Intentions to leave and actual turnover of community midwives in the Netherlands: A mixed method study exploring the reasons why

Background: In the Netherlands, the turnover of midwives of relatively young age is high. This is concerning since a lack of midwifery experience can negatively affect the quality of maternity care. Aim: To study the rate and the reasons for intending to leave, and to explore the reasons for leaving midwifery jobs in the Netherlands. Methods: We used a mixed-methods design including a quantitative survey (N = 726) followed by qualitative interviews (N = 17) with community midwives. Findings: Almost one third of the respondents considered leaving the profession. The decision to actually leave the job was the result of a process in which midwives first tried to adapt to their working conditions, followed by feelings of frustration and finally feelings of decreased engagement with the work. The reasons for leaving midwifery practice are an accumulation of job demands, lack of social resources and family responsibilities. Discussion: Compared to international figures, we found a lower rate of midwives who considered leaving the profession. This could be explained by the differences in the organisation of midwifery care and the relatively high job autonomy of midwives in the Netherlands. Nevertheless, changes must be made in terms of decreasing the demands of the job and creating more job resources. Conclusion: Innovations in the organisational structure that focus on continuity of care for pregnant individuals, job satisfaction for midwives and building a sustainable workforce may result in an increase in the retention of midwives. These innovations would ensure that women and their babies receive the best care possible.