A mixed-method study examining barriers and facilitators to the mental health of midwives in Ontario | BMC Women’s Health

by admin
A mixed-method study examining barriers and facilitators to the mental health of midwives in Ontario | BMC Women’s Health

Our mixed-methods study is the first comprehensive examination of the factors that influence the mental health of midwives in Ontario. Our analysis revealed that the mental health of midwives in Ontario is negatively influenced by factors related to the nature of midwifery work itself, provincial midwifery funding arrangements and their implications, the culture within the profession and the external context in which the profession exists. By drawing on a socio-ecological understanding of mental health and well-being, the interrelationships between these factors can be understood by viewing the work experiences of individual midwives as embedded in relationships within organizations within policy within society, with more micro-level factors, which are formed by meso- and macro-level factors [26]. In our presentation of the results, we included descriptions of the findings in which participants noted these influences. Our online survey of midwives in Ontario revealed a diversity of experiences related to factors influencing mental health, but broad support for solutions such as providing more opportunities for alternative work arrangements and part-time work for midwives, support and respite after traumatic labor experiences and access to mental health care from professionals familiar with the unique challenges of midwifery. Our findings offer insight into the factors influencing midwives’ mental health in a context where the majority of midwives work in a midwifery-led continuum of care model.

Our findings are consistent with and extend findings from previous Canadian and international research examining midwives’ mental health. Previous Canadian research has highlighted the negative impacts of unpredictability and uncertainty on midwives’ mental health associated with the on-call model [2, 20, 27, 28]. A pan-Canadian survey of midwives found that unpredictable schedules and the uncertainty of being called to work had a high personal cost on midwives, leading to difficulties in balancing work and personal life [27]. Another survey of midwives from Western Canada (British Columbia and Alberta) found that 34% of midwives had considered leaving midwifery, 84.8% of whom cited the negative impact of an unpredictable on-call pattern [2]. Finally, a study of busy midwives in New Zealand found that the unpredictability of busy work has the potential to increase levels of burnout [28].

Several previous studies have identified the risk of post-traumatic stress disorder and burnout as a consequence of exposure to workplace trauma for midwives [6,7,8]. The literature suggests that the majority of midwives will experience at least one traumatic perinatal event in their career [8, 29, 30]which is significantly associated with burnout in midwives[6, 31] and may influence midwives’ intention to stay in the profession [8, 32]. This makes it imperative to address the impact of trauma on midwives and ensure that midwives are aware of the potential impact of indirect birth trauma [33]have enough time to rest after traumatic experiences [20]and receive appropriate support after such experiences [32, 34]as these steps can help reduce the burden of trauma on midwives’ mental health.

Previous research has also identified the impact of interpersonal conflict, with bullying, harassment and poor interprofessional relationships identified as the main reason for midwives leaving their practice group or profession [2, 35, 36]. Our findings offer new nuances to our understanding of how tensions within the profession affect mental health, including the impact of a culture within the profession of ‘midwifery machismo’ or ‘pushing’ and the power structures that have emerged in some communities as a consequence of midwifery funding flowing through practice groups in the context of managed growth of the profession which created monopolies. Furthermore, while previous midwifery research suggests that the public [37,38,39,40,41,42] and other health care providers [43,44,45] misunderstand the role, education and scope of midwifery, we believe our research is the first to articulate how this lack of understanding negatively affects midwives’ mental health. We did not apply a gender perspective to our analysis, but it is important to note that the HRTO’s 2018 decision found that midwives in Ontario are subject to continued prejudice, stereotypes and barriers due to gender discrimination , and the Ontario Midwives Association’s submission to the HRTO included documentation of the psychological toll this has on midwives [46].

Strengths and limitations

Our study has several strengths. Using a mixed methods design allowed us to provide rich descriptions of participants’ perceptions of factors that influence their mental health, as well as to validate the insights of the 24 participants in Phase I of our study more broadly through a survey. which was open to all midwives in the province. We used member checking and triangulation of both data and researchers to ensure the rigor of our qualitative findings, and our survey response rate provided sufficient power to support the validity of our quantitative findings describing perceptions of the profession as a whole . The triangulation of qualitative and quantitative methods was an additional strength of our mixed methods approach. However, our findings have some limitations. First, some findings are specific to the Ontario context (eg, funding arrangements, model of care) and therefore may not be generalizable to other settings; however, it is important to note that generalizability is not a goal of qualitative research. Second, Phase I participants were more likely to have a disability or chronic illness and to be racist than Phase II respondents. While the proportion of respondents in Phase II self-identifying as Indigenous and/or Black is very similar to the demographics of the profession in Ontario, the proportion identifying as racist in Phase I is higher than in the midwifery population in the province. While it is important when interpreting the qualitative results to consider that the midwives who participated in Phase I may have been motivated to participate because of experiences that differed from the general population of midwives in Ontario, we also consider it a strength that the voices of midwives who may experience marginalization were strongly represented in Phase I and suggest that the guidance of racialized members of our research team in Phase I contributed to participants feeling confident enough to accept targeted invitations to participate. In addition, the use of the phase II study allowed us to confirm our findings based on a representative sample of midwives in Ontario. Third, it was beyond the scope of this analysis to develop a comprehensive theory and explain the relationships between the factors identified in our themes. Future research can enhance our understanding of this topic by applying gendered or intersectional analytical lenses to theory development.

Consequences

We offer five broad recommendations for improving midwives’ mental health based on our findings and other existing literature: (1) providing diverse work opportunities for midwives, (2) addressing the impact of trauma on midwives, (3) improving mental health accessible services tailored to midwives, (4) support healthy relationships between midwives and (5) support improved respect and understanding of midwifery. Previous research has found that midwives want alternative work options, such as reduced on-call times, different models of care, flexible working hours and shift work options, and that the lack of these contributes to their stress and burnout [2, 27, 35, 47]. Providing diverse work opportunities for midwives supports them to continue to use their specialist knowledge and skills when personal or family factors prevent them from working in a full-time, on-call, midwife-led continuum of care model. We need to ensure that midwifery students and practicing midwives are prepared for traumatic events in the workplace and have access to trauma-focused intervention when indicated. Research suggests promising effects of a UK intervention designed to prevent PTSD in midwifery that includes an educational workshop, access to a trauma-focused clinical psychological intervention, peer support and information brochures [48]and other interventions aimed at improving midwives’ mental health through mindfulness and/or meditation have also shown promising results [49, 50]. We identified a strong desire among midwives in Ontario for individual therapy and continuity of care with a mental health professional experienced in midwifery mental health. Peer or group mental health support for midwives is also recommended in the literature for coping with traumatic events and/or poor mental health.19,20,27 Access to personalized mental health support for midwives can be facilitated through online services, but it also needs to be affordable. Supporting healthy relationships between midwives and improving respect and understanding of midwifery are areas that require new interventions and multifaceted approaches. Addressing these two recommendations will also require exploring the ways in which policies, such as funding arrangements, affect both intra- and inter-professional relationships and developing policy-level solutions.

Source Link

You may also like