A major new report on Australia’s midwifery profession has found that more than a third of midwives surveyed are considering leaving the industry due to poor working conditions.

The report, Midwifery Futures: Building the Australian midwifery workforce, also found there are not enough midwives, or current midwifery students in the pipeline, to meet our future needs.

Commissioned by the Nursing and Midwifery Board of Australia (NMBA) and conducted by the Burnet Institute, the report made 32 recommendations under five key areas:

• increasing visibility, governance and leadership of the profession
• scaling-up midwifery models of care
• growing the workforce
• support conditions and career pathways in the workforce
• improving data workforce planning.

New South Wales has the lowest number of midwives per capita in the country, with only 104 midwives per 100,000 population. There are 6,600 practising midwives in the state.

The report authors say that “strong and skilled midwifery leadership is essential for developing the future Australian midwifery workforce”. They call in particular for the appointment of a Chief Midwife in each Commonwealth and state and territory government.

They also call for maternity services that are led by midwives at clinical and executive levels.

Amanda Bailey-Derrett, a registered midwife and president of the Coffs Harbour NSWNMA branch, says: “As midwives we have much responsibility, but not enough support. There is definitely a feeling of not being valued by the employer and the government.”

Amanda, who is a registered nurse and registered midwife, believes more midwife-led management structures are necessary.

“Our branch has been advocating for a number of years to increase midwifery management because there is no management at
executive level that are midwives [at my workplace]. The highest we have is a midwifery manager who is at level two.”

Most midwives want to work in continuity of care models, but inflexible work practices and narrow role definitions are limiting their work opportunities, the report notes.

“I previously worked in Midwifery group practice in Coffs Harbour, but I got burnt out in the role of an MGP midwife, as the workload is very high,” says Amanda, who now works in the Coffs Harbour hospital maternity ward.

As an MGP midwife, when “you can be needed for any length of time, and you never know how long your work is going to take. And we certainly worked and pushed ourselves hard to ensure our colleagues and the women were looked after.”

The report calls for flexible part-time and job share arrangements to ease burdens on midwives who want to stay in MGP. It also calls for reforms to allow midwives to use the full scope of their practice skills.

“I think there are a lot of midwives who feel like they are obstetric nurses, rather than truly being able to practice midwifery because we have a fairly medicalised model in NSW,” Amanda says.

“A lot of the care is led by the obstetric team rather than midwifery-led, and there is also input from paediatric doctors, who are often reluctant to give a lot of consideration to women’s choices when it comes to birth.

“Evidence shows midwifery-led approach is the gold standard. Those models increase satisfaction for women, but they also increase satisfaction for midwives.”

Nichole Flegg, a midwife and President of NSWNMA Macarthur branch, has noticed significant changes in the profession in the nearly 24 years she has been practising.

“Everything is on computer now: no one sits down and does face to face care that we once had time for.

“I was recently told my time management is terrible because I spend too much time with patients.

“We’ve gone from being human beings talking to human beings, to ticking off a checklist on a computer. You don’t use your clinical judgement as often and we are losing our clinical skills and critical thinking.”

“It is not actually personalised care it is generic care.”

Universities, health services and government need to increase midwifery student numbers by two per cent, with quarantined places for Aboriginal and Torres Strait Islander midwifery students, the report authors say. They add that students also need to be better supported during clinical placements.

Nichole says the growing administrative demands on midwives means that not only do experienced midwives have less face-to-face time with women, but they also have less time to spend with midwifery students on placements.

“When everything is actually being done behind a computer screen, and we don’t have the time to spend with women, we are also not able to support our junior staff, our ‘baby midwives’, as much as we would like.”

Support conditions and career pathways in midwifery workforce Improved working conditions and career pathways all need to be addressed, the report notes.

“We have a very junior-heavy workforce because senior midwives don’t want to stay,” says Amanda.

“They are just quite burnt out with the acuity of the kind of presentations that we are seeing now. The birthrate might be falling, but the acuity is rising, with more complications because of the increased average age of mothers.

“And we have more mums with comorbidities and complications, as well as a lot of anxiety that we need to care for.

“The workload is too high. It is extremely rare to have a ratio of three women to one midwife, but when we do, we enjoy our work because we can provide the kind of really good care we are supposed to provide.

“But that doesn’t happen often: we usually care for four to five women, sometimes higher. And if you’ve got five women and five babies you’ve basically got ten patients.

“The pay issue is definitely an issue. We resuscitate newborns on a regular basis, and we get paid less that someone who paints houses,” says Amanda.

“Women’s and babies’ lives are in our hands, and we don’t get recognised or valued for that.”