Other factors that might influence outcomes

There were differences in some outcomes depending on the area of the UK in which a midwife works. When compared to midwives working in the South East of England:

• London, Wales and Northern Ireland: midwives had increased odds of being pleased with their standard of care – no clear reason to explain this as midwives from these regions rated factors having a negative impact on care similar to other regions.
• East of England: midwives had reduced odds of being pleased with their standard of care – this may reflect the higher number of midwives in this region with impaired recovery opportunities.

When compared to band 6 midwives:

• Being employed at a band 5: increased the odds of job satisfaction and reduced the odds of client-related burnout and thoughts about leaving.
• Being employed at a band 7: reduced the odds of client-related burnout, which may be due to their position of authority and being less likely to provide regular, direct care to women.

This was only influential for work-related stress and work-related burnout. When compared to midwives with 30 or more years of experience:

• Midwives with less than one year of experience had the highest odds of work-related stress and work-related burnout. Possibly related to the need for ongoing support.
• But … all midwives with less than 20 years of experience had increased odds of work-related burnout, suggesting other factors mediate this association.

When compared to midwives who had less than a 20-minute journey to work:

• Midwives who had a commute time of 40 minutes or more had reduced odds of being pleased with their standard of care
• Midwives who had a commute time of one hour or more had increased odds of thinking about leaving midwifery

Working part-time was a protective factor, but only for those who worked less than 20 hours per week. When compared to midwives who worked full-time (30 or more hours per week):

• Midwives who worked less than 20 hours per week had reduced odds of work-related stress, personal burnout, and work-related burnout.

This might suggest that the cumulative effect of shift work, and/or recovery time between shifts are important mediators.

When compared to those working on delivery suite/labour ward:

• Those working on the postnatal/antenatal ward had increased odds of work-related burnout and reduced odds of being pleased with their standard of care.

When compared to those working in a Caseload/Continuity of Care team:

• Those working on the postnatal/antenatal ward reduced odds of job satisfaction.

There were no better outcomes for those working in a Caseload/Continuity of Care team.

There were no better or worse outcomes for those working 12-hour shifts (compared to those working up to 8.5-hour shifts).

But … this study found some evidence to suggest 10-11.5 hour shifts might be associated with better outcomes:

• Reduced odds of personal burnout and thoughts about leaving midwifery.
• Increased odds of midwives being pleased with the standard of care they could provide.

A 10-11.5-hour shift may still achieve a compressed working week so the mediating effects of this shift length may be an area worth of further exploration.