– Midwives in smaller birthing rooms are more motivated and satisfied with their jobs than midwives in maternity wards in larger hospitals. That’s what Johanne Pettersen Elvestad says, who has done a quantitative master’s degree study at UiT Norway’s Arctic University in Tromsø. She has seen how midwives at the University Hospital of Northern Norway (UNN) are at work. That means both in Tromsø, Narvik, Harstad, Finnsnes and Sonjatun. Her findings: Midwives at the women’s clinic in Tromsø report a greater degree of very high work pressure. Midwives at the maternity wards in Harstad and Narvik report high work pressure. . Johanne Pettersen Elvestad is doing an experience-based master’s in strategic management and economics at UiT Norway’s Arctic University. She is now finalizing her thesis, where she has investigated how midwives at large and smaller maternity units experience their work and their everyday working life. Photo: Øystein Arild M Antonsen / news Changes in maternity services In the past week, news has made several cases about an internal working document that has been made in connection with Helse Nord’s work on reorganizing the hospitals in the north. It shows various options for solving the hospital structure in the region. news has also told about a very hectic summer at UNN in Tromsø, where both laborers and midwives described a “week of chaos” as unsustainable due to understaffing. That week there was also a tragic event where a newborn child was quietly born. One of the options in the internal working document is to close down the maternity wards at Sonjatun, Finnsnes, Alta and Brønnøysund. The maternity wards in Kirkenes, Narvik, Lofoten and an unnamed location on Helgeland may also be closed down. The blue marks show the maternity institutions that may be closed down, while the red ones are on hold – or added resources in the alternatives to the working document from Helse Nord. – Safer in the district Two-child mother Marte Johansen has given birth both in Tromsø and at Sonjatun. She sees a clear difference in maternity care. – I have been looked after in a completely different way here (at Sonjatun) than in Tromsø. Among other things, I had two midwives and a nurse who stayed with me in the room until the baby was out. In Tromsø, I had a midwife who was on and off, and who was also responsible for other births at the same time, she says. She felt safer in the delivery room. And she points out that she and her husband were looked after as a family, and not just her as a mother. – It was a completely different experience, and much better, from start to finish, says Johansen. Marte Johansen has tested both parts: both giving birth in a large and a small ward. She is quite clear that the proximity and follow-up she received at the small department in Nord-Troms was preferable. Photo: Øystein Antonsen / news Labor pressure affects everything Elvestad believes that more than just the economy must be looked at when considering the various alternatives. And refers to her own master’s degree research, which she believes gives a good picture of how midwives experience their everyday working life, and that the work pressure is greatest in the larger maternity wards. – They also report a higher degree of work pressure that goes beyond work, private life and not least their patients. And there are women in labor and delivery, she says. – There are of course far more births in Tromsø, and also more in Harstad and Narvik than in Sonjatun and Finnsnes. But they are part of the decentralized model, and an important part of it. It is not automatic that people move after their jobs. Johanne Pettersen Elvestad’s survey confirms the experience of the Norwegian Midwives’ Association. – We have the same impression, says political leader Lena Henriksen. She singles out the ABC ward in Oslo, a smaller midwife-run delivery ward for natural births which was closed down in March this year. The closure was explained as financial considerations, and that there was a lack of midwives at Oslo University Hospital. The department was popular because women in labor were offered both check-ups and maternity care in the same department, and with the same staff. Political leader of the Norwegian Midwives Association, Lena Henriksen, is not surprised by the findings of the master’s degree survey. Photo: Sonja Balci / Sonja Balci Henriksen says the work pressure was probably different than in the large departments, and that the organization created well-being and meaning for the midwives. – They had no recruitment problems, they had low sickness absence, and the midwives were up to retirement age compared to the other departments at OUS. – But won’t a closure in the district ensure staffing at the large hospitals, which are struggling with high work pressure? – There is no automaticity in that those who work in smaller places will start at the big hospitals, so it is a measure that may have very little effect on the staffing situation. The focus should rather be how much worse the offer will be for the women out in the rural areas, says Henriksen. Relieves UNN The delivery rooms in Norway must ensure a decentralized maternity service for low-risk women giving birth, according to a national guide on quality requirements for maternity care. Five of the six maternity wards in the country are in Northern Norway. A new version is now being consulted, in which it is recommended that regional health organisations, such as Helse Nord, should continue to facilitate a differentiated maternity service with adapted expertise and staffing. – The offer that women in labor and maternity receive at Sonjatun is completely unique. Many people come here to look at this model, says mayor of Nordreisa, Hilde Nyvoll (Ap). – I understand that you have to reduce budgets and operate differently. But they don’t have to start here, says the mayor of Nordreisa municipality, Hilde Nyvoll (Ap) Photo: Øystein Arild M Antonsen / news The midwife-run delivery room is subject to UNN, and is the base for the midwifery service in Nord-Troms. They have 24/7 emergency medical preparedness within decentralized maternity care. Now all political parties in the municipality have come together and sent a sharp letter to Helse Nord in which they demand that Sonjatun must be strengthened, not reduced. For the birthing room, UNN and the ambulance service relieves the burden, and gives the women in Nord-Troms good pregnancy, birth and maternity services, write the local party leaders who want to stop the closure. – The proposal to shut it down is absolutely crazy, and I wonder what they really think that they are saving on it, says the mayor. – Total preparedness in Norway is important. Cutting health services in the district is starting at the wrong end. You cannot ask people to give birth to more children, and then take away the maternity services. Managing director of Helse Nord, Marit Lind, says the population in the north must be confident that they will also in the future get the health care they need, both acute and planned. Photo: Helse Nord Critical shortage of personnel Managing director of Helse Nord RHF, Marit Lind, writes in an e-mail that she understands that the process they are undertaking creates uncertainty for many. The main reason for the reorganization is the lack of professionals, medical specialization and population growth. Despite the fact that only 9 per cent of the population lives in Northern Norway, in 2022 the country accounted for 40 per cent of all hiring from temp agencies in the specialist healthcare service nationally. – The lack of critical personnel and expertise means that we absolutely have to look at how we can operate differently going forward. All stones must be turned over, says Lind. The conclusion for the future hospital structure will be presented to the board of Helse Nord in December. It will then be subject to consultation until April 2024.
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Midwives in delivery rooms more motivated and satisfied than in hospitals – news Troms and Finnmark
