Staff Shortages Impact Mothers’ Safety, Midwives Say

The vast majority of midwives in Iceland say mothers’ safety has been put at risk due to staff shortages. Almost one-third of midwives have considered leaving the profession altogether within the last two years. Too much strain, staff shortages, and dissatisfaction with how the shortening of the work week has impacted shift work are all named as key reasons.

The data is from a recent survey by BHM which was commissioned by Icelandic Association of Midwives last month. According to the survey, 85% of midwives say the safety of mothers has been put at risk at some point in the past six months due to staff shortages, and 48% of them say that such incidents happen more often than before.

More strain on shift workers

When asked to consider the last six months, 85% of midwives say they have encountered situations where staffing was not sufficient to ensure minimum safety requirements for patients. This percentage is lower among midwives who work daytime hours (72%) and higher among those who work shifts (93%). Notably, 39% of shift workers stated they have often encountered such situations within the past six months.

Dissatisfaction with impacts of “shortened” work week

Three-quarters of midwives stated that the level of strain they experience on the job is “high” or “very high,” and 70% say that strain has increased over time. These figures are higher among shift workers than daytime workers.

When asked how their working conditions had changed with the shortening of the working week, 54% of midwives working shifts in the public healthcare system believe that working conditions have worsened as a result, while only 30% believe that working conditions have improved. There is great satisfaction with the shortened work week among midwives in daytime work, while dissatisfaction among shift workers is mainly related to a system that financially incentivises them to take more evening and night shifts, as well as the negative effect on work flexibility.

Staff shortages and strain have been an issue across Iceland’s healthcare system for years, including among nurses and in emergency care.

New Birthing Centre Aims to Innovate, Empower

A new birthing centre has opened in the capital, Vísir reports. Owned and operated by midwives Embla Ýr Guðmundsdóttir and Emma Marie Swift, the Reykjavík Birthing Centre is a reincarnation of a former birthing centre with the same name, which ceased its operations three decades ago.

Located in the new neighborhood of Hlíðarendi, the Reykjavík Birthing Centre has been open for patient consultation and facility visits for several weeks. On Wednesday, the National Medical Examiner approved the Centre to begin its operations in earnest. It employs four midwives, all of whom have different specialties, and dozens of women are planning to give birth there in the coming months. Emma Marie and Embla Ýr estimate that in the beginning, they will be able to assist ten women a month, although there’s always the possibility they will hire more midwives and expand their facilities in the future, if all goes well.

Focus on continuous care

The Centre aims to give parents more options when planning their births. And given that their services are subsidized by Icelandic national health insurance, the cost to expectant parents is comparable to what they’d find at, for instance, the National University Hospital.

Continuous care is the guiding philosophy at the Centre. “It’s about the midwife accompanying a woman and her family through the pregnancy and birthing process and then for the first ten days after the birth,” says Embla Ýr. The Centre also aims to create a homely environment and parents-to-be are encouraged to visit the facilities and beforehand, to make for a more comfortable birthing experience.

Both Embla Ýr and Emma Marie teach at the University of Iceland and advocate for this style of maternity care in their classes. “We wanted to let the work speak for itself instead of just talking about this style of service and its impact. We wanted to create a place that would give us an opportunity to work in this way,” says Embla Ýr.

Trilingual service for increased accessibility

The Centre has two birthing rooms, as well as consultation rooms and a large hall in which various classes, such as yoga and pregnancy counseling, are held. The courses are taught in three languages—Icelandic, English, and Polish—for increased accessibility.

“We wanted to bring everything together under one roof where the people who come here can be absolutely certain that everything’s being done according to the same philosophy,” says Emma. “That is, to empower, to support natural births, and to support continuous service in such an expanded way.”

Preserving a legacy, but still seeking to innovate

The original Reykjavík Maternity Centre operated on the corner of Þorfinnsgata and Eiríksgata from 1960 to 1992. Emma Marie and Embla Ýr spoke to women who had been patients at the original Centre before opening, and Emma says that most of them had fond memories of it and were eager to see its legacy preserved. And both Emma Marie and Embla Ýr are committed to being just as innovative in the services they offer to their patients today as the original founders were in their own time.

“A lot of things we take for granted today started there and that’s maybe what we’re gesturing at by keeping the name—that we want to be a similar place,” says Emma Marie.

‘Hop a Ride on the Midwife Mobile’

An electric bus adorned with an illustration of two women giving birth with the helping hands of unseen caretakers pays tribute to midwives and the work they do, Vísir reports. The ad, which simply reads “We warmly welcome you,” was sponsored by the Icelandic Midwives Association and made its maiden voyage on Wednesday.

