Getting midwives back to hospitals: A discrete choice experiment

BACKGROUND: There is a severe global shortage of midwives, and the situation worsens when qualified professionals leave their jobs because of inadequate working conditions. Hospitals have increasing difficulties in filling vacancies for midwives. In the case of Germany, midwives tend to give up birth assistance after an average of seven years working in delivery rooms, which are usually led by physicians. OBJECTIVE: We aim to provide concrete recommendations on encouraging qualified professionals to work in maternity wards by examining the job preferences of midwives who currently do not provide such services. These insights shall help policy makers and hospital managers to fill vacancies more quickly and provide adequate care to more women. DESIGN: Discrete choice experiment. SETTING(S): Online survey promoted through email and social media to midwives in Germany. PARTICIPANTS: 415 midwives participated; we examine the subgroup of 241 midwives who do not offer birth assistance. METHODS: We obtain individual parameter estimates through a multinominal logit analysis with hierarchical Bayes estimation techniques, calculate importance weights, and simulate uptake probabilities of different hypothetical job offers that include birth assistance. RESULTS: Participants want to provide birth assistance but fiercely reject doing so under physicians' supervision. With a 15 % increase in income, however, 16 % would accept this least preferred setting. Forty-four percent, however, would choose to offer birth assistance if they could work in a midwife-led unit. An additional increase in income of 5 % (15 %) could even lead to uptake probabilities of 67 % (77 %). CONCLUSIONS: There is a common understanding that midwife-led care is a safe and effective option for healthy women. Policy makers are advised to further extend their initial support for such units to fill vacancies quicker and enable comprehensive healthcare for more childbearing women. TWEETABLE ABSTRACT: Midwife-led units help counter shortages: Midwives want to provide birth assistance but reject doing so under physicians' supervision.