Musculoskeletal disorders among midwives
In the collective imagination, the profession of midwife conjures up images of caring for women and childbirth. However, behind this vocation lies a more difficult reality: a demanding daily routine, punctuated by long shifts, awkward postures and an intense physical and mental workload.
Lifting, bending, holding uncomfortable positions for long hours… So many repetitive movements that, over time, wear down the body and encourage the onset of musculoskeletal disorders (MSDs). These pains, which are harmless at first, can become chronic and have an impact on the health and careers of these behind-the-scenes professionals. However, MSDs among midwives remain a poorly documented subject, often relegated to the background in the face of other occupational health issues.
We decided to take a closer look at this fascinating profession and the associated risks.
Midwifery, a profession with a passion
More than just birth attendants, midwives – or maieuticians for men – have a genuine medical mission.
They provide gynaecological and physiological care for women throughout their lives, from contraception to pregnancy monitoring, as well as expertise in vaccination, abortion and MAP. They also play a key role in preventing and combating violence against women. In France, they carry out over 80% of deliveries, guaranteeing the safety of both patients and newborns.
This versatility goes hand in hand with a wide variety of practice patterns. In January 2023, there were 24,354 midwives in France, of whom only 2.8% were men.
More than half (57%) work in hospitals, where working conditions are particularly demanding: heavy workloads, sometimes insufficient staffing levels, unpredictable emergencies and staggered working hours.
25% have chosen to work as self-employed midwives, which presents other challenges, including professional isolation and the need to run their own practice. Finally, a smaller percentage of midwives work in PMI (Protection Maternelle et Infantile) or in research and teaching.
These constraints, whether related to the hospital environment or to private practice, have a direct impact on the physical health of midwives.
A stressful working environment
The work environment of midwives, whether in hospitals or private practice, is characterised by organisational demands, repetitive movements and physical conditions that can be physically demanding.
THE DELIVERY ROOM
The delivery room is a place where space and ergonomics are not always optimised to protect the health of the carers. Medical furniture, designed to meet the needs of patients, rarely takes into account the needs of healthcare professionals.
Childbirth itself involves awkward postures in which the midwife has to adapt her position according to the patient’s needs: squatting, bending over, exerting pressure or remaining static for long periods of time.
In other cases, managing an emergency delivery or a pathological situation (haemorrhage, foetal distress) requires rapid, repetitive movements, putting even more pressure on the body.
RHYTHM OF WORK
The midwifery profession involves intense work, requiring stamina and increased physical and mental stamina. In the hospital environment, working hours often extend to 12 hours in a row (or even more!), with night shifts, weekends worked and a succession of days without sufficient recovery time. This fatigue affects the body’s ability to recover, leading to muscle and joint pain.
Working as a midwife means an intense work schedule, requiring stamina and increased physical and mental stamina.
In the hospital environment, working hours often extend to 12 hours in a row (or even more!), with night shifts, weekends worked and a succession of days without sufficient recovery time. This fatigue affects the body’s ability to recover, leading to muscle and joint pain.
As well as the physical impact, the profession is also subject to a heavy mental workload. Midwives have to juggle a number of responsibilities:
- Ensuring the safety and well-being of patients and newborns, often in emergency situations.
- Making medical decisions quickly, sometimes under intense pressure.
- Managing emotions, both their own and those of patients and their families, particularly in the event of complications or difficult announcements.
- Maintaining an attentive ear despite accumulated fatigue.
In private practice, other constraints are added: repeated journeys to make home visits, long distances, equipment to be transported, no guaranteed rest between two consultations… All factors that further weaken the practitioner’s body.
These dense working conditions lead to a high risk of MSDs and psychosocial risks (RPS).
MSDs specific to caregivers
MSDs are therefore a major concern for hospital healthcare professionals. Despite increasing recognition in the medical sector, these pathologies remain insufficiently documented scientifically among midwives, even though several indications suggest a significant prevalence within this profession.
In order to take a broader view of these disorders, we will refer to the French job title (FAP nomenclature) “V1Z – Nurses, Midwives”, which encompasses these two categories of carers – who share similar physical and organisational constraints. The aim is to gain a better understanding of the common risk factors and the specific features of MSDs within these professions.
Because of their heavy workloads, the need to lift or move patients, and prolonged exposure to awkward postures, nurses and midwives are vulnerable to wrist, elbow and back pathologies: carpal tunnel syndrome, tendonitis and lower back pain have become common occupational illnesses.