The World Health Organisation (WHO) has designated 2020 the “Year of the Nurse and the Midwife,” in honour of Florence Nightingale, who was born 200 years ago. “These are the people who devote their lives to caring for mothers and children; giving lifesaving immunisations and health advice; looking after older people and generally meeting everyday essential health needs,” reads the campaign description. “They are often, the first and only point of care in their communities. The world needs 9 million more nurses and midwives if it is to achieve universal health coverage by 2030.”

Inviting locals to ‘Hop a ride on the midwife mobile,’ the Icelandic Midwives’ Association praised midwives for the vital role they play in the pregnancy and birth process, and noted that midwives also “provide education and services related to wellbeing, women’s health, and women’s bodies” and “work anywhere and everywhere, including in homes, out in the community, at hospitals, private facilities, and local health centres.”

The organisation then called for “a powerful platform” to be created for midwives and nurses, the better to allow them to participate in the creation of public policy related to healthcare services. “Studies have shown that when a midwife attends a birth, infant mortality rates and illness are reduced by almost 80%,” the call continues, “and premature births by 24%. In addition, under the care of midwives, more women are breastfeeding, women’s psychosocial health is better, and there are fewer interventions in births, particularly caesareans. The work of midwives is, therefore, indisputably important to the welfare of newborns and women; infant mortality in this country is among the lowest in the world.”

“For these reasons, the Icelandic Midwives Association wanted to take this opportunity to call attention to itself and in so doing, reiterate the importance of midwifery here in Iceland. Though we’ve achieved great things, it’s always possible to do better.”

The ‘Midwife Mobile’ is currently running along route #18 from Spöngin shopping mall in Grafarvogur to Hlemmur in downtown Reykjavík.

More Icelanders Consider Home Births Due to Maternity Ward COVID-19 Restrictions

pregnant woman

Icelandic couples with a baby on the way are increasingly considering home births due to the COVID-19 outbreak. The National University Hospital of Iceland has imposed strict regulations that limit expectant fathers’ presence to just the birth itself – they may not attend check-ups with their partners nor stay while the mother recovers. Intended to limit the risk of COVID-19 infection within the maternity ward, these regulations may be what is motivating more couples to consider birthing at home.

Björkin, which provides services for home births, has published a notice on their website to inform potential customers that they are fully booked all spring. There are a few spots open on their waiting list for July, but otherwise, they are not taking new bookings until August.

Changing regulations cause anxiety

Midwife Anna Guðný Hallgrímsdóttir works at the National University Hospital’s maternity ward. She says patients have expressed concerns about the changes to regulation. “Our patients have found it very difficult to think about going through some part of the birthing process without their partner there to support them.” It’s not only having to go through the process alone that induces anxiety for soon-to-be mothers, rather also the uncertainty around the regulations themselves. “They find it very uncomfortable that the rules are often being changed from day to day.”

Rules at the hospital were, however, slightly relaxed this week – while partners were previously allowed in one or two hours before the birth itself, they can now be present for the entire time a woman is actively giving birth. Of course, if a woman’s partner presents symptoms or has been quarantined, they may not attend the birth. Expectant mothers are also directed to avoid visiting the hospital or health clinics if they have symptoms of COVID-19, and call their healthcare provider instead.

Midwives’ tasks change

Although she isn’t experiencing increased pressure on the job, Anna Guðný says the nature of her work has changed somewhat under the circumstances.

“Women now have to stay in their rooms, they can’t walk out to the kitchen to grab food, for example, so we need to bring them food and drinks. And their partners are not present so we often have to help them care for the child, change diapers and so on.” Some services have moved to the phone in order to minimise health care staff’s contact with others. “Women going to their first pregnancy check-up are sometimes attended to by phone, also some 16-week check-ups.”

No changes to services

Anna Guðný assures expectant parents, however, that the same services are still being provided to pregnant women and new mothers. “I think women should know that our services haven’t changed, and if anything, it’s calmer than usual. Because women who have given birth before and who are healthy are choosing to go home sooner and take advantage of home visit services from midwives rather than recover at the hospital which they would have otherwise done, because their partners can be with them at home.”

National Hospital Needs Additional ISK 1 Billion for Wage Hikes

Emergency room

The National Hospital of Iceland needs ISK 1 billion ($8m/€7.2m) in additional government funding to pay out salaries decided upon in previous wage agreements, RÚV reports. The Parliamentary Budget Committee is discussing how to address the issue. If more funding isn’t provided, say hospital representatives, it will be necessary to cut services or run the hospital with a deficit.

Ebba Margrét Magnúsdóttir, chairperson of the hospital’s doctors’ council, says the government undercalculated the hospital’s funding following the signing of recent wage agreements. According to information from the hospital, an additional ISK 500 million ($4m/€3.6m) in funding is needed per year to pay out wage increases laid out in doctors’ 2017 collective agreement. Double that amount is needed to address agreed-upon wage increases of all medical staff at the hospital.

