Factors Affecting the Career Choice of Midwifery Students during the COVID-19 Pandemic: A Qualitative Study

Introduction

The new form of coronavirus infection (COVID-19), first reported by China in December 2019, became a pandemic that affected the whole world in the space of a few weeks. The pandemic required countries, especially educational institutions, to make quick decisions in many areas. In this context, as of March 16, 2020, it was decided that universities in Turkey would continue the 2020-2021 spring semester through distance education (1).

The midwifery profession, which dates back to the beginning of humankind, is a form of work that progresses in line with technological and scientific developments and also has ethical values (2). Studies conducted with midwifery students in Turkey have determined that students chose which department to study in for various reasons, including the ease of finding a job, the department’s academic rating, their family’s wishes or guidance from careers specialists (3, 4, 5). Nevertheless, a person’s being able to lead a successful professional life is closely related to choosing the profession that they think is most suitable for them in terms of their interests and abilities, and then being able to willingly perform it with sufficient knowledge and care (6). The attitudes of professional midwives also influence the development of the profession and its public image (2). In his study with university students, Aydemir (2018) tried to determine the factors that affect the career choice of students (7). The study concluded that the three most important factors affecting the choice of profession were the profession’s maintaining its significance in the future, social prestige, and career opportunities. In addition, it was determined that the factors with the biggest impact on the choice of profession were the family, the school/teachers and other relatives/close friends. Midwives, who are personally involved in women’s healthcare and provide professional health services, have had heavy responsibilities as a result of COVID-19, which was declared a pandemic by the WHO. Given that midwives play an important role in pregnancy follow-up and postpartum follow-up, both within the scope of preventive health and for those in contact with COVID-19, the importance and necessity of providing social support as well as professional clinical support has become ever more significant. To provide successful midwifery support, other studies are needed that are able to project the effects of any similar disease that may cause a global pandemic in the future (8, 9).

In this context, the importance of making the right choice of career or profession can be better understood, considering the vital role that their jobs play in the lives of individuals. As the level of knowledge about the factors affecting the choice of profession increases, individuals will receive better advice about choosing a profession, and the number of individuals satisfied with their profession will increase. This will in turn contribute to the general happiness and wellbeing of society in general. This study was thus carried out to determine the factors affecting the choice of the midwifery profession during the COVID-19 pan.

Materials and Methods

This study, which featured a qualitative content analysis, was conducted using a conventional approach. In conventional content analysis, the researcher allows the categories and subcategories to emerge from the textual data, so that the research follows the tenets of a naturalistic paradigm (10). The research was carried out between 10 March 2021 and 21 April 2021 through socially-distanced face-to-face interviews with first-year students in the Department of MI of a Health School in a district in the Mediterranean Region of Turkey. The criterion for inclusion in the study was to be a first-year student in the midwifery department. No exclusion criteria were used in the study, and all students were included in the study on a voluntary basis.

For the data collection a Student Information Form and Semi-structured Interview Form prepared by the researchers in line with the literature were filled in. The Student Information Form collected information on the sociodemographic characteristics of the participants (e.g., age, parental education level, place of residence), their reasons for choosing the midwifery department and their views about the profession. The Semi-structured Interview Form was developed to obtain information about the participants’ interest in the midwifery profession, their thoughts and perceptions about midwifery, and a questionnaire consisting of nine questions in total was used.  The content of the Semi-structured Interview Form was created by examining the relevant literature (11-13) and was approved after obtaining expert opinion from the faculty members of the midwifery department. All the interviews were conducted by the same researcher to avoid bias caused by different interviewers having different approaches. In addition, the researcher met the interviewees at the same place and time of the day to reduce the impact of external factors. The interviews were carried out in the application laboratory and the interviews (which lasted about 25-30 minutes) were recorded with a digital voice recorder. Data collection was concluded when the data repeatedly reached saturation point during the interviews.

Each interview was regarded as a unit of analysis and analysed according to Graneheim and Lundman method (14). Each unit of analysis was divided into units of meaning units that were then condensed. The condensed meaning units were abstracted and labelled with a code. Finally, five categories emerged. The trustworthiness of data was verified using Lincoln and Guba’s criteria. Various aspects of trustworthiness were considered through the concepts of credibility, dependability, confirmability and transferability (10). In addition, analysing the data from one interview at a time and having it checked by another researcher in the research team served to verify its accuracy (peer check). In addition, two members of research team (the first and last author) jointly coded and categorized the codes into categories until consensus was obtained. Quantitative data were obtained using the Statistical Package for the Social Sciences (SPSS) 21 package program.

