. Stakeholders are committed to the importance of support for NQMs, but established midwives do not yet act accordingly. NQMs and experienced midwives in the Netherlands are highly engaged in their work in maternity care. NQMs are significantly more engaged than experienced midwives. Determinants of midwives’ positive wellbeing are various factors, such as working with colleagues and ‘with women’, together with trainable personal resources, such as resilience and optimism. One in three midwives intend to leave the profession. Determinants of intentions to leave, and reasons for leaving the profession for community-based midwives are a combination of high workload, practice owner roles and responsibilities, and family responsibilities. Components of support for NQMs as agreed by stakeholders include proper induction in practice, expansion of tasks and responsibilities with performance feedback from practice owners or managers, 24/7 back-up during a shift, and mentoring and coaching on work experiences. Systemic, organizational, and cultural aspects of midwifery care hinder the implementation of formal support. We recommend establishing a transition period for all NQMs working in the Netherlands in their first year of practice. We recommend that this period is supported by stable employment combined with practice support. NQMs cannot work at the competence level required for a locum midwife. Components of support on which there is consensus among stakeholders can be implemented at local and regional level, where practice owners and managers should take responsibility for implementation. Design-based research is recommended to further develop detailed support components based on existing literature. At local or regional level, participatory action research can be used to implement these components in a specific region. Regarding midwives’ wellbeing, periodic measures of their wellbeing in practice, their intentions to leave the profession and their intentions to remain in the profession are recommended. Trends in midwives’ wellbeing over time and at different stages of their careers, and on specific job demands and resources, may help identify opportunities for intervention and build or enhance a sustainable midwifery workforce.
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