Negotiations between the midwives and the government have been ongoing for two years, with the crux of the disagreement centering on low salaries and difficult working conditions. In Iceland, midwives require a minimum of six years of higher education—four years in nursing school and two years specialised training, but their stagnant wages do not reflect this.
On July 1st, the crisis reached a boiling point when 12 midwives announced their resignation. By July 6th, that number reached 30, according to Brynja Ragnarsdóttir, an obstetrician at Landspítalinn. Most babies in Iceland are born there, and the hospital has had staffing issues for the past several years.
Brynja explains that the hospital has taken drastic measures to ensure the birth unit keeps functioning during the crisis. “There has been an emergency plan put in place by the hospital to ensure everyone’s safety. The emergency plan involves a shorter stay for women and children after birth. The aim is for women to be discharged four hours after delivery,” she explains. The normal length of stay after delivery is 12-36 hours. On average 8-9 babies are born per day in Landspítalinn.
Brynja received her training in Scotland, and has witnessed what happens when hospitals are understaffed with midwives. “If the antenatal care is understaffed, you have women going through their pregnancy and you miss signs of growth restriction because you don’t have enough midwives to check. They develop pregnancy complications like preeclampsia.” Brynja cites understaffed labour wards as a potential cause of poor outcomes for babies and mothers during birth, like birth asphyxia, intrapartum deaths, and maternal deaths. In the midst of the crisis, more pressure has been placed on the midwives who conduct home visits, as they will now have to monitor the health of mothers and babies more closely.
“We have women and midwives feeling enough is enough. We’ve had to put up with a lot of stress and demands at work and we are not being recognised as the professionals we are,” she says. The typical work week for Brynja is 40 hours, but now she is working on average 48 to 50 hours per week due to summer vacations and the staffing crisis.
The midwives are also demanding a shorter work week, so that they have more time in between shifts. According to Brynja, some midwives don’t even have eleven hours in between shifts, and many have to work on Christmas, New Years, and Easter. Brynja also cites mounting evidence suggesting how harmful night shifts are for one’s health.
Last week, Morgunblaðið published an article with the midwives’ salary figures. The Ministry of Finance claims that midwives working full time are making 848.000 ISK per month. According to Brynja this is far from the truth. “Funnily enough, in the morning, I was in an interview with Vísir where I said something like ‘I think it’s strange that the Minister of Finance is going to be using these midwives to show their muscle’ and the same day this came out,” she says. Brynja explains that this number was calculated as if a midwife would be working on-call only during nights and weekends, receiving extra pay. Most midwives work only day shifts, or mixed shifts involving day, evening, and night shifts. “That was cunning and dishonest of Bjarni to put this forward because it’s not true.” Multiple midwives have made public posts on Facebook showing their payslips. One of the payslips showed 338.109 ISK after taxes.
Helga Reynisdóttir, a midwife at Landspítalinn, tells me how unfair the situation is considering her six years of education. “I could never live off of my salary if I would be single. I could not rent the cheapest apartment. The ones that are single, they have to work 100% and do extra jobs to be able to stay afloat,” she says. Helga’s working conditions are not easy. “For example, here in the shift that I’m working at I have to work as many day shifts as night shifts and then I have to be away from my kids during Christmas and stuff. The salary just doesn’t add up.”
Too little, too late
Helga is heartbroken over the government’s response to the midwives’ demands. “It’s been ten months, and I thought we were reasonable with our demands. It’s just sad that they have let things come to this, and that they’re putting [us] in this situation, midwives being on the floor with not enough staff, and being responsible either way for what happens on the shift, and for putting women and their partners in this position in this really vulnerable time in their life,” she says.
Brynja remains doubtful that a solution is near. “Midwifery is a wonderful profession with great midwives. They are idealists and really compassionate. They do their work 100%, but they have to be rewarded as such. We are hoping that the settlement will be sufficient to reverse this, but the damage may be done.”
Read more about the midwife crisis here.