Professional Autonomy, Burnout, and Intentions to Leave the Profession Among Spanish Midwives: A Qualitative Study

The loss of autonomy in midwives is associated with lower job satisfaction and consequently greater likelihood of leaving the profession. Given the international shortage of professionals, it is essential to explore how to increase their job satisfaction and reduce attrition.

To explore Spanish midwives' perceptions of the causes of their burnout and reasons for leaving the profession.

Descriptive qualitative study. Four discussion groups were held with a total of 21 participating midwives between October 10 and 29, 2024. A thematic analysis of the data was performed. The Ethics Committees of the University of León (ETICA-ULE-033-2020) and the University Healthcare Complex of León (Registration Number 20162) approved the study.

A total of 66.7% of the participants were women, 61.9% worked in hospital care, 47.6% were between 30 and 40 years old, and 57.1% had between 10 and 20 years of professional experience. The thematic analysis revealed several main themes: Causes ("Loss of autonomy," "Excessive medicalization of childbirth," "Conflict with gynecologists," "Traumatic perinatal events," "Lack of representation in management," and "Working conditions") Solutions ("Increased professional autonomy," "Recognition of competences," "Independent midwifery degree," and "Professional Recognition"), and Consequences ("Demotivation, Anxiety, and Frustration" and "Leaving the profession").

In addition to improving overall well-being within the profession, improving midwives' mental health can have a positive impact on professional retention, which would help in the significant crisis caused by the international shortage of professionals.

Nursing and midwifery managers play a pivotal role in preventing burnout by creating organizational environments that support midwives' professional autonomy, meaningful participation in leadership and policy decisions, and respectful interprofessional relationships. Management should ensure access to structured debriefing and psychological support following traumatic perinatal events, promote safe staffing and sustainable workloads, and invest in professional development and supportive workplace cultures. These strategies may improve midwives' wellbeing, strengthen workforce retention, and ultimately enhance the quality and safety of maternity care.