A study of skill mix issues in midwifery: a multimethod approach

Background. While skill mix studies are quite commonplace in health care, most have focused on the most effective use of staff and skill distribution in the field of nursing; few relate specifically to the midwifery profession. In Ireland there is no recognized midwifery assistant grade. Aims. This paper describes a study that investigated the skill mix requirements of a midwifery service based in the Republic of Ireland. The project was built on previous research, which showed that due to undertaking a number of `nonmidwifery duties', midwives were unable to undertake fully the work for which they were trained. Research methods. Data were collected using a variety of methods. These included postal questionnaires and the Delphi technique. The `Delphi' was used to gain a level of consensus from hospital midwives (all grades) (n = 194) and student midwives (n = 79) on what are and what are not nonmidwifery duties. Analysis of secondary data (duty rotas and staff turnover data) was also undertaken. Results. Findings indicate that the respondents spent a large proportion of their time undertaking clerical, domestic, pottering and stock duties. They would welcome the introduction of midwifery assistants into the ward team and were able to identify those duties that such persons could undertake. Conclusions. Skill mix requirements and organizational strategies to deal with the workforce changes are highlighted. Due to the current shortage of midwives in many countries and the dearth of extant research in this area, the results and recommendations have implications for midwives nationally and internationally.