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Midwifery Career Pathway Survey Results

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Midwifery Career Pathway Survey Results

Thank you to everyone who contributed to our 2018 Career Pathways for Midwives survey.  Your responses will help guide the actions and efforts of the ACM when it comes to lobbying for changes and support of midwives working in different areas of health.  They will also enable us to identify where the areas of interest are and to back up the requests we make related to getting access and recognition for midwives.  Further, your responses help us to create, develop and share information that is of interest to midwives and show us where we are on track and where we need to make changes or do more work.


Back in early June we ran a survey to find out what Midwives were thinking about their career.  We wanted to use the data to advise the ACMs future work plans as well as identify what midwives saw as career opportunities or pathways of interest.  We were interested in these views because Midwives have been reaching out to us expressing interest in areas such as perinatal mental health, maternal child and family health, diabetes education, sexual health and ultrasounds. In addition we receive enquiries from midwives about their options as far as branching out into different models of midwifery care.  And then there are midwives who have an interest in a more academic or managerial career pathway who want to know what their options are.  These requests for information are all anecdotal evidence of what Midwives are interested in.  The survey helped us to quantify and strengthen the anecdotal knowledge that we had been collating.

Demographics

Participation was voluntary and we received responses from 267 individuals, where the majority (98.88% n=264) identified as Registered Midwife, or an individual enrolled in a university program that will lead to Registration as a Midwife. 

Image 1 - Registration Status

The majority of responses were from Victoria Midwives (n=61, 37%), followed by NSW and then Queensland.  We even had a response from two International midwives. Unfortunately we had no responses from midwives in Tasmania or the Northern Territory.  Hopefully we will be able to get data from those areas as well as increased engagement when we run this survey again next year (to see where choices and opportunities may have changed).

Image 2 - State Distribution

Interestingly, when comparing the spread of responses to the latest registration data from the NMBA, there were similarities in the distribution, although the results do indicate that our results are not a direct reflection of the midwifery community with slight over representation from South Australia, Victoria and ACT and under representation from New South Wales, Queensland and Western Australia. 

Image 3 - Compare to ABS

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The vast majority of respondents work in an urban setting.  We were unable to identify the distribution of midwives from AIHW statistics as they report them as the number of FTE Midwives per 100,000 population.  The data identified from the 2015 Statistics states FTE rate of Major cities 53.6 (down from 101.2 in 2011); FTE rate of Inner regional areas 47.6 (down from 112.5 in 2011); FTE rate of Outer regional areas 50.6 (down from 118.9 in 2011); and  FTE rate of Remote/Very remote areas 63.1 (down from 195.1 in 2011) (AIHW Data tables: Midwives, detailed tables, Nursing and midwifery workforce 2015 data tables, viewed 6/8/2018 at https://www.aihw.gov.au/reports/workforce/nursing-and-midwifery-workforce-2015/data).

Image 4 - Location

The majority of respondents identified as Midwives (70.13%) and within that cohort there was a fairly even spread of representation of Midwives across the time periods identified since registration  - apart from midwives who identified as being working as a midwife for 16-20 years, where this cohort was not as well represented in the responses.

Image 5 - Work History

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Career related responses

We asked the midwifery (and student) community to tells us about where they wanted their midwifery career to take them. For those who responded it meant reflecting on the work that they do now and identifying where they might want to be in 5-10 years’ time.  Their career choices could be related to working in a different model of care or service to where they are currently located, adding specialisations to their tool belt or moving into a more managerial, governance or educational role.  The responses showed us that midwives have plans, plans for career advancement, plans for maintaining (existing) and obtaining (new) skills, plans for working with women in a more holistic community based setting, plans to guide policy and education, plans to make the most of every opportunity to be the best they can with all the resources at their fingertips!

Types of career pathways

As part of the recent survey that the ACM undertook to formally determine where midwives and students of midwifery want their career to take them a number of areas were identified.  The career progression preferences have been grouped into three distinct pathways.

