Background: Midwives are primary carers for women through pregnancy, birth and the early postnatal period. As such, they have unique work responsibilities and stressors. Despite midwifery being a profession in its own right, midwives have been little studied as a distinct occupational group. Musculoskeletal disorders are common among nurses and have been identified as a source of attrition from nursing. To date, no English-language research has explored musculoskeletal symptoms in midwives from both quantitative and qualitative perspectives.
Aim: The research aimed to estimate the prevalence, and identify risk factors for and functional consequences of neck, shoulder and upper back musculoskeletal disorders among qualified Australian midwives.
Methods: Two systematic reviews of work-related neck, shoulder and upper back musculoskeletal disorders in nurses and physicians were completed first, to gain an understanding of these conditions in two groups of health professionals with work functions most comparable to those of midwives. The research plan was a mixed method design consisting of two cross-sectional studies and one qualitative study.
Data were obtained from the Nurses and Midwives e-Cohort Study (NMeS), a longitudinal study of health and work/life balance in midwives and nurses in Australia, New Zealand and the United Kingdom. The study sample was all NMeS participants who were qualified Australian midwives at baseline in 2006–8 (n = 1388). The first cross-sectional study assessed prevalence and risk factors for neck and upper back musculoskeletal symptoms in this sample. The second cross-sectional study was a subset analysis of prevalence and risk factors for sick leave and functional incapacity due to work-related spinal musculoskeletal symptoms among participants practising midwifery at baseline. The third study examined qualitatively the experiences of midwives with a history of work-related shoulder musculoskeletal symptoms. Data were collected using personal interviews and an inductive process identified themes in the participants’ experiences.
Results: In the sample of qualified Australian midwives, the annual prevalence of self reported, work-related neck and upper back musculoskeletal symptoms was 40.8% and 24.5%, respectively, and of shoulder symptoms, 36.6%. Co-morbidity of neck or upper back was associated with greater than a fourfold likelihood of symptoms in the adjacent body region. Midwives with neck symptoms were more likely to be carers for adult dependents (aOR 1.36, 95% CI 1.07–1.72) and to have been medically diagnosed with anxiety (aOR 1.42, 95% CI 1.02–1.97), whereas current shift work was associated with a decreased likelihood of neck symptoms (aOR 0.55, 95% CI 0.41–0.73). Those reporting upper back symptoms experienced a higher level of workplace psychological demands (aOR 1.06, 95% CI 1.02–1.10) while higher levels of total physical activity resulted in reduced risk (aOR 0.60, 95% CI 0.39–0.93). Of particular note was work in awkward postures, which conferred increased risk for symptoms in both areas (aOR 1.36, 95% CI 1.03–1.78 for neck; aOR 1.45, 95% CI 1.09–1.94 for upper back).
Severity of worst pain was the factor most strongly associated with both sick leave and functional incapacity due to work-related neck (aOR 2.33, 95% CI 1.79–3.04; aOR 1.63, 95% CI 1.40–1.90, respectively) and upper back (aOR 1.76, 95% CI 1.37–2.27; aOR 2.43, 95% CI 1.83–3.24, respectively) musculoskeletal symptoms. A higher level of workplace psychological demands was significantly associated with sick leave taken due to upper back musculoskeletal symptoms (aOR 1.22, 95% CI 1.06–1.42). Functional incapacity was more commonly reported than sick leave by a factor of 2.5 (neck symptoms) to 3 (upper back symptoms), indicating midwives are likely to demonstrate presenteeism.
Analysis of eleven personal interviews revealed the following themes: attribution, universality of the experience, short- and long-term coping, and support. Most participants identified a specific event at work as the source of their shoulder problems. Only three participants formally reported the shoulder problem to their employers. There was a common belief that such problems were to be expected in midwifery work. Participants used a variety of coping strategies, many of which were self-nurturing. The physical demands of midwifery work merit further research attention.
Conclusions: Midwives’ annual prevalence of neck, shoulder and upper back musculoskeletal symptoms is substantial and comparable to that found in nurses and physicians. Additional longitudinal research is needed to investigate causation with a particular focus on modifiable risk factors. Data on practising midwives should be improved by collecting it separately from that of nurses. Until more is known, regular physical activity and creative strategies to minimise time spent working in awkward and static postures can be recommended as possible ways to reduce midwives’ risk. Midwives should be encouraged to report musculoskeletal symptoms to occupational health personnel for accurate monitoring and risk assessment.