Restructuring

Minister of Health Svandís Svavarsdóttir stated that although ensuring healthcare funding over the long term is important, “we also need to organise it better,” and suggested the government’s new health care policy would play a part in addressing funding.

The National Hospital of Iceland has already undergone significant restructuring in order to address its operational deficit. Directorial positions at the hospital have been reduced, and nurses’ and midwifes’ shift premiums have been cut. According to Ebba, however, these are measures the hospital shouldn’t have to take. “The people on the floor have pretty much had enough,” she stated.

In Focus: Midwives’ Wage Dispute

Midwives' strike Iceland

In 2013, ljósmóðir was voted the most beautiful word in the Icelandic language. The word translates to “midwife,” but its literal meaning is “mother of light.” Even if their title sounds ethereal, the members of this currently all-female profession insist that their demands for increased wages are all but lofty. The Ministry of Finance disagrees […]

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Eight Midwives Withdraw Resignations

Eight midwives have redrawn their resignations from the National and University Hospital, Vísir reports. This came in the wake of the contract that the Icelandic Association of Midwives voted to approve on Wednesday afternoon after a 10-month-long wage dispute between the association and the government. The new contract was approved by a 95% majority and with an impressive 91% of midwives taking part in the vote.

A total of 34 midwives tendered their resignations over the course of their increasingly contentious negotiations with the government. Linda Kristmundsdóttir, the head of the Women’s and Children’s department at the National and University Hospital, says that she hopes more midwives will withdraw their resignations and return to work. The maternity ward at the hospital reopened this week after closing during the previous when the midwives collectively agreed to stop working any overtime hours. Linda says that the ward is getting back onto its feet now, albeit slowly, but that they still are lacking the staff they need across all shifts. Therefore it’s important, she says, that everyone who tendered their resignations return to their jobs.

Midwives Approve New Contract

The Icelandic Association of Midwives has voted to approve a new employment contract with a 95% majority. RÚV reported first. An overwhelming 91% of members voted on the deal.

When national broadcaster RÚV contacted chairperson of the Association of Midwives Katrín Sif Sigurgeirsdóttir for comment, she had not yet been informed of the outcome of the vote. Katrín expressed dissatisfaction that the government’s negotiation committee would publish the results online without informing the midwives’ negotiation committee first.

“We thought the results would be presented to us at two o’clock,” Katrín stated. “This really is the cherry on top of our relations with the government.”

The contract approval brings to a close a 10-month-long wage dispute between the association and the government. Midwives asserted their salaries did not reflect their level of education or the responsibilities inherent to their profession. Over 20 midwives resigned from their positions, most at the National University Hospital, as a result of the dispute. It remains to be seen whether they will return to their jobs.

Midwives and Government Reach Agreement

A ten-month-long wage dispute between the Icelandic Association of Midwives and the government may be over, RÚV reports. An agreement was reached between the two parties thanks to the National University Hospital of Iceland. “What happened was that the National University Hospital has agreed to reassess the job description and responsibilities of midwives at the institution and apply that to its payroll,” stated Katrín Sif Sigurgeirsdóttir, chairperson of the Association of Midwives. Since the hospital is the largest single employer of midwives in Iceland, the decision is significant.

Voting on the contract begins today and is scheduled to be completed by Wednesday.

The ten-month-long dispute has led to two strikes and over 20 midwife resignations. Midwives argue that their wages and working conditions do not reflect their level of education and the responsibility inherent in their profession.

A work-to-rule strike at the hospital which had begun last week has been called off due to the development. Katrín expressed hope that the agreement would encourage midwives who had resigned from their positions to return to work.

Hospital in Crisis as Midwives’ Strike Begins

A midwives’ word-to-rule strike which began at midnight last night has put added strain on the maternity and outpatient wards at the National University Hospital of Iceland. The hospital’s Director Páll Matthíasson says staff numbers in the maternity ward are below safety limits. The strike is the result of a ten-month-long wage dispute between the Icelandic Association of Midwives and the government, which has led to over 20 midwife resignations.

“It was a difficult night, both in the maternity ward and the outpatient ward where the resignations have had the greatest impact,” Páll said in a radio interview this morning. “It was a very difficult night there, a lot of stress and few midwives working, about half of how many there should be under normal circumstances. What has now been added is that the work-to-rule strike has had an effect on the birthing procedure.” Páll added that some labour inductions scheduled for today may be postponed due to the situation.

As to why an agreement has not been reached in negotiations or why the next meeting was not scheduled earlier than Monday, Páll stated he did not have any answers. He described the situation at the hospital as a crisis that cannot be allowed to continue for long.