Giving of the self and Midwife Burnout – An exploration of the consequences of being ‘with woman’ and how individual midwives can reduce or prevent burnout

Published:December 15, 2022DOI:



      The emotional nature of midwifery practice has been described by several researchers and midwives have reported extremely high burnout levels. Burnout is dynamic and effects individual midwives differently, depending on individual coping abilities and demographic and contextual factors. However, midwives themselves can reduce burnout at an individual level.


      This study aimed to explore the concept of burnout with midwives and to ascertain their perspectives on how burnout can be reduced. This paper presents findings in relation to individual midwives’ responsibilities for the reduction of burnout.


      This was a Participatory Action Research study. A total of 5 co-operative inquiry meetings were held with practising midwives (n = 21) over a six-month period (October 2018 - March 2019), in a large, urban teaching maternity hospital in Ireland. Data was analysed using Thematic Network Analysis.


      Midwives explored in detail the emotional nature of midwifery practice and how this contributes upon midwives’ burnout levels. Recommendations were made for individuals to reduce their own burnout levels. These include self-awareness and basic self-care skills. Some specific individual characteristics were suggested as increasing the risk of burnout such as younger, less experienced midwives.

      Conclusion and recommendations

      Midwives require high levels of self-awareness to identify external demands, which make them more susceptible to burnout, and utilise their own positive coping mechanisms. Basic self-care is also necessary for midwife well-being. However, without commitment from healthcare systems to reduce chronic excessive workload, burnout levels will remain high, which impacts negatively on midwives and the women in their care.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Carolan-Olah M.
        • Kruger G.
        • Garvey-Graham A.
        Midwives׳ experiences of the factors that facilitate normal birth among low risk women at a public hospital in Australia.
        Midwifery. 2015; 31: 112-121
        • Leinweber J.
        • Rowe H.J.
        The costs of ‘being with the woman’: secondary traumatic stress in midwifery.
        Midwifery. 2010; 26: 76-87
        • Hunter B.
        • Fenwick J.
        • Sidebotham M.
        • Henley J.
        Midwives in the United Kingdom: levels of burnout, depression, anxiety and stress and associated predictors.
        Midwifery. 2019; 79102526
        • Creedy D.K.
        • Sidebotham M.
        • Gamble J.
        • Pallant J.
        • Fenwick J.
        Prevalence of burnout, depression, anxiety and stress in Australian midwives: a cross-sectional survey.
        BMC Pregnancy Childbirth. 2017; 17: 13
        • Hildingsson I.
        • Westlund K.
        • Wiklund I.
        Burnout in Swedish midwives.
        Sex. Reprod. Health. 2013; 4: 87-91
        • Salvagioni D.
        • Melanda F.
        • Mesas A.
        • Gonza´lez A.
        • Gabani F.
        • de Andrade S.
        Physical, psychological and occupational consequences of job burnout.
        A Syst. Rev. Prospect. Stud. - ProQuest. 2017; (accessed March 20, 2020)
        • Toppinen-Tanner S.
        • Ojajärvi A.
        • Väänaänen A.
        • Kalimo R.
        • Jäppinen P.
        Burnout as a predictor of medically certified sick-leave absences and their diagnosed causes.
        Behav. Med. 2005; 31: 18-32
        • Pezaro S.
        • Patterson J.
        • Moncrieff G.
        • Ghai I.
        A systematic integrative review of the literature on midwives and student midwives engaged in problematic substance use.
        Midwifery. 2020; 89102785
      1. Peterson U. Stress and burnout in healthcare workers. 2008.

        • Fedele R.
        The rise of burnout: an emerging challenge facing nurses and midwives.
        Aust. Nurs. Midwifery J. 2017; 25: 18-23
        • Doherty J.
        • O’Brien D.
        Reducing midwife burnout at organisational level – midwives need time, space and a positive work-place culture.
        Women Birth. 2022; (S1871519222000282)
        • Suñer-Soler R.
        • Grau-Martín A.
        • Flichtentrei D.
        • et al.
        The consequences of burnout syndrome among healthcare professionals in Spain and Spanish speaking Latin American countries.
        Burn Res. 2014; 1: 82-89
      2. McConnell E. Burnout in the Nursing Profession. 1982.

