Midwives perceptions of empowerment in maternity services in Ireland: A mixed methods study

Background: The benefits of having empowered midwives include improved outcomes for women and babies; increased maternal satisfaction; increased job satisfaction; staff retention; and cost-effective services. In Ireland, there have recently been major changes in the education of midwives, and in the provision of maternity care services but no research to date has examined midwives’ empowerment. Aims: The aim of this research was to determine midwives’ empowerment levels in clinical practice and to understand what influences those levels. The objectives were to establish the relationship between midwives’ empowerment levels and: models of care; education; job satisfaction; and any plans to leave their job. Study Design: A convergent parallel mixed methods design was chosen. Methods: This was a national study and recruited 420 midwives using a convenience stratified sampling approach. For the quantitative strand the perception of empowerment survey (PEMS) with 3 open ended questions along with demographic questions, and questions on job satisfaction, and considering leaving was used. Descriptive, inferential and exploratory factor analysis was used to interpret this data. 19 self-selected midwives were interviewed for the qualitative strand, in which a grounded theory approach for analysis was used. Data integration of both sets of data provided comprehensive information about midwives empowerment levels and the maternity care services they work in. Findings: Over half (58%) of midwives reported a high empowerment level. However, four in ten midwives (42%) reported a moderate empowerment level only. Midwives working in a midwifery-led model of care reported higher empowerment levels than those in consultant-led models of care. The higher the levels of empowerment the higher the level of job satisfaction. Those with higher levels of empowerment were less likely to consider leaving. However, 61% of midwives had considered leaving for reasons such as unsupportive midwifery management, lack of professional autonomy, high workload, and the way work is organised. Those in the largest unit reported the highest empowerment levels. Conclusions: Those working in midwifery led services were the most empowered. Midwives that worked in the consultant led service model reported a lower empowerment level than those that worked across both consultant-led and midwifery-led models of care. Midwives working in small maternity units (<4000 births) are the least empowered. Those midwives who worked across three areas of clinical practice reported high scores across the three factors. Higher empowerment levels were reported among those who undertook further academic and professional skill development than those that did not on woman- centred care factor. Level of education contributed to the reported high level of empowerment. Just over half (58%) of midwives reported having a high empowerment level with two thirds of the midwives reported having a third level honours degree. This study identified a relationship between job satisfaction and empowerment levels, with the higher the empowerment level the higher the level of job satisfaction. The majority of those surveyed had considered leaving. Those who considered leaving their job had lower empowerment levels than those who did not. Professional recognition influences empowerment. Midwifery autonomy is an important component of midwifery empowerment and without autonomy midwives cannot fully realise it. Midwives consider their professional role and practice as ‘woman-centred care’ and some existing organisational structures are not conducive to midwifery practice and this needs to be reviewed and improved. The study results found a range of interesting findings that will at the very least inform the development of maternity services in Ireland into the future.