A meaningful work in a strained context - exploring midwives' work situation and professional role

Midwives report a challenging work situation globally with a work force shortage, which is a large challenge for health-care organisations and can influence midwives’ professional role. The overall aim of this thesis was to explore midwives’ work situation and professional role in relation to models of care, salutogenic factors and job satisfaction and demands. The methods used in studies I-IV and the synthesis were classical grounded theory (I: n=27, III: n=12, synthesis) simultaneous mixed method (II: n=16/58) and statistical analyses of survey measurements (IV: n=1747). Data were collected by conducting focus group and face-to-face interviews and surveys, one of which was nation-wide. Results: In study I, other professions’ main concern were midwives marching to own drum and safeguarding midwifery and that the midwifery profession was veiled. The other professionals thus used unveiling strategies scrutinising, streamlining and collaborating admittance. All professionals co-existed in a strained baby factory context. In study II, a theoretical midwifery model of woman-centred care had the potential to strengthen midwives’ professional role and practice but not the strained work situation. In study III, the substantive theory of professional courage to create a pathway within midwives’ fields of work provided an explanation of health-promoting facilitative conditions in midwives’ work. However, there were vital organisational prerequisites that needed to be fulfilled, organisational resources, visualising midwifery and a reflective environment. In study IV possibilities for development, quality of work, role conflict, burnout and recognition, explained most of the variance in midwives’ job satisfaction (R2 =.626). Midwives demonstrated the largest mean difference from the reference population in terms of higher emotional demands, lower influence at work and a greater meaning in their work. The theoretical synthesis of the results of studies I-IV emerged as a ‘professional courage to maintain a meaningful work in a strained context’. The overall conclusion was that midwives report great meaningfulness in their work related to having a possibility to work based on the midwifery profession and having organisational prerequisites. Having a distinct professional role was facilitated by professional courage and by safeguarding a high-quality evidence-based midwifery care. These resources enhanced the motivational processes and job satisfaction. However, the midwives were found to work in a highly strained, factory-like, over-medicalised context with high demands and lack of organisational resources and support systems. Which in turn streamlined midwifery work, induced the impairment processes and adversely affected job satisfaction and occupational health