Work-related stress among midwives in Central Uganda. A key comparison between rural-urban and private-public midwives: A Cross-sectional Study

Background: Midwives in Uganda face challenges that predispose them to vulnerability and traumatic work-related stress which may impact the provision of quality midwifery care and the well-being of midwives. This study aimed at exploring the prevalence and sources of work-related stress and comparing the differences in the experiences of stress among rural or urban midwives and private or public midwives in health facilities in central Uganda. Methods: A descriptive cross-sectional study design was utilized. The 57-item Expanded Nursing Stress Scale (ENSS) was used to collect data from 208 midwives working in urban and rural (both public and private) health facilities within central Uganda. Descriptive statistics were used to analyse the data. Mean scores were computed for all nine subscales of the ENSS including death and dying; conflict with physicians; inadequate preparation; problems with peers; problems with supervisors; workload; treatment uncertainties; patients and their families; and discrimination. Results: About 108 (51.9%) and 69 (33.2%) of all participants had a total stress score that indicated extremely stressful and frequently stressful working conditions respectively. The total mean score was 3.44 ± SD 0.86. The major stress subscales were patient and family (3.74 ± 0.860) and workload (3.56 ± 0.84). There was a significant difference among midwives working in rural versus urban settings for the subscale items related to death and dying χ2 =14.6, p <0.05, conflict with physicians χ2 = 10.68, p <0.05, problems with supervisors χ2 =11.9 p <0.05, and treatment uncertainties χ2 = 21.07, p.001. Conclusion: Practicing midwives in central Uganda experience high levels of stress. The most common stressors relate to patients and their families, workload, problems with supervisors, conflict with physicians, and uncertainty with treatments.