In order to conduct the study, ethical approval was obtained from the non-invasive clinical research ethics committee of the university before it began. Written informed consent was obtained from all the participants included in the study. The identities of the participants were and remain confidential. The research and publication ethics have been complied with within this article.

Results

The ages of the students included in the study ranged from 19 to 28, with a mean age of 20±1.8. As Table 1 shows, the type of school students had mostly graduated from was an Anatolian/ Science High School (83.7%). 55.8% of the students lived in the local district. A plurality of the parents had received a primary education only (44.2-37.2%). In terms of the perceived family income, a plurality of the participants stated that their income matched their expenditure (48.8%).

While the positive feelings of the students included in the study about the profession were “moderate” before starting their midwifery education with 41.9%, this changed to “very good” with 44.2%, and “good” with 39.5%, after starting. 88.4% of the students were satisfied with the midwifery department, and 85.4% of the students stated that the future of the profession was good with regard to the pandemic.

34.9% of the students stated that they chose the midwifery department during the pandemic because they were very interested in the profession, while 25.6% said they chose it because it was a very hallowed profession (Table 2).

As a result of the analysis of the interviews with the students, five themes were determined: “interest in midwifery as a profession”, “the future of midwifery”, “the public image of midwifery”, “choosing midwifery as a profession” and “anxiety about midwifery as a profession”. Numbers were given to the interviewed participants, and their numbers in sequence (M1, M2…etc) was indicated after their statements. Statements summarizing the themes determined are included.

Interest in Midwifery as a Profession

Examples of internal motivation included interest in the profession, willingness to learn, making career plans, having expectations that drove their preferences, willingness to learn and achieve, being careful, wanting to be competent and wanting to develop. Especially during the pandemic, it is an important that midwifery students be interested in the profession. The students expressed their interest in the midwife profession in the following words:

“My interest in the midwifery profession comes entirely from my love of health and babies. As someone who takes pleasure in helping people and who always backs up and supports women, I thought this profession would make me happy so I was interested in this profession.”(M5)

“Ever since I was a child, I’ve wanted to work in the health field. It’s also a great feeling to support a woman in her most difficult moment. It’s wonderful to witness the beginning of a new life every day… that sparked my interest in midwifery.” (M16)

“In my opinion, working as a midwife is sacred because helping in the birth of a baby and bringing an individual into the world is something very important. Just as teachers make a great contribution in educating future adults by teaching us how to read and write in the first place, midwives make an important contribution in how an individual enters the world. The more I thought about all this, the more my interest in the midwifery increased, so I chose midwifery. I realised my dreams and I have become involved in a beautiful profession.” (M17)

“It was my childhood dream. I loved healthcare workers’ uniforms when I went to the hospital. I loved the midwives’ uniforms the most because they would be dressed very colourfully. What impressed me the most was that they were very compassionate towards and smiled at the children and babies. I always said to myself that I should be like that.” (M3)

The Future of Midwifery

The future of midwifery is to continue to be of meaning and value for women, children, families and public health. In order to shape this future, it is necessary to be aware which resources need to be mobilized. Women themselves are the most important resource in shaping the future of the midwifery profession. It is very important for the future of midwifery to inform women about the services provided and the benefits of care from a midwife. The students attending the midwifery department during the pandemic discussed the future of their profession in the following words:

“In my opinion, this profession will get through the pandemic successfully as well. Because for midwives, pandemics or other obstacles should not be an excuse for them to not do their jobs. All midwives are obliged to perform their duties successfully despite all kinds of obstacles, diseases or other problems.” (M5)

“I think that the midwifery profession will become more valuable day-by-day and the interest in it will increase. One of the conditions necessary for living beings to survive is reproduction. As long as people continue to live, midwifery is going to have a future. But only midwives can remind people of the value and importance of midwifery as a profession.” (M10)

“Midwifery has been among the most valuable professions from the past to the present, and I think that it’ll continue to be a valuable profession in the future (M11).”

