Musculoskeletal disorders in midwives: prevalence, impact and contributory factors

2019-06-03T15:31:22Z (GMT) by Kubra Okuyucu
Musculoskeletal symptoms have been problematic for healthcare staff, resulting in sickness absenteeism, functional limitations, staff shortages and financial costs to organisations. Maternity professionals who care for women in labour, particularly midwives and obstetricians, are also at high risk of developing musculoskeletal disorders due to a range of associated risk factors including heavy working conditions and awkward caring positions. There has been, however, limited research into this condition in midwives. The aim of this thesis is to investigate musculoskeletal disorders with prevalence, distribution, severity and impact, and to explore contributing factors from a biopsychosocial perspective.
A first stage survey study (n=635) explored the extent of musculoskeletal disorders and association with risk factors. The Nordic Musculoskeletal Questionnaire identified a very high prevalence of symptoms, mostly in the lower back (71%), neck (45%) and shoulders (45%) within a 12-month period. These symptoms resulted in activity limitation (50%), sickness absences (30%) and change of job/duties (45%). An investigation into the associations between potential contributing factors and musculoskeletal symptoms showed that younger age, less experience in the profession, a higher body mass index, longer working hours, lower job satisfaction and higher job stress can each play a role in developing such symptoms.
In-depth interviews with 15 midwives and a further validation focus group (n=7) explored risk factors and prevention strategies in considerable detail. The majority of such symptoms were considered to be work related, including working tasks, equipment, environment, heavy workloads, staff and mother characteristics. The primary concern expressed by midwives was the lack of application of protective strategies in real practice due to the heavy workload and mother-centred practice approach. They also argued that they did not benefit from standardised manual handling training due to a lack of content dealing with midwifery caring activities.
Finally, the risk of musculoskeletal symptoms associated with common working positions was evaluated by using the Rapid Entire Body Assessment postural analysis tool with a sample of midwives (n=22). This analysis suggested that working postures resulted in a significant increase in the risk of developing musculoskeletal disorders, with all postures having a very high to medium risk level, indicating that immediate action is required to address this issue. The trunk, neck and upper arm were found to be the most commonly affected body parts.
The findings will inform the development of risk management strategies to reduce musculoskeletal symptoms in the absence of such data in the United Kingdom. Management of such symptoms may have a positive impact on staff shortages, early retirements, individuals’ life trajectories, mother and baby safety as well as staff wellbeing. Organisations and professional bodies play a key role in this regard.