  • Model of Care – relates to the way the provision of midwifery is delivered to women and families within the midwives community.  There is a clinical element but apart from the aeromedical career choice as identified by less than 1% of the respondents, these choices are not specifically reliant on any additional skills or training outside of midwifery.  Access to these options for midwives are typically dependent on support from health departments to design, fund, implement and provide ongoing support for the models of care.  There is usually a clear pathway and career progression pathway for midwives to follow for these career options.
  • Governance & Educational Roles – relates to areas of midwifery management and development that are typically defined by health services, universities, professional organisations and government.  Whilst career progression to these areas does require the development or utilisation of skills pertinent to the role, they are not clinical midwifery specific.  
  • Specialisations – Skills/Extended Scope – relates to areas that require additional clinical based education and training.  In some cases a credential from a professional association is also required for employers to consider the midwife qualified to work in the specified area of health care. Career progression is not clear and there are often multiple barriers restricting midwives access to these pathways (Midwifery Endorsement is a particular exception where the educational requirements have been developed specifically for midwives).

Image 7 - Career preferences

Response rates from the survey showing Career Pathways areas of interest for Midwives and students of Midwifery (green = model of care; purple = governance & educational; blue = specialisation).

Another way to look at the responses is to look at the way that a midwife might access/move to a new or diversified career pathway.  We were interested in looking at the results in this way as we are currently talking with universities, starting with the Council of Deans Nursing and Midwifery about how we make changes so that midwives can be accepted into the existing courses. 

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Image 6 - Midwives area of interest
Within the University pathway Maternal Child and Family was the most popular career pathway (35%) followed by Sexual Health (24%) and then Perinatal Mental Health (22%).

Image 8 - University preferences  

We had a look at why these areas might be of interest to midwives and noted that it was most likely because the work (career pathway of interst) is closely aligned to core midwifery practice.

Image 9 - Career to Midwifery alignment

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And yet midwives identify that there are a variety of actual or perceived barriers to moving into the career pathway/choice that they desire.

Image 10 - career barriers


When asking midwives what they knew or thought the barriers to their career pathways might be the responses were varied (across each of the career pathways) although the most common response for the majority of the pathways that related to a Specialisation (skills or extended scope) was the perceived requirement to hold registration as a nurse.  Other barriers were identified as time to complete training, impact to work-family balance, cost of training, belief that there were no jobs available for midwives, lack of local training options or styles, their current manager would not support the change to their role resulting from the additional training and there was a lack of clarity on what career progression looked like or required.  In addition those respondents who were students identified that they had not yet graduated and so their primary concern was to complete their midwifery degree.

Interestingly apart from the career pathway of Neonatal nursing – eg neonatal intensive care (level 3), only a small percentage of midwives surveyed thought that registration as a nurse was a requirement for the majority of other career pathways identified as a specialisation.

Image 11 - RN barrier

Midwives views on what career pathways, leading to a specialisation, require existing Registered Nurse status

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Another potential barrier was the need to undertake additional training to attain the necessary skills and qualifications.  In all career pathways leading to a specialisation additional training, over and above midwifery skills and training was identified as being a requirement.  Responses identified that the training required was separate to that provided on the job and that this usually takes place in a University or a Registered Training Organisation (RTO).  The issues for midwives when it comes to the additional training is ensuring the course being offered by the University or RTO allows midwives to apply.

Image 12 - training requirements
 
Midwives perceptions on what training is required for career pathways leading to a specialisation

Existing options for career progression for midwives

A number of the career pathways leading to a specialisation already have clear options in place for midwives to progress through and obtain a qualification.  Examples of these include Lactation Consultant which has long been an area of specialisation for midwives.  In recent years midwives have also been venturing into pregnancy ultrasound with a number of courses being accredited and run every year to facilitate this interest.

There are a number of career pathways that on the surface look like they have a clear pathway for midwives to follow, and minimal barriers, however there may be State or Territory specific impediments to employment (such as position descriptions or roles available) or access to courses or the required training.  

Finally there are those career pathways where there is a lack of directive around the role of midwives in this space – specifically maternal child and family health and perinatal mental health.

