Midwifery Professional Stress and Its Sources: A Mixed-Methods Study

Introduction: Professionally-related stress among midwives has been demonstrated in a global context to have deleterious effects on their professional, physical, and psychological health. Despite global interest in the subject, there has been no study about professional stress in a cohort of US midwives. Methods: A convergent parallel mixed-methods design was used. The Job-Related Tension Index (JRTI) survey was administered to a self-selected sample of certified nurse-midwives and certified midwives in clinical practice in the United States via email solicitation of the American College of Nurse-Midwives’ membership. A single qualitative open-ended question was also included in the survey. Results: A total of 644 midwives participated in this study. The mean (SD) score on the JRTI across all midwife participants was 38.3 (9.65); the possible range of scores was 15 to 75. Midwives who were biologically older and/or had practiced longer and who had higher levels of education were shown to have higher levels of job-related tension. Those who believed their stress levels had negatively affected patient care showed higher job-related tension scores than those who did not. Call hours did not significantly affect tension scores in this study sample. Nearly all midwives in the cohort (97.1%) had experienced traumatic birth. Seven themes were identified after content analysis. These included the following: I'm SO tired, conflict with colleagues, selling your midwifery soul, leaving midwifery, non-respectful maternity care, balancing work and personal life, and medicolegal fears. Discussion: Systems should recognize and validate midwives’ levels of work-related tension and develop specific interventions to help alleviate it. Because of the size and racial homogeneity of the sample, further studies are recommended to identify stress levels and their contributing factors in a larger, more diverse population of midwives. Qualitative themes should be more fully explored to identify specific contributors to midwifery stress.