Workload of primary-care midwives.
OBJECTIVE
to assess the actual workload of primary-care midwives in the Netherlands.


BACKGROUND
In 2000, a strike and large demonstration before parliament convinced everyone of the shortage of midwives and their excessive workload. The government reacted by increasing the capacity of the midwifery schools and lowering the 'standard caseload' for a full-time working midwife. To assess whether this would lead to sufficient improvement of the situation, more insight was needed of the actual workload of midwives in primary care.


METHODS
a 4-year prospective survey of the work of primary-care midwives, during 3 weeks each year, including all midwives working in a representative sample of midwifery practices. On average, 224 midwives participated each year. During 3 weeks in the summer and autumn, midwives kept a diary of their work, with an accurate timetable, covering 24 hours a day. They also filled out questionnaires about practice organisation, work schedules and experiences of workload.


RESULTS
primary-care midwives worked an average of 29 hours a week, and about 74% of their time (22 hours a week) was spent on client-related activities. On average, a midwife was on call during 53 hours a week, and 17 of the 29 hours of work took place during on-call-hours. This meant that an average midwife was involved in her work 65 hours a week. The time spent on direct client care increased by nearly 20%. In particular, the average time spent with a woman during labour and birth increased by almost one-third.


CONCLUSIONS
primary-care midwives spend an average of 29 hours per week working, and this has remained constant between 2001 and 2004. In client-related care, there has been a shift towards fewer clients per midwife but more time per client.
Wiegers
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Netherlands institute for health services research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands. t.wiegers@nivel.nl
D000328:Adult; D005260:Female; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D007587:Job Description; D007588:Job Satisfaction; D008427:Maternal Health Services / Q000458:organization & administration*; D008875:Middle Aged; D008880:Midwifery / Q000458:organization & administration*; D009426:Netherlands; D009721:Nurse Midwives / Q000458:organization & administration; D015403:Nursing Evaluation Research; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D011446:Prospective Studies; D014940:Work Schedule Tolerance; D016526:Workload