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Midwives increasingly confronted with poverty and social hardship

Midwives practising idependently are increasingly confronted with social and economic hardship in their work. A ZHAW study shows that midwives detect such difficulties very early on and support families accordingly, although these services are unrecognised and unpaid.

The birth of a child is generally a joyous occasion. However, not all families are able to provide their newborns with the best possible opportunities in life. When poverty, traumatising migration experiences, domestic violence, social isolation or mental illness are present, additional support becomes necessary. As independent midwives provide care for about 80 per cent of young families at home for two months after hospital discharge, they recognise very early on if families are in difficult situations. A study conducted at the ZHAW’s Institute of Midwifery has investigated how midwives identify social burdens, how they support families and how they seek assistance when a young family’s living circumstances require it. Interviews were conducted with about 400 independent midwives who provided postpartum care in 2016. The project received support from the national programme for preventing and combating poverty (Nationales Programm zur Prävention und Bekämpfung von Armut) and the Familystart Zürich association. 

Early detection of problems

Giving families support at an early stage is the most important form of prevention to ensure that children can develop in a healthy manner and have better opportunities. “It is important that both medical and social risks are identified early on,” says Jessica Pehlke-Milde, who headed and carried out the project with her colleague Astrid Krahl at the ZHAW. “The sooner support is given, the better the chances of unimpaired development.” Around the time of the birth, she says, parents are motivated to do all they can for their child. In this phase, they are more likely to accept help and change their behaviour.

“In Switzerland, far too little use is made of the opportunities provided by midwives’ early access to and trustful relationships with socially disadvantaged families,” says Pehlke-Milde.

Uncompensated additional work

Midwives are increasingly confronted with social and economic hardship in the families they care for. One midwife gives an example: “The effectiveness of breastfeeding counselling is limited when the refrigerator is empty and the breastfeeding mother has nothing to eat at the weekends.”

The ZHAW study shows that making sure families are provided for and building appropriate support networks is very time-consuming for the midwives and requires a great deal of flexibility. Midwives respond to emergencies around the clock, seven days a week and spend many hours working on finding solutions. The leaders of the ZHAW study therefore find it all the more incomprehensible that this service is not recognised.

“This additional work is nowhere near covered by the flat rates paid for home visits. In this respect there is a difference between midwives and other professionals in early intervention, who are paid by the hour,” says Jessica Pehlke-Milde.

Support is needed

The health-promoting and preventative work of midwives is increasingly gaining in importance, as is the collaboration between midwives and professionals in the social sector. Midwives participate in various networks and work closely with parent counselling services. At the end of the postpartum care period, home visits are sometimes carried out with members of both professions in order to ensure the continuity of care and to maintain the families’ trust.

“However, there are grey areas where the work of the various care and service providers overlaps. All too often, collaboration is hampered by resentment between professions or ill-defined areas of responsibility,” says Pehlke-Milde. However, there are also many good examples of collaboration. In particular, midwives with strong networks appreciate the exchanges within their professional group and other networks, which they believe benefit the families and children they care for.

In order to provide competent care and support to socially disadvantaged families, midwives need to expand their range of care services, especially in the psychosocial area. This is why training and further education should integrate these requirements in their assessment, communication and network activities.

Regional differences

According to the ZHAW study, midwives working in cities provide care to many more socially disadvantaged families and have stronger networks. In rural areas, midwives are confronted with few cases that urgently require additional assistance, but in these cases mostly have no access to help at all. There is a lack of contacts and networks for families around the time of the birth.

“The period of time after the birth of a child can be challenging,” say the ZHAW researchers. This is why they recommend that parents who are overwhelmed or exhausted should have easy access to support and counselling services. Central points of contact for anonymous counselling which are open at all times, including weekends and holidays, could provide support for midwives and families in emergencies.


Prof. Dr. Jessica Pehlke-Milde, head of Midwifery Science Research Unit
phone 058 934 64 66, e-mail

José Santos, head of Corporate Communications, ZHAW School of Health Professions
phone:  058 934 63 84, e-Mail