Public Image of Midwifery

While serving both sick and healthy individuals, the way midwife care is presented and the way midwives behave affects the image of the profession in society in general. It is possible that society’s developing more positive perspective about healthcare professions during the pandemic will also have a positive effect on student motivation. The students who had chosen their profession during the pandemic made the following statements:

“I think the public image of the profession is fine, but when people ask me what job I want to do in the future I tell them that I want to become a midwife and they say,‘ So you’ll be a nurse,” and I say, ‘No, I’m going to be a midwife, it’s a different profession than being a nurse!’ This upsets me a little.” (M1)

“Midwifery is a very valuable career from a social point of view. It is also considered to be profession that strengthens communication between people, leads to a more respectful society, and adopts the right approach.” (M8)

“I think being a midwife is a sincere profession, and people can easily communicate with us, especially in the fields and the countryside, so we are welcomed by society in general.” (M17)

Choosing Midwifery as a Profession

Students' career choices in Turkey start with a university entrance exam, which is taken during adolescence, and often students choose to study for professions they do not really want to do. Midwifery is often selected without being sufficiently understood by the candidates; their choice is influenced by criteria such as greater possibilities of finding a job, economic factors, interest in the profession and people, their families’ and relatives’ wishes, and a low mark for the university entrance score. Those who choose the department voluntarily are generally better motivated and get satisfaction from what they do. During the pandemic, the students expressed their reasons for choosing midwifery as profession in the following ways:

“I wasn’t affected by the pandemic when I chose the midwifery profession. However, later, when I understood all the difficulties this process has caused, I was happy to be studying such a profession. The pandemic is a situation that all humanity has to deal with, but during this period more responsibility falls on health workers. I’ve realised that midwifery is even more important during such a significant event.” (M4)

“I think healthcare professionals are always at the forefront in every period, and we’ve understood this much better during the pandemic. I’d always wanted to be there for people and support them, but I understood this much better during the pandemic, and considering the fear felt by pregnant women, this brought me closer to midwifery.” (M10)

“Although I was a little hesitant about choosing to study in a health-related department during this period, I’m extremely happy with my choice as I will be looking after two lives (i.e. the mother and baby) and public health in particular. I would be proud if I could provide some help to my country during this difficult period.” (M8)

Anxiety for selecting Midwifery as a Profession

Midwifery is a profession with difficult working conditions. Midwives take on the important responsibility of providing care and counselling to the family and the community with regard to health education. The care provided by the midwife includes measures to protect the health of the mother and baby. Any abnormal symptoms or issues with the mother and/or baby require assistance with medical care if necessary, as well as the action to be taken in emergencies. Even during the pandemic, the midwife has to be an expert in the development of patient care, and in planning, providing and evaluating the care of pregnant women. The students expressed their concerns about their chosen profession as follows:

“The fact that there are many negative and sad consequences of the pandemic, such as gender discrimination, domestic violence, human rights violations, the medicalization of birth, the dissemination of false information and fear, creates anxiety in me.” (M16)

“I’m not normally that paranoid but I’d always feared that I’d be the person who tried to prevent and alleviate diseases in the follow-ups of pregnant women, babies, children and other women if I ever encountered a pandemic in my life and professional life.” (M13)

Discussion

The current study covers the reasons why first-year students studying in the midwifery department of a university had chosen this profession during the pandemic and their views about their future role. As a result of the content analysis, the main themes of the study were determined as “interest in midwifery as a profession”, “the future of midwifery”, “the public image of midwifery”, “choosing midwifery as a profession” and “anxiety about midwifery as a profession”. Taking on a profession that one enjoys doing is required to be successful in professional life. Midwifery is a profession that requires valuing and caring for people (15), and 88.4% of the students in our study stated that they were satisfied with the midwifery department. This situation is positive.

For people to choose a profession that matches their interests, it is first necessary to provide them with the necessary information about different professions (16). The practice of midwifery, which contributes to the improvement of the health and well-being of mothers and babies, varies greatly worldwide (17). In the current study, the students expressed their interest in midwifery in a number of ways. This shows that people can be expected to be spontaneously interested in a profession, and this interest can be increased through information and observation, as the students confirmed in their statements. According to the findings of this study, another indicator that had a significant relationship with the students’ preference for midwifery was their perception of the profession. The more positive their perception, the more likely students are to be interested in a profession (18). Studies show that midwifery students generally like their profession, have positive thoughts about it, think that it is a suitable profession for them and are very happy to study in the field (5, 7, 11, 15, 19).

