Exploring working conditions and job stability of midwives in Spain: results from a cross-sectional national survey

BACKGROUND: Midwives are essential to perinatal care in Spain's healthcare system, with roles expanding due to demographic changes to encompass technology integration, multidisciplinary collaboration, and pharmacotherapeutic management. Challenges persist, including suboptimal remuneration, competency misalignment, and employment precarity (92.7% temporary contracts in 2024), aggravating professional dissatisfaction, reduced job satisfaction, and well-being deficits. Influential factors include workload, contractual stability, and work-life balance, emphasizing the imperative for empirical analysis of labour conditions. This study describes midwives' perceptions of Spanish work environments and assesses contract-type variations. METHODS: We conducted a cross-sectional, quantitative survey of registered midwives in Spain using a self-administered, 23-item, web questionnaire (five domains) on EUSurvey to assess working conditions, capturing demographics, job characteristics, training/competence, and entitlements, and evaluating differences in professional perceptions by contract type. Bivariate analyses and multivariable logistic regression models (adjusted for age group and years of professional experience) were performed to evaluate differences in professional perceptions by contract type. RESULTS: Of the 2,499 responses, 2,310 met the requirements (27.8% of practicing midwives in Spain). The majority worked in public hospitals (66.1%); 43.4% had permanent contracts, a figure that increased with age and experience. Temporary shiftcts, more common in the private sector, were associated with lower salaries and less salary satisfaction (mean scores 4.0-4.1 vs. 4.6 on a 10-point scale; p < 0.001) and greater exposure unfavourable working conditions due to staff shortages (requests for off-hours shifts: 90.2%, denied leave: 55.4%, approved leave cancelled: 22.8%; p < 0.001). Role intrusion was frequent (77.1%). Despite widespread participation in continuous training, only 15.8% felt fully competent in all core competencies. CONCLUSIONS: Employment temporariness and staffing shortages are associated with poorer working conditions, greater role intrusion, and low pay satisfaction among midwives. Despite access to training, key competencies remain under-implemented, highlighting the need for greater job stability, adequate staffing, and equitable professional development.