Switzerland’s maternity care system is quietly running on a thinner midwifery workforce than most of the country realizes, and the hidden culprit is not unfilled job postings but staff absences, according to a nationwide cross-sectional survey published in BMC Health Services Research. The study, led by Isabel Naya Widmer of the Research Institute of Midwifery and Reproductive Health at ZHAW Zurich University of Applied Sciences together with the SOCRATES Study Group, provides the most comprehensive picture to date of how the structural characteristics of Swiss maternity care institutions shape the capacity of their intrapartum midwifery workforce. Its central finding is striking: across 100 participating institutions, the overall absence rate reached 9.1 percent of total full-time equivalents, nearly four times the overall vacancy rate of 2.4 percent. In other words, the midwives who are employed but unavailable for work, whether through illness, burnout, parental leave or other forms of absence, drain far more capacity from the system than the positions that never get filled.
The survey was conducted in 2025 as a nationwide online census of maternity care institutions, achieving a response rate of 89 percent, an unusually high figure for health workforce research. The 100 participating institutions span the full spectrum of Swiss birth settings, from public hospitals to birth centres, and cover all of the country’s language regions. Respondents, who acted as representatives of their institutions and gave informed consent before completing the questionnaire, reported on vacancy full-time equivalents, absence full-time equivalents and staffing ratios, defined as the number of annual births per FTE midwife responsible for intrapartum care. The questionnaire was developed with support from the Swiss Federation of Midwives, whose manager held an expert role in its design, ensuring that the indicators captured the realities of day-to-day maternity staffing. The overarching SOCRATES study, which examines stress among co-parents related to traumatic birth experiences across Switzerland, received approval from all Swiss ethics committees, and the institutional survey itself was conducted in accordance with the Declaration of Helsinki.
Only 29 percent of institutions reported vacancies, but 69 percent reported absences, meaning that nearly seven in ten Swiss maternity care institutions were operating below their nominal midwifery capacity because employed midwives were unavailable. This asymmetry has profound implications for how workforce shortages are measured and managed. Most workforce monitoring systems, in Switzerland and internationally, focus on vacancy rates, the visible tip of the shortage iceberg. The Swiss data suggest that the submerged mass, the absence burden, is far larger and far more widespread. A system can appear fully staffed on paper while nearly a tenth of its effective workforce is missing from the labour ward floor on any given day, a discrepancy that directly affects the intensity of one-to-one care during labour and birth.
To untangle the associations between institutional characteristics and workforce capacity, the research team deployed a sophisticated statistical arsenal. Vacancy and absence FTE levels were analysed using zero-inflated negative binomial regression models, a choice that reflects the peculiar structure of the data. Many institutions reported zero vacancies or zero absences, creating an excess of zeros that standard count models cannot handle, while the counts that were non-zero were overdispersed, varying more than a Poisson distribution would predict. The zero-inflated negative binomial framework models the probability of reporting no absences at all separately from the intensity of absences among institutions that do report them, allowing the team to distinguish between the odds of being absence-free and the volume of absence FTEs. Staffing ratios, being continuous variables, were analysed with linear regression. Model quality was assessed using widely applicable information criterion and Pareto-smoothed importance-sampling leave-one-out cross-validation, with posterior predictive checks confirming that the models reproduced the observed data faithfully. Sensitivity analyses, reported in the supplementary materials, tested the robustness of the findings across alternative model specifications, including zero-inflated Poisson variants.
The results reveal a Switzerland divided along linguistic and geographic lines. Vacancy FTE levels were more than twice as high in French-, Italian- and Romansh-speaking regions as in German-speaking regions, with a rate ratio of 2.23 and a 95 percent credible interval of 1.39 to 3.66. Rural and intermediate areas similarly reported vacancy levels nearly double those of urban centres, with a rate ratio of 1.94 and a credible interval of 1.10 to 3.44. Absence FTE levels followed the same linguistic gradient, running 85 percent higher in the Latin language regions, with a rate ratio of 1.85 and a credible interval of 1.38 to 2.49. These context-specific associations suggest that workforce capacity is not a uniform national problem but a patchwork shaped by regional labour markets, recruitment pools and possibly differing working conditions across the country’s cultural zones. The geographic distribution of midwifery staffing ratios across major Swiss regions, mapped in the study’s supplementary figures, underscores how unevenly the effective workforce is spread across the territory.
