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A robust, skilled midwifery workforce is integral to provision of safe maternity care. In Australia there is a lack of evidence regarding adequacy of the midwifery workforce, recruitment, retention and distribution of midwives in rural, regional, and metropolitan settings. We aimed to explore the state of the midwifery workforce in Victoria from the perspective of managers of maternity services and currently working midwives. An online, population-based cross-sectional survey of midwifery managers and midwives in all Victorian public and private maternity services was conducted between March and October 2021. Questions explored midwifery staffing numbers and adequacy, recruitment, staff turnover, midwives' years of experience, career plans, and intention to leave the profession. Fifty-six percent (38/68) of managers of Victorian maternity services and 1016/5134 midwives responded (20% of midwives in Victorian maternity services). Of the managers, 76% reported inadequate midwifery staffing levels in their services, with a reported combined total deficit of 135 full-time equivalent midwives. Public metropolitan hospitals had higher rates of turnover than public regional/rural services, but regional/rural services experienced a greater impact. Managers ascribed staff turnover to midwives retiring or 'experienced' midwives choosing to leave to seek new opportunities with better work/life balance. Most (73%) managers reported difficulties in recruiting midwives. More than half (61%) of midwives in this study were ten years or less post-qualification. One in five midwives were unsure how long they would stay in the midwifery profession, and over a quarter were planning to leave the profession in the next five years. However, almost 40% of midwives were regularly thinking about leaving the profession. The Victorian midwifery workforce is currently inadequately staffed and lacking in experienced midwives. A significant number of midwives are considering leaving the profession. A focus on supporting recruitment and retention in urgently required. [ABSTRACT FROM AUTHOR]

Due to the COVID-19 pandemic, rapid service changes were made to maternity care provision in Victorian maternity services. From March 2020 many routine face-to-face visits in pregnancy were replaced by telehealth (telephone or video), along with changes to routine screening. Many providers plan to continue these changes despite a lack of evidence to guide practice. We aimed to describe the changes in maternity care provision, understand the perceived impact and explore services' future plans regarding these changes. A population-based cross-sectional study of midwifery managers of all Victorian public and private maternity services was conducted between March and October 2021. Questions explored health service characteristics, changes to maternity care delivery, telehealth practices, perceived impact of changes, and future plans. Fifty percent of services (34/68, 27 public and 6 private) responded, with broad representation of location, birth numbers and size of service. Around 50% of all pregnancy visits became telehealth. There were multiple combinations of which visits were face-to-face and which were telehealth. No visit was conducted face-to-face by all responding services. Visits most likely to be face-to-face were at 39 and 40 weeks gestation (65%). For telehealth appointments there was an ad hoc approach to advising women on routine screening, e.g., measuring blood pressure (11% did not advise at all), fetal growth (26% – no specific strategy) and fetal heart rate (15% – no specific strategy). Over half (52%) would consider maintaining telehealth post-pandemic. Even in a single state there is great variation in telehealth timing, when pregnant women should have face-to-face visits, and what routine screening is maintained. In light of emerging evidence of some potentially poorer clinical outcomes associated with telehealth in pregnancy, these findings need to be considered. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic meant there were significant changes to the way maternity care was provided. Postnatal care was impacted by restrictions on visitors and support people in hospitals as well as decreased home-based midwifery care after birth. Anecdotally, many providers report considering maintaining some of the restrictions post-pandemic. Women's views and health outcomes should be considered in policy decisions. Explore the impact of changes to postnatal care for women who birthed during COVID-19 restrictions in Melbourne. A cross-sectional survey of all women who birthed at one tertiary service in Melbourne in September and October 2020 was undertaken. Women were invited to participate in the study when their baby was four to six months old. They could choose to complete the survey via telephone or online. In total, 483 out of 1002 eligible women (48%) participated, of whom 40%rated their hospital postnatal care as 'Very good', with 53% rating their baby's care as 'Very good'. Two-thirds felt postnatal hospital visitor restrictions impacted their experience, with most reporting this was a negative impact (72%). During the first six weeks postpartum, 75% of respondents felt the restrictions impacted the support they received from their partner, family or friends, and two-thirds felt this was a negative impact. At four months, 83% of women were giving any breast milk, and 60% were giving only breast milk. Eighty-three percent of reported that the way they were feeding their baby was affected, and 73% of these considered it had a negative impact. The COVID-19 pandemic affected women's postpartum experiences in a variety of ways, most often negatively. As we emerge from the pandemic, it is important to reflect on women's experiences and outcomes and refocus on what the women themselves consider to be the important elements of support for optimum outcomes. [ABSTRACT FROM AUTHOR]

A well-supported, skilled midwifery workforce is critical to the provision of safe maternity care that optimises outcomes for women and babies. Issues such as burnout, workplace culture and workplace safety can affect how midwives' function, and the quality of care they provide, but there is limited evidence regarding these factors in the midwifery context. We aimed to measure burnout, workplace culture and workplace safety among Victorian midwives. An online population-based cross-sectional survey of midwives in all private and public maternity services in Victoria, Australia was conducted between March and October 2021. Measures included the Copenhagen Burnout Inventory; the Australian Midwifery Workplace Culture survey; specifically designed questions to assess skill mix safety, level of occupational violence and bullying; and an open-ended question about key messages on the midwifery workforce. In total, 1016/5134 midwives responded (20% of midwives in Victorian maternity services). A large proportion of the respondents were experiencing personal burnout (72%) and work-related burnout (67%). Three-quarters felt midwifery skill mix was unsafe at some point in an average week. Half had experienced occupational violence and a quarter had experienced bullying in the 12 months prior to the survey. The majority of midwives (72%) felt their concerns were not taken seriously by their managers or midwifery units and that they had inadequate support when short-staffed. Only one in five felt their workplace had a positive culture. Midwives reported that they felt they were providing unsafe and inadequate care due to staffing issues and unsustainable workloads. Victorian midwives are experiencing very high levels of burnout and poor workplace culture and safety. Strategies are urgently needed to address these issues for Victorian midwives. It would be of value to repeat this work in other jurisdictions to understand these challenges at a national level. [ABSTRACT FROM AUTHOR]