Clinical supervision for midwives

Many midwives are feeling demoralised, disempowered, and overwhelmed. Some of the reasons for this are an over-medicalisation of the workplace, a lack of autonomy and under-staffing (for example, see this recent article about Chronic understaffing at Wollongong maternity services). These factors are leaving midwives emotionally fragile and feeling unsupported by their managers (Catling & Rossiter, 2020; Hunter et al, 2018; Pezaro et al. 2016).

Blogs such as Midwife Diaries are heartbreaking to read and confirm the results of the Work, Health and Emotional Lives of Midwives (WHELM) study (Hunter et al, 2018). The WHELM study surveyed the wellbeing of nearly 2000 midwives in the UK and found significant levels of emotional distress, burnout, stress, anxiety, and depression. Two thirds of participants stated that they had thought about leaving their profession in the last six months, and alarmingly, early career midwives were over-represented in those leaving (Harvie et al, 2019).

Australian research echoes findings about midwives who have left the profession (Matthews, 2021), along with similar findings about work-related distress (Creedy et al, 2017; Catling & Rossiter, 2020). A Royal College of Midwives document Why midwives leave – revisited (2016) reported that 88% of midwives who had left the profession might consider returning if there were appropriate staffing levels. Eighty percent of midwives said they would return if their workplace culture was changed for the better, although this report did not outline what a positive workplace culture was.

Positive workplace culture

We suggest the following list (although not exhaustive) highlights some important things that midwives want from maternity services:

• Fully staffed ward/unit with adequate resources for staff to do their jobs.
• Visible managers who provide support to their staff to excel and flourish.
• Support to engage in educational opportunities, support to attend conferences / seminars / complete higher degrees.
• Emotional support following adverse events.
• Timely feedback and assistance with relationships in the workplace including zero tolerance for bullying behaviour.
• Autonomy in practice with multi-disciplinary assistance when indicated.
• Opportunity to work in midwifery continuity of care.

In essence, a positive workplace culture would have trust in, and collegiality with, work colleagues and knowledge that your work with women was high-quality and valuable.

How can we support midwives?

Clinical supervision is a well-known supportive strategy that has been used in many health disciplines to help promote staff professional development and health and wellbeing. The Co-Director of the CMCFH, Associate Professor Christine Catling, gained a National Health and Medical Research Council investigator grant for 2021-2025 to investigate whether group clinical supervision makes a difference to Australian midwives and the midwifery workplace culture. We know it reduces burnout from observational studies, but it has not been studied extensively and experimentally before in the midwifery discipline.

The trial of group clinical supervision

The cluster randomised controlled trial (for maternity units in Greater Sydney) will involve 12 maternity sites (the ‘clusters’). Each cluster will be randomised to either receive the intervention (group clinical supervision) or not.

The trial will measure midwifery burnout rates (using the Copenhagen Burnout Inventory), the perceptions of their workplace culture (using the Australian Midwifery Workplace Culture (AMWoC) tool, and intentions to leave the profession. For the intervention sites, the efficacy of the clinical supervision will be measured through using the Clinical Supervision Evaluation Questionnaire (CSEQ) (Horton, 2008).

The results of this 5-year study are forthcoming.