Author Identifier

Dianne Bloxsome

Date of Award


Document Type

Thesis - ECU Access Only


Edith Cowan University

Degree Name

Doctor of Philosophy


School of Nursing and Midwifery

First Supervisor

Associate Professor Sara Bayes

Second Supervisor

Dr Deborah Ireson


Midwifery shortages and the trend towards an inability to retain midwives in the profession is a global problem. The World Health Organisation (WHO) expressed concern about this issue in 2006, and despite efforts to implement remedial change, the retention of midwives continues to pose a large problem for healthcare internationally. The WHO (2006) asserted that midwives are the cornerstone to the reduction of maternal mortality and predicted that if the workforce retention issue was not addressed, then increases in maternal and neonatal mortality would ensue. In 2014, the United Nations Population Fund identified that, despite extensive worldwide efforts to address the midwifery shortage issue, the problem still existed and was worsening; an ageing workforce compounded by rising birth numbers means the issue is likely to persist. Consequently, the need for implementation of effective midwifery staff retention strategies is urgent, as is the need for evidence to inform these strategies.

No research about why midwives stay has been undertaken in Australia since that conducted by Sullivan, Lock and Homer in 2011. There is more current research around reasons underlying midwifery workforce attrition; however, it cannot be assumed that simply addressing these issues will correct the problem.

The aim of the study reported in this thesis was to understand why midwives across Western Australia (WA) choose to remain in the profession. The purpose of the research was to expose the factors leading to midwives staying in their jobs. Knowledge of why and how midwives stay in midwifery is imperative for recruitment into the profession and its sustainability and longevity.

This WA study was undertaken using the Glaserian version of grounded theory methodology. Fourteen midwives currently working in clinical practice were interviewed about why they remain in the midwifery profession. Data were collected from December 2017 to November 2018 and were generated through open ended semi-structured interviews, together with memos and field notes. The interviews were digitally recorded, transcribed verbatim and analysed and interpreted with the guidance of Glaser and Strauss’s coding stages.

The core category derived from the data was: “I love being a midwife; it's who I am.” Two interrelated major categories emerged from the data that represent why midwives stay in midwifery; the factors that enable them to stay are comprised of eight sub-categories. The data revealed that, broadly, midwives’ ability to be “with woman,” the difference they feel they make to these women, the people they work with, and the opportunity to “grow” the next generation of midwives are crucial influences on whether they remain in the profession.

The theory of “I love being a midwife; it's who I am” provides new information about why midwives working in various models of maternity care across WA stay in the profession, and the factors that enable them to do so.

A number of recommendations arose from this study for practice, policy, organisational processes, further research and pre-registration midwifery education.


Paper Location