Intentions to leave and actual turnover of community midwives in the Netherlands. A mixed method study exploring the reasons why | 95 INTRODUCTION In the Netherlands, the workforce of midwives consists of a relatively low number of experienced midwives, leading to an unbalanced workforce.1 Sixty-one percent of Dutch midwives are under the age of 40, which differs from most other countries.1 For instance, the median age (37 years of age) of the Dutch population of midwives differs from that in the United Kingdom (47 years of age). 2 In the United States, 58% of midwives are 40+ years old compared to 38% in the Netherlands. Seventy-two percent of midwives in the Netherlands work in the community, 28% in the hospital.1 A good balance between experienced and less experienced midwives ensures a stable workforce and contributes to good practice.3 Experienced midwives can share their accumulated expertise and knowledge to less experienced midwives.4 Low ratios of experienced midwives to less experienced midwives could negatively affect the delivery of safe care.3 In order to maintain a balanced workforce, and taking into account that almost 90% of pregnant women in the Netherlands start care in midwifery care, it is highly important to gain insights into the number of midwives who intend to leave the midwifery profession, the underlying reasons for this intention to leave and the reasons for the actual turnover of midwives.5,6 The intention to leave a profession refers to the probability of staying or leaving the profession. Although the intention to leave a job does not necessarily mean actual turnover, it is one of the most important indicators of leaving a profession.7,8 Intention to leave is often triggered by negative reactions to organisational factors (e.g. organisational culture or interpersonal relations), work-related employment factors (e.g. workload or financial rewards), employee factors (e.g. demographic factors such as years of experience or the area of work) or external aspects of the job (e.g. family issues and the availability of other compatible jobs).8 These negative reactions (or triggers) are often followed by negative psychological responses, such as frustration and withdrawal. Withdrawal has been found to manifest itself as absenteeism, avoidance behaviour and lowered performance.7,8 In relation to the number of midwives who have intentions of leaving the profession, it is known that 66.6% of UK (United Kingdom)-midwives, 42.8% of Australian midwives and 67.3% of Canadian midwives considered leaving the midwifery profession in the last 6 months before completing the questionnaire.2,9,10 The most commonly cited reasons for Canadian midwives’ intention to leave were the negative impact of an on-call schedule on personal life, followed by concerns about their mental and physical health.10 Within the UK study, the most common reason for considering leaving the profession
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