Structural characteristics of maternity care institutions and midwifery workforce capacity: a cross-sectional study from Switzerland

Abstract Background Global midwifery shortages threaten outcomes for mothers, newborns and professionals. However, the availability of robust workforce capacity data varies substantially across contexts and remains limited in several countries. In Switzerland, the extent of intrapartum midwifery workforce capacity and its associations with structural characteristics of maternity care institutions are unknown. We therefore aimed to describe workforce capacity and examine these associations. Methods We conducted a nationwide cross-sectional online survey of maternity care institutions in 2025. Associations between structural characteristics and workforce capacity indicators were investigated. Vacancy and absence full-time equivalent (FTE) levels were analysed using zero-inflated negative binomial regression models. Staffing ratios, defined as annual births per FTE midwife, were analysed using linear regression. Results Among 100 participating institutions (response rate 89%), the overall absence rate exceeded the overall vacancy rate (9.1% vs. 2.4% of total FTEs). Vacancies were reported by 29% of institutions and absences by 69%. Vacancy FTE levels were higher in French-, Italian- and Romansh-speaking than in German-speaking regions (RR: 2.23; 95% CrI: 1.39, 3.66) and in rural or intermediate than in urban areas (RR: 1.94; 95% CrI: 1.10, 3.44). Each additional 100 births per year was associated with lower odds of reporting no absences (OR: 0.84; 95% CrI: 0.73, 0.94) and slightly higher absence FTE levels (RR: 1.03; 95% CrI: 1.00, 1.05). Absence FTE levels were also higher in French-, Italian- and Romansh-speaking regions (RR: 1.85; 95% CrI: 1.38, 2.49), while birth centres showed some indication of lower absence FTE levels than public hospitals (RR: 0.65; 95% CrI: 0.44, 1.00). Staffing ratios varied across settings, with birth centres reporting fewer births per FTE midwife than public hospitals (β: -22.17; 95% CI: -29.71, -14.62). Each additional 100 births per year was associated with an increase in annual births per FTE midwife (β: 1.30; 95% CI: 0.87, 1.72). Conclusions This study highlights the importance of staff absences for workforce capacity, variation in staffing ratios across institutions and context-specific associations between institutional characteristics and workforce capacity. Establishing a nationwide system for monitoring staffing indicators alongside structural characteristics could help inform workforce planning for high-quality care across all settings.