Birth volume emerged as a powerful driver of absence dynamics. Each additional 100 births per year was associated with lower odds of reporting no absences, with an odds ratio of 0.84 and a credible interval of 0.73 to 0.94, and with slightly higher absence FTE levels among institutions that did report absences, with a rate ratio of 1.03 and a credible interval of 1.00 to 1.05. The interpretation is intuitive: busier maternity units push their midwives harder, increasing the likelihood that at least some staff will be absent at any time and modestly inflating the total absence burden. Meanwhile, each additional 100 annual births was associated with an increase of 1.30 in the staffing ratio, meaning 1.30 more births per FTE midwife, with a confidence interval of 0.87 to 1.72. High-volume institutions thus operate with leaner effective staffing per midwife than their smaller counterparts, a pattern consistent with economies of scale in obstetric care but also with the risk that efficiency gains come at the price of workforce strain.
Setting type mattered as well. Birth centres reported significantly fewer births per FTE midwife than public hospitals, with a regression coefficient of -22.17 and a confidence interval of -29.71 to -14.62, meaning that a midwife in a birth centre attends roughly 22 fewer births per year than her hospital colleague. Birth centres also showed some indication of lower absence FTE levels than public hospitals, with a rate ratio of 0.65 and a credible interval of 0.44 to 1.00, a result that just misses conventional significance thresholds but hints that smaller, lower-acuity settings may protect their midwives from the absence spiral seen in high-volume hospitals. Staffing ratios varied substantially across settings, and the study’s maps of staffing ratios across major Swiss regions reveal how the effective capacity per midwife differs between hospital-based obstetric units and freestanding birth centres, a variation with direct consequences for the continuity and intensity of care that birthing women experience in each setting.
The methodological rigour of the study deserves emphasis because workforce capacity data of this quality are rare. The availability of robust workforce capacity information varies substantially across countries, and Switzerland previously lacked any systematic picture of intrapartum midwifery capacity and its institutional determinants. The research team followed STROBE reporting guidelines for observational studies, examined multicollinearity using variance inflation factors, and handled missing data transparently, with supplementary materials documenting missing data patterns and the analysis samples for each multivariable model. Bivariable analyses, presented in supplementary tables, laid the groundwork for the multivariable models, and sensitivity analyses confirmed that the key findings held across alternative specifications. The study was funded by the Swiss National Science Foundation under grant 32HW-0_220494 as part of the SOCRATES project, with additional financial support from the Swiss Federation of Midwives, and open access funding was provided by ZHAW Zurich University of Applied Sciences. The authors declare no competing interests.
The study’s conclusions carry weight far beyond Switzerland’s borders. Global midwifery shortages threaten outcomes for mothers, newborns and professionals alike, and the World Health Organization has repeatedly warned that workforce capacity data remain limited in several countries, hampering evidence-based planning. The Swiss finding that absences, not vacancies, constitute the dominant capacity drain offers a transferable lesson: workforce monitoring systems that track only unfilled positions will systematically underestimate the true shortage. The authors propose establishing a nationwide system for monitoring staffing indicators alongside structural characteristics, a recommendation that could inform workforce planning for high-quality care across all settings, from university hospitals to rural birth centres. As maternity systems worldwide confront rising birth complexity, midwife burnout and uneven regional capacity, the Swiss survey stands as a methodological template for measuring the invisible workforce, the midwives who are employed but absent, whose unavailability may be the single most important structural determinant of whether a labour ward can deliver the one-to-one care that safe childbirth demands.
Subject of Research: Structural characteristics of maternity care institutions and midwifery workforce capacity: a cross-sectional study from Switzerland
Article Title: Structural characteristics of maternity care institutions and midwifery workforce capacity: a cross-sectional study from Switzerland
Article References: Widmer, I. N., Mueller, A. N., Lorthe, E., Celetta, E., Naef, R., Hansson, M., Gaucher, L., Grylka-Baeschlin, S., & SOCRATES Study Group (2026). Structural characteristics of maternity care institutions and midwifery workforce capacity: a cross-sectional study from Switzerland. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15596-7
Image Credits: AI Generated
DOI: 10.1186/s12913-026-15596-7
Keywords: Structural, characteristics, maternity, care, institutions, midwifery, workforce, capacity, cross-sectional, Switzerland, scientific research
News Source: Ophelia Keating. (October 18, 2026). Swiss Maternity Wards Face Midwife Absence Crisis, Landmark Survey Reveals. Scienmag.
