Registered Midwife Shortage Affects the Quality of Care in Maternity Hospitals

Abstract

Purpose: The lack of an adequate number of registered midwives has resulted in a serious management and professional problem for labor and delivery units at maternity hospitals. In addition, the main issue examined in this working document concerns how insufficient staffing among registered midwives affects the quality of care in labor and delivery units, relative to patient safety, patient experience, and staff workload. This subject matter is important to address because maternity care is extremely time-sensitive, and unstaffed shifts or positions may adversely affect timely clinical observation, appropriate communication among caregivers, respectful care, and emergency preparedness.

Methodology: To examine this issue, this working document employed a qualitative evidence synthesis approach based on recent systematic review articles, multi-center observational study articles, qualitative research articles, and articles related to the midwifery workforce literature concerning staffing levels, workload, patient safety, patient satisfaction, and workforce retention. In addition, the working document applied Donabedian's (1966) structure-process outcome model to illustrate how structural weaknesses, such as midwife shortages, affected care processes and patient and workforce outcomes.

Findings: The results indicate that midwife shortages were associated with longer times to receive care; higher rates of adverse events during care; higher rates of postpartum readmission; greater utilization of certain medical interventions; lower ratings from patients regarding their experiences; decreased access to respectful maternity care; and increased staff dissatisfaction and intentions to leave. An additional finding was that midwife shortages created a self-fulfilling cycle. When there were fewer midwives on duty, the workload per nurse increased, which in turn diminished the quality of care provided to women and negatively affected nurses' physical and mental wellbeing, reducing their capacity to continue providing high-quality care.

Unique Contribution to Theory, Practice and Policy: For both the midwifery profession and leaders of maternity hospitals, the implications of these findings are clear: workforce planning will need to focus on creating sustainable improvements rather than simply replacing personnel who are absent. Therefore, developing evidence-based staffing models, improving working conditions for registered midwives, fairly compensating them, providing continuing education opportunities, supporting them through effective leadership, and implementing retention-fostering policies to enable registered midwives to provide safe, respectful, and woman-centered care are essential.