Image 13 - access status

Response rates showing Career Pathways areas of interest for Midwives and students of Midwifery, identified by the types of barriers (if any) that exist (clear pathway = orange; recent removal of barriers = yellow; state specific barriers = light blue; national barriers = dark blue)

Recent changes to career options for midwives

Through a successful lobbying of ADEA midwives are now able to access the credential program and the associated university courses.  This is a fabulous opportunity for midwives wishing to move into this space as diabetes education is a core component of antenatal and postnatal care specifically for those women with pre-existing diabetes and those who develop gestational diabetes.

The ACM is currently working with the National Wound Management Innovation CRC to have midwives included in the national credential program as peer reviewers, as representatives on the advisory committee and to engage with the credential program.  This recognition of midwifery in the field of wound management is a reflection of the growing understanding of the importance of a national approach to the management of wounds which may occur abdominally or to the perineum for women during birth.-

What now...

The Australian College of Midwives believes that the education that is undertaken in the Bachelor of Midwifery course, which has a strong focus on holistic, preventative community based health, adequately prepares midwives for undertaking further education in a variety of occupational roles such as sexual health, vaccination, maternal child and family health, perinatal mental health and neonatal. Further, with the changing landscape of health care moving towards more community based services to accommodate Australia’s population distribution, the inclusion of midwives who do not hold an additional qualification as a nurse in such occupational roles may address workforce shortages issues, particularly in rural and remote areas where it would be ideal to have midwives who could work in multiple community based health promotion areas.

Therefore, in response to requests from midwives, the Australian College of Midwives, via the Midwifery Education Advisory Committee, has been contacting relevant associations to initiate dialogue aimed at progressing career options for midwives who do not hold an additional qualification as a nurse. A briefing paper has been developed, and is updated as progress is made, changes occur to course availability or employment access for midwives.

Contacts so far:

  • Chief Nurse/Midwife or Midwifery Officers.  Ongoing engagement with CNMO/CNM's around Australia regarding foundational support for midwives to be working in the career pathway areas identified as well as looking at issues related to models of care and workforce.
  • Council of Dean Nursing and Midwiferyhttp://www.cdnm.edu.au/ . Presented to the CDNM in June regarding access for midwives specific to career pathways that require completion of training via a university course.
  • Maternal, Child & Family Health Nurses Australia (MCaFHNA) - www.mcafhna.org.au - related to midwives working in the area of maternal, child and family health (in progress).
  • Australian College of Mental Health Nurses - www.acmhn.org/ -  related to midwives working in the area of mental health and/or perinatal mental health (in progress).
  • Centre for Perinatal Excellence (COPE)www.cope.org.au/  - related to midwives working in the area of perinatal mental health (in progress).
  • Australian Diabetes Educators Association (ADEA) - www.adea.com.au - related to midwives working in the area of diabetes education (succesful)
  • Australian College of Neonatal Nursing (ACNN) - www.acnn.org.au - related to midwives working in the area of neonatal nursing (succesful)
  • Australasian Sexual Health and HIV Nurses Association (ASHHNA) - www.accypn.org.au - related to midwives working in the area of sexual and reproductive health (in progress)
  • Wound Management Innovation CRC - http://www.woundcred.com/ - related to midwives working in the area of wound management (succesful)

At this stage Maternal, Child and Family Health and Perinatal Mental Health are seen as the most important career pathway to be addressing from an education and workforce perspective, as reflected by the level of interest from the midwifery community (where there are national barriers to access). ACM will continue to communicate activities and outcomes via ACM communication platforms and channels to keep you informed.  We will probably run this survey again next year to see if there have been any changes in where midwives want their career to go, and also whether we have been successful in removing barriers to midwives accessing the career of their choice.  If you did not engage in the survey this time, we would love for you to take part next time.  The more midwives and midwifery students we hear from the better prepared we are to work on making change.

For now, we hope that having a read of the results has prompted you to think about where you want your career to be in 5- 10 years and strated you thinking about the opportunities that are available to you, or maybe identifying where there is a barrier that needs addressing.  

If you have a career development journey that you would like to share, so that other midwives can learn from your experiences, then we would love for you to contact us at education@midwives.org.au so we can work with you to find the best way to share.