How midwives' perceptions of work empowerment have changed over time : A Swedish comparative study

Objective: The aim of this paper was to compare current perceptions of empowerment in their work with results from a sample of midwives recruited 2012. Design: A comparative cross-sectional cohort study of national samples of midwives in Sweden from 2012 to 2022. Participants: 475 midwives recruited from the Swedish midwifery association in 2012 and 1782 through two midwifery unions in 2022. Methods: Data were collected using a questionnaire with background information and the revised version of the Perception of Empowerment Scale (PEMS). Mean scores and domains of the PEMS were compared between the years. Findings: Midwives' perceptions of empowerment changed over time, in both directions. Their perception of their skills and education, advocating for and empowering women as well as support from the team and manager increased over the years. Midwives in 2022 were less likely to perceive that they were involved in a midwifery-led practice, and the communication with managers was rated lower. Midwives sensed a lack of professional recognition from the medical profession and their contribution to the care of birthing women. Access to resources for birthing women was perceived lower in 2022 compared to 2012. Younger age, shorter work experience and working in labour wards or postnatal wards were associated with lower perceptions of empowerment. Conclusions: Midwives need to have the authority and reality to practice midwife-led care, to receive control over their work. Good communication and recognition from the medical profession is essential to be empowered. This is important in order to maintain a healthy workforce.