Midwives’ occupational wellbeing and its determinants. A cross-sectional study among newly qualified and experienced Dutch midwives | 69 INTRODUCTION The organisation of care is changing, from a strict division between community and hospital care, there is a growing trend towards integrated care focusing on interprofessional collaboration. Women's preferences have also changed, with more women giving birth in hospital and expressing a greater need for pain relief.1,2 These challenges may threaten the historically independent position of midwives in the Netherlands as guardians of physiological birth (at home)1,2 and may also lead to unnecessary medical interventions in low-risk pregnant women.3 In addition, on a global level, rising health care costs, increasing use of technology and interventions, and decreasing numbers of normal births are challenges for midwives.2 Midwives are at risk of burnout symptoms and occupational stress, which has implications for the quality of care for pregnant women.4 Burnout is a process whereby professionals deplete their energy resources and their dedication, leading to reduced involvement with clients.5 Work-related burnout among midwives internationally ranges between 20 and 60 percent.4,6 Midwives are at risk for burnout when they feel unsupported, undervalued or not been able to work according to the midwifery philosophy.7 Previous research on intentions to leave midwifery ranged from 21-43%.810 Hunter et al. found that burnout, stress and anxiety levels were higher among midwives with ITL than among those without.6 Important reasons for intentions to leave were dissatisfaction with the organisation of midwifery and/or my role as a midwife,8 concerns about their mental and physical health, and the negative impact of an on-call schedule on personal life.10 Occupational wellbeing includes two constructs: burnout and work engagement.11 High work engagement in healthcare professionals is associated with better mental and physical health, better workability and is beneficial for work performance and workplace safety.12 Previous studies on midwives’ wellbeing measured burnout, stress and anxiety and did not include work engagement.4 It is known that healthcare professionals show high levels of work engagement due to job content: working with clients is meaningful and resourceful.12 Including work engagement in studies on midwives can provide a comprehensive view on midwives’ wellbeing.11 In the JD-R model (Fig. 1),13 burnout and work engagement are interrelated constructs and can serve as distinct concepts covering the same underlying dimensions, namely work demands and work resources. For example, an individual's energy level can be a source of both vigour and exhaustion.14
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