Midwifery is a profession that involves care and counselling, providing support for the mother and baby during pregnancy, childbirth and the postpartum period. Like other professions, the sustainability of midwives depends on hiring new professionals inspired to train for a future career in midwifery (18). To develop midwifery as a profession, it is very important to promote midwifery departments and to use approaches that are collaborative (19). In the current study, the students who chose midwifery during the pandemic stated that midwifery was the oldest profession and that it would continue to play an active role in reproductive health. Other studies have found that students who had positive thoughts about midwifery believed that the profession had a healthy future (2).

The opinions and expectations of society play a decisive role in the development and quality of health services (12). Different results have been obtained in studies conducted nationally and internationally to determine society’s opinions and expectations of midwives (12, 20, 21). The study by Taşpınar et al. (2021) revealed that the society’s opinions about midwives and the experience of receiving services from midwives were mostly positive, and that the main expectation of midwives was that they would have a professional attitude and behave appropriately.

Research has revealed that what society wants from midwives is for them to be respectful, soft-spoken, friendly, open to communication, understanding, fair and honest, tolerant, unprejudiced, as well as for them not to shout during labour and to value their patients’ privacy (12). However, while some members of the community described nurses and midwives as professional, knowledgeable and caring, others described them as rude, cruel and lazy (20). In the study conducted by Yurtsal et al. (2014) 69.1% of the students stated that the image of midwifery was negative. In the current study, receiving feedback such as the question “Are you a nurse?” when explaining that they midwives did not affect the students’ choice of their profession. It was also stated that midwives only delivered babies. According to the students’ statements, it can be said that society either does not understand the midwifery profession or lacks knowledge about it.

Individuals’ choice of profession and their employment plans are among the most important decisions they make and affect their whole life (22). The sense of belonging to a profession is very important to maintain professional standards (23). In the current study, the students stated that although they experienced anxiety and fear while choosing the profession during the pandemic, they were satisfied with their choice, especially with regard to the public health aspect. In a study conducted in Hazar it was stated that the students had had little intent to choose midwifery, and the reason for this was lack of knowledge about the profession, negative perceptions, disrespect of midwifery as a profession and fear of contact with blood (19). Similar to the results of the current study, other studies conducted with midwifery students in Turkey, found that factors such as loving midwifery, finding a job easily, the family’s wishes, good salary, and an adequate academic rating for the midwifery department were among the reasons for choosing midwifery as a profession (2-4, 15).

Along with other issues that may lead to anxiety in young people – in particular in university students – about beginning a profession, COVID-19, which caused a worldwide pandemic, including in Turkey, has challenged individuals’ physical and psychological resilience (24). The pandemic, along with the psychological pressure it brought with it (25) has heightened levels of anxiety as a result of sudden, negative and unexpected changes to daily life. In the current study, the midwifery students stated that they experienced anxiety in the following areas while making their choice: doing distance learning, and the difficulties they would experience trying to follow-up the pregnant women, infants and children. In one study conducted with midwifery students they stated that they disinfected everything, were very worried during this period, were frightened that they would infect their families, and had a lot of personal concerns (13).

Despite the pandemic, the face-to-face interviews conducted in this study are one of the strengths of the research. The weakness of the study is that only first-year students were interviewed within the scope of the research and that the results cannot be generalized because the study was a qualitative one.

Conclusion

The themes that affected students’ choice of the profession during the pandemic are worthy of note. The best career choice for students is the one that suits their personal qualities. Having a good public image of midwifery as a profession will positively affect those students who will choose to study it. In line with the results of this study, sharing positive thoughts of current midwifery students about their departments with the students who are thinking about choosing the profession may be beneficial as a form of advice for these future students. At the same time, promotional activities in the media during the pandemic can also play an important role in increasing positive views about midwifery.

Acknowledgements

We thank all those who participated in the research. Before starting the study, ethical approval was obtained from the Non-Invasive Clinical Research Ethics Committee of Burdur Mehmet Akif Ersoy University (Date: 06.01.2021; Decision No: GO 2021/07). Written informed consent was obtained from all participants in the study.

Conflicts of interest

Authors declared no conflicts of interest.