The impact of working long hours is also a cause for concern, as is the case for midwives. According to the INRS, in 2014, on-call duty of 12 hours or more increased the risk of occupational accidents and back problems.
A survey carried out in 2021 as part of a research dissertation highlighted the prevalence of MSDs in this profession.
Of 1,453 midwives surveyed, 60% said they had suffered from MSDs in their lifetime, and 56.2% in the last 12 months (Occhiminuti, 2022).
These figures show the extent to which this problem remains underestimated, even though it has a direct impact on the health and careers of midwives.
If not treated early on, these MSDs can develop into chronic and disabling forms. For midwives, these conditions often result in persistent pain, reduced physical capacity and, in some cases, temporary or permanent inability to work. Despite these obvious risks, the prevention of MSDs among midwives remains inadequate. There are several reasons for this:
- Inadequate ergonomics: the layout of delivery rooms and medical equipment remains focused on the needs of patients, to the detriment of the comfort of carers.
- A lack of specific training: while technical gestures are taught during initial training, little emphasis is placed on good postural practices or MSD prevention strategies.
- A culture of going the extra mile: in a profession where personal commitment is high, it’s difficult to express pain or fatigue…
On top of this, recognition of MSDs as an occupational disease among midwives is still too low. Unlike care assistants and nurses, their exposure to physical risks remains less studied, making it more difficult to put in place compensation measures or adapt workstations.
What solutions, what future for the profession?
Faced with this situation, there are a number of areas for improvement:
- Adapting the ergonomics of delivery rooms: giving preference to adjustable furniture, favouring tools that make it easier for patients to handle.
- Continuously train midwives in MSD prevention and awareness.
- Encouraging more balanced working patterns: limiting overly long on-call periods, encouraging sufficient recovery time to avoid physical and mental exhaustion.
While passion for the profession is undeniable, it must not be at the expense of midwives’ health. Despite the current challenges (understaffing, budget restrictions), it is essential to rethink risk prevention in order to guarantee the sustainability of this profession.
In 2021, the World Health Organisation (WHO) warned of a worldwide shortfall of 900,000 midwives, i.e. a third of the number needed. In France, the profession is expected to grow between now and 2050, before a slight decline in numbers. According to DREES, the increase in the number of midwives over this period (+27%) should make it possible to meet the healthcare needs of French women. However, this projection implies that the current density of midwives is well below what is needed to cover demand effectively.
Against this backdrop, improving their working conditions and preventing MSDs is becoming a crucial issue, not only for the health of female professionals, but also for the future of the profession itself…
Sources :
Être Sage Femme aujourd’hui – Les sages-femmes à l’horizon 2050 : plus nombreuses et plus libérales ! https://www.etresagefemmeaujourdhui.com/logiciel-sage-femme-liberale/les-sages-femmes-a-lhorizon-2050-plus-nombreuses-et-plus-liberales/
Helena Occhiminuti. Les troubles musculo-squelettiques chez les sages-femmes en France : étude épidémiologique. Médecine humaine et pathologie. 2022. ⟨dumas-04085646⟩. https://dumas.ccsd.cnrs.fr/dumas-04085646v1/file/2022NICEMSF13.pdf
INRS – Organisation du travail en 2x 12h https://www.inrs.fr/media.html?refINRS=TP%2018
Profession sage-femme – Le travail de nuit en 12h est populaire mais pas sans risque https://profession-sage-femme.com/le-travail-de-nuit-en-douze-heures-est-populaire-mais-pas-sans-risque/
OMS – Un nouveau rapport tire la sonnette d’alarme : il manque 900 000 sages-femmes dans le monde : https://www.who.int/fr/news/item/05-05-2021-new-report-sounds-the-alarm-on-global-shortage-of-900-000-midwives#:~:text=Il%20manque%20actuellement%20900%20000,effectifs%20n%C3%A9cessaires%20au%20niveau%20mondial.
Ordre des sages-femmes – Données démographiques de la profession : https://www.ordre-sages-femmes.fr/etre-sage-femme/donnees-demographiques-de-la-profession/
Santé Gouv – Fiche Métier Sage-femme : https://sante.gouv.fr/archives/archives-metiers-et-concours/les-fiches-metiers/sages-femmes/