Reducing midwives risk of work-related injury

Professional Update

Search for an image of a “midwife,” and you will see the internationally identified photo of our profession – a smiling midwife with their head turned, bent over a pregnant belly listening to a foetal heart through a pinard stethoscope.

This heart-warming posture is demonstrative of the strange positions that midwives adopt during their regular day.

Women and midwives have spent decades advocating for active positions during labour and birth. Midwives are delighted to enter a birth suite and see a woman squatting, kneeling, in the shower or bath, or side-lying with a leg supported high in the air. These positions, while excellent for birth, can be extremely damaging to the accoucher.

The positions that we support women in during long labours are challenging to our bodies. Straining a back while holding a monitor on a woman seeking relief in the shower, or crouching under a birth stool to visualise a perineum during tightenings can put tremendous pressure on a midwife’s body. Midwives expect to conform to the chosen position of the birthing woman, and national workplace shortages have led to longer shifts with fewer breaks for relief.

On postnatal wards, midwives assist with awkward breastfeeding positions, and move neonates from uniform cots (poor height work surfaces for most) to low beds. During home visits, furniture is made with little to no ergonomic support offered for weighing neonates on floors or kitchen tables, or checking stitches in a dimly-lit bedroom.

For midwives in Australia, neck and upper back injuries are common, with 25% of midwives reporting upper back injuries and 41% reporting neck injuries.1

A UK study demonstrated that 91.5% of midwives report having a musculoskeletal disorder in the 12 months prior.2 The majority of these were in the lower back, shoulders, and neck, although older midwives reported more knee pain. These were increased with the demands of the profession; those who worked 12 hour shifts, or night shifts, were more likely to be injured.

A 2021 study found that midwives adopt up to 140 positions during the birthing process.3 Many of these positions involve spinal misalignment and postural instability – exactly what the manual handling experts warn of. Manual tasks, such as vaginal exams or episiotomy, required a wrist position of >15% flexion – a recipe for injury to the hands, wrists, or shoulders.

What can you do to protect yourself?

Start by re-familiarising yourself with the ANMF national policies on Work health and safety and Safe patient handling.

Those who participate in regular physical activity and strengthening exercises are less likely to become injured. Gentle stretching before, during and after shifts helps to loosen tight muscles in the wrists and feet. Of course, listening to your body’s limits during tricky procedures will help prevent some injuries.

Consider the position of your shoulders when holding a neonate, and your back when assisting with breastfeeding. Are they square and straight? When was the last time you had a break from this position? Protective postures like squats and lunges, used daily throughout your career, can delay symptoms.

Workplaces should also help reduce the effects of the problem. Bringing in physiotherapists to regularly educate the workforce on protective exercises for midwives’ hands, shoulders, knees, and backs can prevent workplace absences due to injury.

If you are injured at work, be sure to report it immediately. Contact your state or territory Branch. Consult with your workplace and with your state’s worker compensation model as soon as possible. Record dates and times, and attend appointments as needed to help you get back on track as soon as possible.

1 Long MH, Bogossian FE, Johnston V. Functional consequences of work-related spinal musculoskeletal symptoms in a cohort of Australian midwives. Women Birth. 2013;26(1):e50-e58.
2 Okuyuco K, Gyi D, Hignett S, et al. Midwives are getting hurt: UK survey of the prevalence and risk factors for developing musculoskeletal symptoms. Midwifery. 2019;79.
3 Kacem I, Boughattas W, Ghardallou M, et al. Prevalence of work related upper limb disorders and the associated psychosocial factors among midwives. Int J Afr Nurs Sci. 2021; 15.

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