Research into stress among midwives has identified the most effective actions individual midwives and healthcare trusts can make to enhance wellbeing and reduce negative outcomes, including staff leaving the profession.

The University of Bath’s Stress, Anxiety, Resilience, and Thriving (StART) research group has published two new research papers describing the most pressing workplace demands among midwives, and the most effective interventions.

The researchers interviewed and carried out surveys with midwives in 2021 and 2022. They were funded by the National Institute for Health and Care Research (NIHR) as a partnership between the University of Bath and the Royal United Hospitals Bath NHS Foundation Trust (the RUH), with the aim of gaining insights into national-scale concerns in the profession.

More recently, Economic and Social Research Council IAA funding supported the co-production of a video illustrating the findings of the work, which will be integrated into an interactive activity for future RUH midwifery study days.

Dr Rachel Arnold, a Reader in Sport and Performance Psychology in Bath’s Department for Health, and one of the project leaders, said: “Occupational stress has been identified by the World Health Organisation as a 21st century global health epidemic, given its links to many of the leading causes of death. When we began working with the midwives at our local NHS trust, which was during the COVID-19 pandemic, they had increased sickness and reduced retention rates, which echo nationwide statistics that midwives are one of the groups reporting the highest levels of stress and burnout in the NHS.”

Dr Lee Moore, Senior Lecturer in the Department for Health, and another of the project leaders, said: “Our goal via this collaboration was to improve understanding of occupational stress amongst midwives, including the impact of workplace demands and midwives’ responses to them on their health, wellbeing, and performance, and how it can be optimally managed to enable midwives to thrive in the workplace.”

Stress audit identifies biggest impacts

The first study that the University of Bath and the RUH midwives collaborated on was a ‘stress audit’ now published in Women and Birth. The stress audit explored which stressors had the biggest negative impacts on midwives and why, which groups of midwives were most at-risk of negative stress-related outcomes, and how midwives can be better supported to thrive at work.

The stressors identified as having the most negative impacts on midwives’ health, wellbeing, and intention to leave the profession were:

• workplace demands – including staff shortages, work overload, and insufficient breaks
• change and communication – including changes to birthing units (in response to the pandemic), on call requirements, and new initiatives and ways of working
• manager support - junior staff typically noted a relative lack of manager support

Experiencing intense workplace stressors was found to trigger negative, and at times overwhelming, emotions including worry, anger, frustration, guilt, and even emotional breakdowns.

Midwives on night shifts and on call, community midwives, those on a lower band, and more experienced and older midwives were identified as most at risk of stress-related consequences, such as mental ill-health. This provides an important steer on where interventions should be pitched and who they should be tailored for.

How midwives view and respond to stressors – as either a threat or a challenge – was also found to be important in determining their impact, with viewing workplace demands as a challenge linked to beneficial outcomes and better health. Further, the findings illustrated the power of social support to cope with workplace stress. Additionally, it was found that managers and hospital trusts play a key role in ensuring optimal job design, autonomy, communication, and support.

Review of most effective interventions

The second study, also published in Women and Birth, was a systematic review of midwifery stress management interventions (SMIs) to identify which are most effective at reducing occupational stress, and improving the health, wellbeing, performance, and job satisfaction of midwives.

While both individual- and organisation-led SMIs were shown to be effective in improving job satisfaction and performance, there was a trend for organisation-level interventions to be more effective in reducing work stress and improving health and wellbeing. Specific individual- (e.g., mindfulness, simulation training) and organisation-level (e.g., reflective groups, midwifery care models) SMIs were most beneficial. The research recommends that health practitioners and policy makers implement interventions targeted at both individual and organisational levels to optimally support midwives’ workplace stress and thriving.

Jessica Murray, Retention Support Midwife at the RUH Trust said: “It has been great to work with the University of Bath on these projects around stress and thriving in midwifery. It has given us the opportunity to provide essential tools to our midwifery workforce to help support them with better managing stress in the workplace. We hope this will help to educate our workforce around occupational stress in the workplace, and support them to not only remain but also thrive in their roles."

Zita Martinez, Director of Midwifery at the RUH Trust, added: “We know that working in the NHS can be stressful and we are committed to ensuring our fantastic maternity team has the support it needs to provide the very best care at all times. This research from the University of Bath has been really valuable in further enhancing the wellbeing support already on offer for our staff, helping us to tailor support and interventions to specific groups of midwives.

“In March this year, the Care Quality Commission announced that maternity services at the RUH had an 'outstanding' rating, which reflects the hard work and commitment of our staff based at the RUH and those in our community birth centres, who go that extra mile every day. We were particularly proud that inspectors said staff felt respected, supported, and valued and were focused on the needs of women and birthing people receiving care.”

The StART research group has also conducted workplace stress and thriving audits in policing, Formula 1, and the ambulance service. With their policing colleagues, they have used their findings to create a prototype, virtual-reality decompression tool for usage by those in the 999 call rooms, and are starting to develop a supportive resource for managers to conduct more effective one-to-one conversations with staff.

Organisations interested in learning more about stress and thriving audits can contact Dr Rachel Arnold (R.S.Arnold@bath.ac.uk) or Dr Lee Moore (L.J.Moore@bath.ac.uk) for more information.

The paper A mixed-methods stress audit with midwives in the United Kingdom, is published in Women and Birth (DOI: 106.1016/j.wombi.2024.101639).

The paper Effectiveness of interventions on occupational stress, health and well-being, performance, and job satisfaction for midwives: A systematic mixed methods review, is also published in Women and Birth (DOI: 10.1016/j.wombi.2024.02.005).