Midwifery Autonomy and Employment Changes During the Early COVID-19 Pandemic

Area of Science:

• Perinatal Care
• Public Health
• Health Workforce Studies

Background:

• The COVID-19 pandemic created significant challenges for the midwifery workforce, impacting care access and safety.
• Understanding the effects of professional autonomy on employment and compensation is vital for workforce stability.

Purpose of the Study:

• To analyze the associations between professional autonomy and changes in midwives' employment and compensation during the early COVID-19 pandemic.
• To identify factors that promote resilience within the midwifery workforce during public health crises.

Main Methods:

• An online survey was distributed to 727 midwifery practices across the US in fall 2020.
• Chi-square analysis examined relationships between employment/compensation changes (Feb-Sept 2020) and measures of midwife autonomy.

Main Results:

• Midwifery practice ownership was linked to increased salaries and decreased loss of benefits and furloughs.
• Community-based practice settings were associated with more full-time equivalent (FTE) positions, part-time positions, and salaries, alongside fewer benefit losses and early retirements.
• State practice environment and decision-making participation showed no direct association with employment/compensation changes.

Conclusions:

• Policies supporting midwifery practice ownership and community birth settings are essential for perinatal care workforce stability.
• These policies can enhance flexibility during crises and improve patient access to care and health outcomes.