Bernburg M, Vitzthum K, Groneberg DA, Mache S. Physicians' occupational stress, depressive symptoms and work ability in relation to their working environment: a cross-sectional study of differences among medical residents with various specialties working in German hospitals. BMJ Open. 2016; 6:(6)

Bruschini M, Carli A, Burla F. Burnout and work-related stress in Italian rehabilitation professionals: A comparison of physiotherapists, speech therapists and occupational therapists. Work. 2018; 59:(1)121-129

Chegini Z, Janati A, Asghari-Jafarabadi M, Khosravizadeh O. Organizational commitment, job satisfaction, organizational justice and self-efficacy among nurses. Nursing Practice Today. 2019; 6:(2)86-93

Creedy D, Sidebotham M, Gamble J, Pallant J, Fenwick J. Prevalence of burnout, depression, anxiety and stress in Australian midwives: a cross-sectional survey. BMC Pregnancy Childbirth. 2017; 17:(1)1-8

Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997; 315:(7109)629-634

Elmir R, Pangas J, Dahlen H, Schmied V. A meta-ethnographic synthesis of midwives' and nurses' experiences of adverse labour and birth events. J Clin Nurs. 2017; 26:(23–24)4184-4200

Enjezab BFF. Relationship between job stress and psychological and behavioral responses among midwives working in Yazd hospitals. Journal of Shahid Sadoughi University of Medical Sciences. 2002; 10:(3)32-38

Favrod C, Jan du Chêne L, Martin Soelch C Mental health symptoms and work-related stressors in hospital midwives and NICU nurses: a mixed methods study. Frontiers in psychiatry. 2018; 9

Geraghty S, Speelman C, Bayes S. Fighting a losing battle: Midwives experiences of workplace stress. Women and Birth. 2019; 32:(3)e297-e306

Ghaffari K, Davoodi H, Rashnoo S. Compare job burnout, job stress, and job satisfaction among midwives working in hospitals and midwives working in health centers. Career and Organizational Counseling. 2020; 12:(42)73-94

Gheshlagh RG, Parizad N, Dalvand S The prevalence of job stress among nurses in Iran: A meta-analysis study. Nursing and Midwifery Studies. 2017; 6:(4)

Grech LM, Hili C. Midwives' perceptions of work related stress in midwifery in Malta. Malta Journal of Health Sciences. 2019; 16-23

Hadizadeh Talasaz Z, Nourani Saadoldin S, Shakeri MT. Job satisfaction and occupational stress in organizational commitment among midwives working in the maternity wards; Mashhad, Iran, 2014. Health Scope. 2017; 6:(1)

Hashemi Nejad N, Rahimi Moghadam S, Mohammadian M, Amiri F. Survey of relationship between mental health and job stress among midwives who were working in hospitals of Kerman, Iran, 2011. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2013; 16:(64)1-9

Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21:(11)1539-1558

Hildingsson I, Westlund K, Wiklund I. Burnout in Swedish midwives. Sexual & Reproductive Healthcare. 2013; 4:(3)87-91

Ilieva S, Dimitrova V, Laleva R. Midwives coping with stress. Scripta Scientifica Salutis Publicae. 2017; 2:138-141

Jahromi MK, Minaei S, Abdollahifard S, Maddahfar M. The effect of stress management on occupational stress and satisfaction among midwives in obstetrics and gynecology hospital wards in Iran. Global Journal of Health Science. 2016; 8:(9)91-98

Kerkin B, Lennox S, Patterson J. Making midwifery work visible: The multiple purposes of documentation. Women and Birth. 2018; 31:(3)232-239

Khavayet F, Tahery N, Alizadeh Ahvazi M, Tabnak A. A survey of job satisfaction among midwives working in hospitals. Journal of Midwifery and Reproductive Health. 2018; 6:(1)1186-1192

Knezevic B, Milosevic M, Golubic R, Belosevic L, Russo A, Mustajbegovic J. Work-related stress and work ability among Croatian university hospital midwives. Midwifery. 2011; 27:(2)146-153

Kordi M, Mohamadirizi S, Shakeri MT. The relationship between occupational stress and dysmenorrhea in midwives employed at public and private hospitals and health care centers in Iran (Mashhad) in the years 2010 and 2011. Iran J Nurs Midwifery Res. 2013; 18:(4)

Kordi M, Mohamadirizi S, Shakeri MT, Modares Gharavi M, Salehi Fadardi J. The relationship between occupational stress and work ability among midwives in Mashhad, Iran. Journal of Midwifery and Reproductive Health. 2014; 2:(3)188-194

Lachat C, Hawwash D, Ocké MC Strengthening the reporting of observational studies in epidemiology–nutritional epidemiology (STROBE-nut): An extension of the STROBE statement. Nutr Bull. 2016; 41:(3)240-251

Mackin P, Sinclair M. Labour ward midwives' perceptions of stress. J Adv Nurs. 1998; 27:(5)986-991

Masoumi SZ, Mirzaiinajmabadi K, Shobeiri F, Khodakarami B, Montazeri A. Quality of life among midwives working in Hospitals, in Hamedan, Iran. Payesh (Health Monitor). 2013; 12:(3)283-288

Regulation of determining midwife competencies with B.A. and M.A. degrees.Tehran: Ministry of Health and Medical Education of Iran;

Moghadam SR, Moosazadeh M, Mohammadyan M, Emkani M, Khanjani N, Tizabi MNL. Psychological health and its relation with occupational stress in midwives. International Journal of Occupational Hygiene. 2016; 8:(4)217-222

Mohamadirizi S, Kordi M, Shakeri MT, Salehi Fadardi J, Hafizi L. Relationship between job stress with menstrual bleeding pattern among midwives. Hayat. 2013; 18:(5)1-11

Mohammadian M, Hashemi Nejad N, Rahimi Moghadam S, Amiri F. The survey of musculoskeletal disorders of midwives and its relationship with job stress. Journal of Fundamentals of Mental Health. 2013; 15:(59)171-183

Mollart L, Skinner VM, Newing C, Foureur M. Factors that may influence midwives work-related stress and burnout. Women and Birth. 2013; 26:(1)26-32

Nobahar M, Ahmadi F, Alhani F, Khoshknab MF. Work or retirement: Exploration of the experiences of Iranian retired nurses. Work. 2015; 51:(4)807-16

Nourani Saadoldin S, Kohansal Daghian Z, Esmaily H, Hooshmand E. The relationship between organizational citizenship behavior, job satisfaction, and occupational stress among midwives working in healthcare centers of Mashhad, Iran, 2014. Journal of Midwifery and Reproductive Health. 2016; 4:(2)622-630

Nwankwo TO, Odo GU, Eze MI, Ezeome IV, Umeh UA. Challenges and adherence to standard precautions for prevention of percutaneous injuries and exposure to blood borne pathogens in clinical practice: a review. Open J Prev Med. 2020; 10:(8)195-216

Oncel S, