Ingrid Jepsen

A qualitative study of how caseload midwifery is constituted and experienced by Danish midwives

OBJECTIVE the aim of this study is to advance knowledge about the working and living conditions of midwives in caseload midwifery and how this model of care is embedded in a standard maternity unit. This led to two research questions: 1) What constitutes caseload midwifery from the perspectives of the midwives? 2) How do midwives experience working in caseload midwifery? DESIGN AND SETTING phenomenology of practice was the analytical approach to this qualitative study of caseload midwifery in Northern Denmark. The methodology was inspired by ethnography, and applied methods were field observations followed by interviews. PARTICIPANTS thirteen midwives working in caseloads were observed during one or two days in the antenatal clinic and were interviewed at a later occasion. FINDINGS being recognised and the feeling of doing high quality care generate high job satisfaction. The obligation and pressure to perform well and the disadvantages to the midwives׳ personal lives are counterbalanced by the feeling of doing a meaningful and important job. Working in caseload midwifery creates a feeling of working in a self-governing model within the public hospital, without losing the technological benefits of a modern birth unit. Midwives in caseload midwifery worked on welcoming and including all pregnant women allocated to their care; even women/families where relationships with the midwives were challenging were recognised and respected. KEY CONCLUSIONS caseload midwifery is a work-form with an embedded and inevitable commitment and obligation that brings forward the midwife׳s desire to do her utmost and in return receive appreciation, social recognition and a meaningful job with great job satisfaction. There is a balance between the advantages of a meaningful job and the disadvantages for the personal life of the midwife, but benefits were found to outweigh disadvantages. IMPLICATIONS FOR PRACTICE In expanding caseload midwifery, it is necessary to understand that the midwives׳ personal lives need to be prepared for this work-form. The number of women per full time midwife has to be surveilled as job-satisfaction is dependent on the midwives׳ ability of fulfilling expectations of being present at women׳s births.

Is caseload midwifery a healthy work-form?: A survey of burnout among midwives in Denmark

Abstract Objective To investigate the level of burnout among midwives working in caseloading practices compared to other models of midwifery care. Study design and setting In this survey the Copenhagen Burnout Inventory was used to measure burnout among midwives working in a tertiary maternity unit Denmark. Main outcome measures Mean burnout scores and the proportion of midwives with high burnout scores (a score >= 50). Results The response rate was 82.0% as 50 out of 61 midwives answered the questionnaire. In caseload midwifery the burnout scores in personal, work-related and client-related burnout were significantly lower when compared to “other models of care”. Among caseloading midwives, none had high scores of burnout in any of the measured domains. The proportions of high burnout scores among all of the participating midwives were 22% (95% CI: 12%–36%) in personal burnout, 20% (95% CI: 11%–34%) had high scores in work-related burnout, and 10% (95% CI: 4%–22%) had high scores in clientrelated burnout. Conclusion Caseload midwifery was associated with lower burnout scores, which is in accordance with the results from other studies on burnout among caseloading midwives. The proportion of high score among all the midwives in this study were low compared to results from other countries. According to the high response rate the results are valid for this maternity unit but this study is too small to be generalised. This study should be repeated among all midwives in Denmark. In studies of burnout in caseload midwifery the midwives’ self-selection into this workform needs consideration.