In late 2022, La Trobe University School of Nursing and Midwifery released its FUCHSIA Report on future proofing the midwifery workforce in Victoria.
The report was commissioned to address the lack of accurate, up-to-date evidence regarding the Victorian midwifery workforce, in particular around the health and wellbeing of the state’s midwifery workforce, and its sustainability.
Over 1000 Victorian midwives responded to the surveys, along with more than half of the managers of Victorian maternity services, and 22 privately practising midwives.
In response to the survey, Branch Secretary Lisa Fitzpatrick noted that ‘the focus and recommendations of the report are consistent with the work of the Branch and it ‘parallels ANMF strategies and work in improving the state of the working environment for our midwives and midwives to be.’
‘The midwives who have participated in this research have challenged the system to evaluate itself and what can be achieved to ensure retention of midwives, recruitment to the profession and, as a result, the continued provision of safe and quality midwifery care to women and families of Victoria.’
Findings
Unsurprisingly, the report identified significant EFT (equivalent full-time positions) deficits across the workforce. At the time of the study, at least 200 midwives were required to fill the EFT deficits.
A key recruitment challenge was a lack of ‘experienced’ midwives. The midwifery turnover was also high, with many experienced midwives either retiring or looking for improved work/life balance, remuneration, or to avoid shift work.
One in five midwives reported being unsure how long they would stay in the profession. Almost 40 per cent said they regularly thought about leaving the profession, and over one quarter were planning on leaving in the next five years, due to feeling ‘worn out’, experiencing ‘work-related stress’ and being ‘disillusioned with midwifery’.
There were several key midwifery workforce challenges identified, among them:
- physical and mental health issues (including back problems and burn out)
- poor workplace culture
- heavy workloads, inadequate midwife-to-patient ratios, short staffing
- the impact of the COVID-19 pandemic.
Pleasingly, midwives reported having good relationships with their colleagues, and a key positive in their work was being able to provide a high level of care to women and families.
Recommendations
To address the issues identified, the report recommended focusing on five key areas to improve midwifery workforce sustainability:
- workforce planning and flexibility
- working conditions
- workplace culture
- early career midwives and skill mix
- and the midwifery profession.
Workforce planning and flexibility
In addition to recommending a state-wide mapping project to accurately measure the number and EFT of Victorian midwives and workforce deficits, the report suggests implementing more flexible work options for midwives.
ANMF (Vic Branch) is currently working with Safe Care Victoria, the Department of Health and three health services on a rostering project that aims to change the way we roster and make work more flexible for members.
Working conditions
Unsurprisingly, the report’s authors called for improved midwife-to-patient ratios that include babies. While recognition of care of unwell babies in ratios is still ongoing work, lobbying by ANMF on behalf of members saw the Andrews Labor Government commit to introducing new postnatal night-shift ratios of 1:4 in Level 4, 5 and 6 services under the Safer Care Victoria Maternity Capability Framework.
The government also committed to trialling a registered nurse in a neonatal support role per ward above the postnatal ratio on all shifts in three pilot health services. This initiative is as a result of anecdotal evidence seen over the recent past where nurses who have been exposed to midwifery have then sought to undertake midwifery studies. Criticallly the ANMF is committed to growing our midwifery workforce.
The FUSCHIA Report’s other recommendations to improve midwifery working conditions included individualising the length of inpatient postnatal stay to individual women’s needs, increasing the availability and accessibility of midwifery continuity models across all services, and increasing use of the ANMF (Vic Branch)-initiated Registered Undergraduate Student of Midwifery (RUSOM) model to support midwives and reduce workloads.
Workplace culture
Among the report’s recommendations to improve workplace culture was leadership training for maternity managers, increasing administrative support for managers, and increasing availability of mentoring and clinical supervision for midwives.
Early career workforce/skill mix issues
The report’s recommendations to ease early career workforce/skill mix issues included improving workplace culture; increasing clinical support staff to support early career midwives; proactively identifying early career midwives with leadership capabilities for midwifery leadership education and training; and an increased focus on supporting early career midwives to develop skills, knowledge and expertise.
The midwifery profession
Increasing the recognition of midwifery as a respected and independent profession with unique needs and philosophies separate to those of nursing was a key recommendation. To achieve this, the FUSCHIA Report suggested the following initiatives:
- Create a dedicated Chief Midwifery Officer role in Victoria.
- Ratios specific to maternity services
- Subsidise education programs that build midwifery leadership and which expand opportunities for midwives to reach their full scope of practice
- Ensure midwives receive adequate remuneration to reflect the complexity of midwifery work.
Midwifery Workforce Initiative Trial
In January 2023, ANMF (Vic Branch) began collaborating with Safer Care Victoria, the Department of Health and several health services on a trial maternity workforce initiative, which aims to address several of the above recommendations not already being tackled. Work is still underway, and we will update members as this work progresses.
