Work experience and work environment of midwives in German maternity theatres: Implications for the quality and safety of care

Background: Nursing research indicates a correlation between work environment and the quality and safety of nursing care. For intrapartum care there is evidence that continuous one-to-one support is associated with better perinatal outcomes and fewer interventions. Little is known about the work environment of midwives working in German maternity theatres. Aim: To analyse the work environment in German maternity theatres from the midwife's perspective. Methods: Online survey among 1,599 midwives using a validated instrument adapted to the specific characteristics of midwifery care. Results: The response rate for the survey was 44 %. The number of patients has risen substantially over the last three years without an equivalent increase in staff numbers. Nearly two thirds of the midwives (65 %) are responsible for three or more women simultaneously, most of the time; 35 % are normally providing care for two women at the same time. There are significant differences between these two groups with regard to nearly all the work environment aspects analysed. The most pronounced differences were found with regard to not being able to accomplish tasks during regular working hours (64 % vs. 33 %; OR 3.7, 95% CI 3.0 to 4.6; p < 0.001), taking legally required breaks (5 % vs. 19 %; OR 4.2, 95% CI 2.9 to 5.9; p < 0.001), frequency of interruptions (96 % vs. 88 %; OR 3.5, 95% CI 2.3 to 5.4; p < 0.001), lack of time for individual care (90 % vs. 63 %; OR 5.6, 95% CI 4.2 to 7.4; p < 0.001), need for improving the personal interaction between midwives and obstetricians (28 % vs. 20 %; OR 1.6, 95% CI 1.2 to 2.0; p = 0.001), lack of support from hospital management (92 % vs. 83 %; OR 2.2, 95% CI 1.6 to 3.1; p < 0.001) and the intention to leave the employer (60% vs. 40%; OR 2.2, 95% CI 1.8 to 2.7; p < 0.001). Conclusion: The current work environment of midwives in German maternity theatres does not allow for one-to-one-care during labour. If the necessary increase in midwifery staff is to be effective, it needs to be accompanied by an improved work environment. Further research into the work environment of midwives, likely predictors and associations with perinatal outcomes is urgently needed.