Midwifery Workforce Challenges: Education and Outcomes

Midwives are central to maternal and neonatal care. They are responsible for managing pregnancy, labour, childbirth, and postnatal care, while also supporting the newborn and family.

When the workforce is under-resourced or underprepared, the impact is immediate. Outcomes worsen, risks increase, and healthcare systems shift from preventative to reactive care.

The global midwifery challenge is not only a shortage of staff. It is a gap between what the role requires and how practitioners are prepared.

What Midwives Are Responsible For

Midwives are expected to:

• Detect complications in mother and infant early
• Support and manage normal labour and birth
• Respond to emergencies such as haemorrhage or fetal distress
• Provide postnatal and neonatal care
• Educate and support families
• Escalate care when needed

This requires clinical judgement, technical skill, communication, and the ability to act under pressure.

These are not isolated tasks. They occur simultaneously in dynamic, unpredictable environments.

The Global Workforce Shortage

There is an estimated global shortfall of around 900,000 midwives.

In many regions, particularly across Sub-Saharan Africa and parts of Asia:

• Staffing levels are insufficient to meet demand
• Experienced practitioners are limited
• Health systems rely on under-supported or newly qualified staff

Shortages increase workload, reduce supervision, and limit time for patient care.

This creates conditions where errors are more likely and early signs of complications may be missed.

Burnout, Retention, and System Pressure

Midwifery is a high-pressure profession with:

• Irregular hours and night shifts
• High emotional and clinical responsibility
• Exposure to critical incidents

Studies report high levels of stress, fatigue, and burnout among midwives.

This has direct consequences:

• Reduced concentration and decision-making quality
• Communication breakdowns with patients and teams
• Increased likelihood of clinical error
• Lower retention rates

Workforce shortages and burnout reinforce each other, creating a cycle that is difficult to break.

What Happens When Education Falls Short

The clinical environment is complex. Labour can change rapidly, and decisions must often be made with incomplete information.

Where education does not reflect this reality, new practitioners may:

• Recognise complications too late
• Struggle to prioritise under pressure
• Apply procedures correctly but in the wrong context
• Lack confidence in emergency situations

Traditional training often focuses on isolated tasks rather than full clinical scenarios.

This creates a gap between knowing what to do and being able to do it in real time.

Evidence from Midwifery Education

Recent studies highlight this gap and how it can be addressed.

A cohort study comparing VR simulation with traditional manikin-based training found:

• Higher skills scores (77.57 vs 68.26)
• Higher confidence (67.17 vs 56.97)
• Higher knowledge retention (77.58 vs 68.00)

All differences were statistically significant (p < 0.001).

A separate study in Ghana showed:

• Significantly higher post-test and practical scores in VR-trained students
• Higher satisfaction and perceived effectiveness
• Greater confidence in clinical application

Students trained using immersive simulation were better prepared to manage complete clinical scenarios, not just individual procedures.

Why This Matters for Patient Outcomes

Midwifery is often the first and most consistent point of care during pregnancy and childbirth.

When training is insufficient:

• Delays in recognising complications increase
• Interventions may be mistimed or inappropriate
• Communication with patients and teams deteriorates
• Maternal and neonatal risks increase

In high-pressure environments, small delays can have significant consequences.

Improving workforce numbers alone does not address this. Capability is the critical factor.

The Role of Simulation in Closing the Gap

Simulation changes how students experience training.

Instead of learning isolated skills, they can:

• Manage full labour and birth scenarios
• Respond to complications such as shoulder dystocia or cord prolapse
• Interpret maternal and fetal indicators in real time
• Make decisions under pressure
• Receive immediate feedback and repeat scenarios

In the Ghana study, VR allowed students to complete the entire birth process, from early labour through to postpartum care, within a single continuous scenario.

This directly addresses the gap between theory and clinical practice.

Education, Not Just Numbers

Expanding the workforce is necessary, but not sufficient.

Without high-quality, clinically aligned education:

• New graduates enter practice underprepared
• Senior staff carry an additional burden
• Errors and inefficiencies persist

Improving education has a direct impact on:

• Clinical competence
• Confidence
• Retention
• Patient outcomes

Conclusion

The global midwifery workforce challenge is a combination of shortage and preparation.

Midwives are expected to manage complex, high-risk situations. Where training does not reflect this reality, patient safety is affected.

Improving outcomes requires more than increasing numbers. It requires structured, realistic, and repeatable training that prepares practitioners for the conditions they will actually face.

Q&A

What is the main global challenge in midwifery?
A combination of workforce shortages and inconsistent education quality.

Why are midwives critical to maternal and neonatal care?
They manage pregnancy, labour, childbirth, and postnatal care, often as the primary point of contact.

How does poor training affect outcomes?
It increases the risk of delayed decisions, errors, and complications during labour and delivery.

Why is burnout a major issue?
High workload and pressure reduce performance, increase errors, and lead to staff leaving the profession.

How can simulation improve midwifery training?
By providing realistic, repeatable scenarios that develop decision-making, technical skills, and confidence.