Midwifery Autonomy and Employment Changes During the Early COVID‐19 Pandemic

Abstract

Introduction:The COVID-19 pandemic presented the midwifery workforce with challenges for maintaining access to high-quality care and safety for patients and perinatal care providers. This study analyzed associations between different types of professional autonomy and changes in midwives' employment and compensation during the early months of the pandemic.Methods: An online survey distributed to midwifery practices in fall 2020 compared midwives' employment and compensation in February 2020 and September 2020. Chi-square analysis determined associations between those data and measures of midwives' autonomy: state practice environment, midwifery practice ownership, intrapartum practice setting, and midwifery participation in practice decision-making.Results: Participants included lead midwives from 727 practices, representing 50 states and the District of Columbia. Full-time equivalent (FTE) positions and number of full-time midwives were stable for 77% of practices, part-time employment for 83%, and salaries for 72%. Of the remaining practices, more practices lost FTE positions, full-time positions, part-time positions, and salary (18%, 15%, 9%, and 18%, respectively) than gained (11%, 8%, 8%, and 9%, respectively). Early retirements and furloughs were experienced by 9% of practices, and 18% lost benefits. However, midwifery practice ownership was significantly associated with increased salaries (20.3% vs 7.1%; P < .001) and decreased loss of benefits (7.8% vs 19.9%; P = .002) and furloughs (3.8 vs 10.1%; P = .04). Community-based practice was significantly associated with increased FTE positions (19.0% vs 8.8%; P = .005), part-time positions (17.4% vs 5.1%; P < .001), and salary (19.7% vs 7.0%; P < .001), as well as decreased loss of benefits (11.5% vs 21.1%; P = .02) and early retirement (1.4% vs 6.6%; P = .03). State practice environment and participation in practice decision-making were not directly associated with employment and compensation changes.Discussion: Policies should facilitate midwifery practice ownership and the expansion and integration of community birth settings for greater perinatal care workforce stability, greater flexibility to respond to disasters, and improved patient access to care and health outcomes.

Midwifery Practice Leaders’ Experiences of Practice Changes Early in the COVID‐19 Pandemic: A Qualitative Exploration

“…Published disaster plans that focused on perinatal care during an extended viral pandemic did not exist at the onset of COVID‐19. In particular, available recommendations dealing with infectious disease failed to consider the special needs of pregnant women and newborns 11 . Guidelines developed in the aftermath of Hurricane Katrina contained detailed advice for governmental and health organizations to plan and prepare for perinatal care in an emergency 22 .…”

“…Full survey methodology and quantitative findings have been published elsewhere. 11 ✦ Providing care during the COVID-19 pandemic proved stressful and demanding for midwifery practice directors, with regulations, institutions, team dynamics, and financial logistics driving most of the changes that occurred in midwifery practices.…”

“…3,4,6,8 There are fewer studies examining the effects of the pandemic on midwifery practices within the United States. 2,10,11 The purpose of the present study was to explore the adaptations of US midwifery practice to the shifting health care landscape created by COVID-19.…”

Application of the birthrate plus (BR+) methodology to identify midwifery workforce shortages in China: a retrospective multisite study

“…It has been recognized as the "gold standard" 9 for midwifery workforce prediction and has been proven to be very effective when applied in the National Health Systems of the United Kingdom 10 . Full-time equivalent (FTE) midwives, defined as the proportion of midwifery service hours per midwife in the maternity ward, have been applied in other research for employment changes or human resources 11,12 . Therefore, the aim of this study was to adopt the BR + method to investigate midwifery workforce shortage in the midwifery settings in China.…”

Experiences of Midwives Attending Home Births in Massachusetts During the COVID‐19 Pandemic

“…Although community births continue to represent less than 2% of the total number of births in the United States, the rate of home birth rose by 23.3% from 2019 to 2020 2 and by an additional 12% from 2020 to 2021 3 . Authors who surveyed midwifery and obstetric care providers during the early months of the pandemic found that the largest staffing and work hour increases occurred among midwives in community birth settings, compared with midwives and obstetricians in hospital settings 4,5 . Based on Google search data, interest in home birth remains significantly elevated from prepandemic levels 6 .…”