The world needs more midwives.

The world needs more midwives. Millennium Development Goals include increasing the number of skilled birth providers on a global level to improve maternal and neonatal morbidity and mortality rates.   Often when we talk about global maternal and neonatal outcomes, our assumption is that the US is exempt from them.  However, the obstetric care work force in the United States is predicted to experience a 25% decline by 2030 (HRSA, 2013). This is in addition to the already existing 49% of US counties that do not currently have access to a practicing obstetrician. Certified nurse-midwives are considered a potential solution to these types of outcomes, which are predicted to become more serious as the rates of skilled birth attendants in the United States, and globally, decreases (Day-Stirk, 2014).

Midwives are always excited to serve as a part of the solution where quality care for birthing parents and their babies are concerned. However, there is a stressful side to the profession that not many on the outside see, and it is also having an effect on the work force.

Erin Wright, DNP, CNM, APHN-BC Instructor, Johns Hopkins School of Nursing
Erin Wright, DNP, CNM, APHN-BC
Instructor, Johns Hopkins School of Nursing

Beck and LoGuidice (2015) noted in their recent study of certified nurse-midwives who experience traumatic birth that an astounding 35% met DSM-V diagnostic criteria for post-traumatic stress disorder (PTSD) while another 29% screen positive for secondary traumatic stress (STS). Often practitioners think this won’t affect them as they won’t be among the practitioners

experiencing traumatic birth. However, if one works around birth, it is reasonable to expect to encounter this experience at some point in their career (Leinweber & Rowe, 2010). These types of experiences as well as emotional exhaustion, political pressures, excessive work hours, and feelings of depersonalization contribute to the stress experienced by midwives and are, in fact, prompting many to leave the profession (Banocinova & Bascova, 2014). Individuals who are under constant or chronic stress have been shown to experience high rates of diabetes, depression, and hypertension. These health concerns also contribute to an abbreviated career for some practitioners. Stress is not unique to the midwifery community but has been demonstrated to have a negative impact on NICU, ICU, ER and oncology nursing practices and negatively affect patient outcomes (Mehrabi, Azadi, Pahlavanzadeh & Meghdadi, 2012; Fortney, Luchterhand, Zakletskai, Rakel, 2013). When you combine the number of midwives leaving the profession for stress or burnout related reasons with the number from the baby boomer generation who are reaching retirement age, it is difficult to imagine being able to supply an appropriate number of midwives needed to positively address the predicted upcoming provider shortages.

However, there is some good news. Self-care can be a positive factor in helping to reduce levels of stress. Activities such as yoga, meditation, mindfulness based stress reduction, exercise, or simply a walk around the block or in the woods have been shown to significantly lower stress levels, reduce anxiety, relieve depression, improve nutrition, and reduce blood pressure (Halland, et al., 2015; Newsome, Waldo & Gruszka, 2012). Many midwives have expressed reluctance to engage in self-care activities out of concern that it steals time away from their families or patients. These well intentioned and conscientious midwives can rest assured that self-care is also considered an ethical practice. The American College of Nurse-Midwives’ Code of ethics states “Midwives in all aspects of professional relationships will respect their own self-worth, dignity and professional integrity.” Taking part in self-care activities is very much in alignment with this requirement. When we take care of ourselves, we are better able to care for our patients and our families.

In addition to the developing self-care practices within the practicing midwifery community it is also important to disseminate these skills to our nursing and midwifery students. By educating our future nurses and midwives about self-care practices and encouraging them to develop and integrate these skills into their daily life we are providing them with the skills necessary for career excellence and longevity. This not only helps them to provide the best possible care to their patients on a daily basis, but also addresses potential obstetric workforce shortages and improves the overall quality of maternal child health, both in the US and globally.


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Beck, C. T., LoGiudice, J., & Gable, R. K. (2015). A mixed-methods study of secondary traumatic stress in certified nurse-midwives: Shaken belief in the birth process. Journal of Midwifery & Women’s Health,60(1), 16-23. doi:10.1111/jmwh.12221 [doi]

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Health Resources and Services Administration. Projecting the supplu and demand for primary care practitioners through 2030. supplydemand/usworkforce/primarycare/. Published November 2013.

Mehrabi, T., Azadi, F., Pahlavanzadeh, S., & Meghdadi, N. (2012). The effect of yoga on coping strategies among intensive care unit nurses. Iranian Journal of Nursing and Midwifery Research, 17(6), 421-424.

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Tarantino, B., Earley, M., Audia, D., D’Adamo, C., & Berman, B. (2013). Qualitative and quantitative evaluation of a pilot integrative coping and resiliency program for healthcare professionals. Explore: The Journal of Science & Healing, 9(1), 44-47 4p. doi:10.1016/j.explore.2012.10.002

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