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Midwives fear skills loss from general duties

Innovative approaches are needed to stop the reliance on midwives to fill general nursing gaps in rural and remote areas, new research finds. By Linda Belardi.

Rural midwives forced to work in a dual role fear they will lose their midwifery skills as they spend the majority of their time outside the maternity ward plugging a shortfall in nursing staff, a new study shows.

Researcher Dr Karen Yates, regional maternity services coordinator at Cairns Base Hospital, said more opportunities were needed to employ direct-entry midwives into rural and regional areas.

Her findings, undertaken as part of her doctoral studies, show the majority of midwives would prefer to work as a midwife-only, but accepted they did not have a choice.

However Yates said redesigning models of care to allow midwives to practice their full midwifery skills would significantly improve retention and help ease shortages in the outback.

Yates’ survey shows rural midwives spend 70 per cent of their time performing a generalist rather than midwifery role.

She said the use of midwives in general nursing had the potential to erode their skills and placed them in unsafe and stressful clinical situations.

The surveyed midwives, who worked in hospitals in far-north Queensland, stayed in their roles because they wanted to live in a rural area for family or lifestyle reasons, the study found.

However, the constant pull to work between departments and across roles contributed to high levels of stress and increased workloads.

“This dual role may occur during a shift or across the working week. Whichever way it occurs, it means midwives are taken out of their area of specialty to fill a gap in the general side of the facility,” said Yates.

“I can certainly see the need for a dual role for very small and remote places such as Cape York but in places where there are 200-300 births a year that is an ideal number to implement a midwifery-led continuity of care model.”

Yates said it was time for health services to think about employing midwives on an annual salary that would structure the work of midwives around patient demand and the needs of women rather than in traditional eight-hour shifts.

Hannah Dahlen, spokeswoman for the Australian College of Midwives said the college’s own surveys confirmed Yates’ findings.

“We know clearly from our surveys that midwives want to do midwifery and many leave because they are forced to work in other areas such as nursing when they don’t want to.”

While some rural employers were pushing for a versatile workforce, others were clinging to outdated attitudes that a ‘real’ midwife was a nurse first, said Dahlen.

But midwifery education internationally was moving towards training midwives at the undergraduate level, she said.

“In England more than 80 per cent are midwives-only. They are not nurses first. In New Zealand 100 per cent are midwives-only. In Canada 100 per cent of midwives are midwives-only and some of them work in the most remote, snowbound places on earth where there are very few people birthing and they don’t have nursing qualifications,” she said.

Direct entry training for midwives is a relatively new phenomenon in Australia. In NSW, the first Bachelor of Midwifery course was offered by UTS in 2005.

Dahlen said student demand for bachelor of midwifery courses was strong and exceeded the number of places. Universities were receiving more than four applications for every place on offer and for some courses the entry cut-off was more than 90.

She said health services in some rural and remote in Australia preferred additional nursing qualifications so their workforce was more flexible.

“But that is not making them take up more innovative models of care which would enable their midwives to do midwifery and their nurses to do nursing,” she said.

A report by Health Workforce Australia, which collected data from 27 universities offering courses in midwifery, identified this industry preference for flexibility as a significant factor in university planning for courses.

“Midwives continue to be predominantly employed in public health services and in some states and regions the public health employers are seeking more flexibility in their workforce through employment of combined nurse/midwives who can work in general hospital settings,” said the report Mapping clinical placements: capturing opportunities for growth.

“Some universities have adapted their programs to meet this preference and offer or are considering offering dual degrees in nursing and midwifery.”

However, the requirement for students to attend a set number of births was placing a constraint on delivering clinical placements, especially in rural and regional areas.

“One major midwifery provider indicated that it is considering discontinuing the midwifery program because of these difficulties with clinical placements,” said the report.

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