title: Midwifery empowerment: National surveys of midwives from Australia, New Zealand and Sweden.
abstract: BACKGROUND
  the predicted midwifery workforce shortages in several countries have serious implications for the care of women during pregnancy, birth and post partum. There are a number of factors known to contribute to midwifery shortages and work attrition. However, midwives assessment of their own professional identity and role (sense of empowerment) are perhaps among the most important. There are few international workforce comparisons.
  
  
  OBJECTIVE
  to compare midwives' sense of empowerment across Australia, New Zealand and Sweden using the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised).
  
  
  METHODS
  a self-administered survey package was distributed to midwives through professional colleges and networks in each country. The surveys asked about personal, professional and employment details and included the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). Descriptive statistics for the sample and PEMS were generated separately for the three countries. A series of analysis of variance with posthoc tests (Tukey's HSD) were conducted to compare scale scores across countries. Effect size statistics (partial eta squared) were also calculated.
  
  
  RESULTS
  completed surveys were received from 2585 midwives (Australia 1037; New Zealand 1073 and Sweden 475). Respondents were predominantly female (98%), aged 50-59 years and had significant work experience as a midwife (+20 years). Statistically significant differences were recorded comparing scores on all four PEMS subscales across countries. Moderate effects were found on Professional Recognition, Skills and Resources and Autonomy/Empowerment comparisons. All pairwise comparisons between countries reached statistical significance (p<.001) except between Australia and New Zealand on the Manager Support subscale. Sweden recorded the highest score on three subscales except Skills and Resources which was the lowest score of the three countries. New Zealand midwives scored significantly better than both their Swedish and Australian counterparts in terms of these essential criteria.
  
  
  CONCLUSIONS
  midwives in New Zealand and Sweden had a strong professional identity or sense of empowerment compared to their Australian counterparts. This is likely the result of working in more autonomous ways within a health system that is primary health care focused and a culture that constructs childbirth as a normal but significant life event. If midwifery is to reach its full potential globally then developing midwives sense of autonomy and subsequently their empowerment must be seen as a critical element to recruitment and retention that requires attention and strengthening.
authors.affiliation: Mid Sweden University, Department of Nursing, Sundsvall, Sweden; Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden. Electronic address: Ingegerd.hildingsson@kbh.uu.se.
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Hildingsson
authors.affiliation: Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia. Electronic address: j.gamble@griffith.edu.au.
authors.forename: Jenny
authors.initials: J
authors.lastname: Gamble
authors.affiliation: Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia. Electronic address: m.sidebotham@griffith.edu.au.
authors.forename: Mary
authors.initials: M
authors.lastname: Sidebotham
authors.affiliation: Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia. Electronic address: d.creedy@griffith.edu.au.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Creedy
authors.affiliation: New Zealand College of Midwives, New Zealand. Electronic address: ceo@nzcom.org.nz.
authors.forename: Karen
authors.initials: K
authors.lastname: Guilliland
authors.affiliation: Research Development, New Zealand College of Midwives, New Zealand. Electronic address: practice@nzcom.org.nz.
authors.forename: Lesley
authors.initials: L
authors.lastname: Dixon
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Australia. Electronic address: j.pallant@griffith.edu.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Pallant
authors.affiliation: Menzies Health Institute Queensland, School of Nursing & Midwifery, Griffith University, Australia; Gold Coast University Hospital, Australia. Electronic address: j.fenwick@griffith.edu.au.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fenwick
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009520:New Zealand; D009721:Nurse Midwives / Q000523:psychology* / Q000600:supply & distribution; D010465:Perception; D011209:Power, Psychological; D011247:Pregnancy; D011795:Surveys and Questionnaires; D013548:Sweden
keywords: Cross-sectional; Midwives; Professional empowerment; Survey; Workforce attrition