        • Skovholt T.M.
        • Trotter-Mathison M.
        The Resilient Practitioner: Burnout and Compassion Fatigue Prevention and Self-Care Strategies for the Helping Professions.
        third ed. Routledge, 2016
        • Ericson-Lidman E.
        • Strandberg G.
        Burnout: co-workers? perceptions of signs preceding workmates? burnout.
        J. Adv. Nurs. 2007; 60: 199-208
      3. Hunter B., Henley J., Fenwick J., Sidebotham, Mary, Pallant J. Work, Health and Emotional Lives of Midwives in the United Kingdom: The UK WHELM study. 2018.

        • Suleiman-Martos N.
        • Albendín-García L.
        • Gómez-Urquiza J.L.
        • et al.
        Prevalence and predictors of burnout in midwives: a systematic review and meta-analysis.
        Int. J. Environ. Res. Public Health. 2020; 17: 641
        • Dawson K.
        • Newton M.
        • Forster D.
        • McLachlan H.
        Comparing caseload and non-caseload midwives’ burnout levels and professional attitudes: a national, cross-sectional survey of Australian midwives working in the public maternity system.
        Midwifery. 2018; 63: 60-67
        • Jepsen I.
        • Juul S.
        • Foureur M.
        • Sørensen E.E.
        • Nøhr E.A.
        Is caseload midwifery a healthy work-form? – a survey of burnout among midwives in Denmark.
        Sex. Reprod. Health. 2017; 11: 102-106
        • Jordan K.
        • Fenwick J.
        • Slavin V.
        • Sidebotham M.
        • Gamble J.
        Level of burnout in a small population of Australian midwives.
        Women Birth. 2013; 26: 125-132
        • Henriksen L.
        • Lukasse M.
        Burnout among Norwegian midwives and the contribution of personal and work-related factors: a cross-sectional study.
        Sex. Reprod. Health. 2016; 9: 42-47
        • Menage D.
        • Bailey E.
        • Lees S.
        • Coad J.
        Women’s lived experience of compassionate midwifery: human and professional.
        Midwifery. 2020; 85102662
        • Cornwell J.
        • Goodrich J.
        Exploring how to enable compassionate care in hospital to improve patient experience.
        Nurs Times. 2009; : 105
        • Geraghty S.
        • Speelman C.
        • Bayes S.
        Fighting a losing battle: midwives experiences of workplace stress.
        Women Birth. 2019; 32: e297-e306
        • Maslach C.
        • Jackson S.E.
        The measurement of experienced burnout.
        J. Organ Behav. 1981; 2: 99-113
        • Kristensen T.S.
        • Borritz M.
        • Villadsen E.
        • Christensen K.B.
        The Copenhagen burnout inventory: a new tool for the assessment of burnout.
        Work Stress. 2005; 19: 192-207
        • Lazarus R.
        Toward better research on stress and coping.
        Am. Psychol. 2000; 55: 665-673
      4. Folkman S., Lazarus R.S., Gruen R.J., DeLongis A. Appraisal, coping, health status, and psychological symptoms. 1986. 50: 571–579.

      5. DeLongis A., Coyne J.C., Dakof G., Folkman S., Lazarus R.S. Relationship of daily hassles, uplifts, and major life events to health status. 1982. 18.

