Midwives Experiences and Views of Their Working Conditions in Vietnamese Maternity Care – A Qualitative Study

Abstract

Background There is a global need to extend the midwifery workforce in order to improve maternal and newborn health. On the other hand, a significant number of midwives experience work-related psychological distress, present work-related burnout symptoms and are considering leaving the profession due to work strain. This study explores Vietnamese midwives’ experiences and views of their working conditions in maternity care.Methods Four focus group discussions with midwives (n=25) working within maternity care at three hospitals in the Hanoi area, Vietnam, were undertaken. Data were analysed using qualitative content analysis. Results The overall theme, “Practising midwifery requires commitment”, represents midwives’ views of the need to always being alert and flexible as their work continually shifts. The first category “Being the central link in the web of care”, describes midwives having a key role in maternity care although collaborations with other health professions were important to be able to provide high quality maternity care. Counselling of patients was reported as a central component of midwives’ duties. Challenges related to working within different healthcare levels were described, with regard to the Vietnamese context of crowded upper level hospitals. In the second category “Rewarding role but also vulnerable”, positive aspects of midwifery were expressed although the great pressure of the work was prominent. High workload, patients’ demands, and being negatively exposed and vulnerable when adverse events occurred, were reported. In the third category, “Morally challenging tasks”, ultrasound examinations to reveal fetal sex and working with abortions were described as emotionally stressful. In addition, non-medically indicated caesarean sections were reported to be performed to please patients. Conclusions Although midwifery basically includes positive aspects, Vietnamese midwives are exposed to significant workload pressures, ethically demanding work and may be negatively affected when adverse obstetric events occur. Interventions to inform Vietnamese citizens about reproductive issues may increase the understanding of evidence-based maternity care and complications that may occur during pregnancy and birth. To further improve Vietnamese midwives’ working conditions, legal protection of health professionals is needed when adverse obstetric events occur.