        • Johnson J.
        • Cameron* L.
        • Mitchinson L.
        • et al.
        An investigation into the relationships between bullying, discrimination, burnout and patient safety in nurses and midwives: is burnout a mediator?.
        J. Res. Nurs. 2019; 24: 604-619
        • Hunter B.
        • Warren L.
        Midwives׳ experiences of workplace resilience.
        Midwifery. 2014; 30: 926-934
        • Barker K.
        Giving midwives some ‘me’ time.
        Br. J. Midwifery. 2019; 27 (210–210)
        • Glasberg A.L.
        • Eriksson S.
        • Norberg A.
        Burnout and ‘stress of conscience’ among healthcare personnel.
        J. Adv. Nurs. 2007; 57: 392-403
        • Borritz M.
        • Rugulies R.
        • Christensen K.B.
        • Villadsen E.
        • Kristensen T.S.
        Burnout as a predictor of self-reported sickness absence among human service workers: prospective findings from three year follow up of the PUMA study.
        Occup. Environ. Med. 2006; 63: 98-106
        • Doherty J.
        • O’Brien D.
        A participatory action research study exploring midwives’ understandings of the concept of burnout in Ireland.
        Women Birth. 2021; (S1871519221001037)
        • Coghlan D.
        • Brannick T.
        Doing Action Research in Your Own Organisation. fourth ed. Sage Publications, London2014
        • Reason P.
        • Bradbury H.
        Handbook of Action rEsearch Participative Inquiry and Practice. second ed. Sage Publications, London2008
        • Whitehead J.
        • McNiff J.
        Action Research Living Theory. second ed. Sage Publications,, London2011
      6. National Maternity Hospital (NMH). Clinical Report, 2018. Dublin: National Maternity Hospital, 2019.
        • Attride-Stirling J.
        Thematic networks: an analytic tool for qualitative research.
        Qual. Res. 2001; 1: 385-405
        • Compson J.
        The CARE heuristic for addressing burnout in nurses.
        J. Nurs. Educ. Pract. 2015; 5: p63
        • Maslach C.
        • Leiter M.P.
        Early predictors of job burnout and engagement.
        J. Appl. Psychol. 2008; 93: 498-512
        • Maslach C.
        Job burnout: how people cope.
        Burnout in the Nursing Profession. Mosby Company, Missouri1982: 75-77
        • Deery R.
        • Kirkham M.
        Supprting Midwives to Support Women.
        in: The New Midwifery E-Book: Science and Sensitivity in Practice. Elsevier Health Sciences, London2006: 125-129
        • Cramer E.
        • Hunter B.
        Relationships between working conditions and emotional wellbeing in midwives.
        Women Birth. 2019; 32: 521-532
        • Holly D.
        • Swanson V.
        Barriers and facilitators of midwives’ physical activity behaviour in hospital and community contexts in Scotland.
        J. Adv. Nurs. 2019; 75: 2211-2222
        • McNamara K.
        • Meaney S.
        • O’Connell O.
        • McCarthy M.
        • Greene R.A.
        • O’Donoghue K.
        Healthcare professionals’ response to intrapartum death: a cross-sectional study.
        Arch. Gynecol. Obstet. 2017; 295: 845-852
        • Fenwick J.
        • Lubomski A.
        • Creedy D.K.
        • Sidebotham M.
        Personal, professional and workplace factors that contribute to burnout in Australian midwives.
        J. Adv. Nurs. 2018; 74: 852-863
        • Kilroy S.
        • Bosak J.
        • Flood P.C.
        • Peccei R.
        Time to recover: the moderating role of psychological detachment in the link between perceptions of high-involvement work practices and burnout.
        J. Bus. Res. 2020; 108: 52-61
        • Demerouti E.
        • Le Blanc P.M.
        • Bakker A.B.
        • Schaufeli W.B.
        • Hox J.
        Present but sick: a three‐wave study on job demands, presenteeism and burnout.
        Career Dev. Int. 2009; 14: 50-68
      7. Royal College of Midwives (RCM). Caring for You Campaign: Survey Results RCM campaign for healthy workplaces delivering high quality care. London: Royal College of Midwives, 2016.
        • Royal College of Midwives (RCM)
        Caring for midwifery staff will ensure better care for women.
        Br. J. Midwifery. 2016; 24
      8. Cabrita J. COVID-19 intensifies emotional demands on healthcare workers. Eurofound. 2020; published online March 31. 〈〉 (accessed April 26, 2020).

        • Hunter B.
        Emotion work and boundary maintenance in hospital-based midwifery.
        Midwifery. 2005; 21: 253-266
        • Pezaro S.
        • Clyne W.
        • Turner A.
        • Fulton E.A.
        • Gerada C.
        ‘Midwives Overboard!’ Inside their hearts are breaking, their makeup may be flaking but their smile still stays on.
        Women Birth. 2016; 29: e59-e66
        • Foureur M.
        • Besley K.
        • Burton G.
        • Yu N.
        • Crisp J.
        Enhancing the resilience of nurses and midwives: pilot of a mindfulnessbased program for increased health, sense of coherence and decreased depression, anxiety and stress.
        Contemp. Nurse. 2013; 45: 114-125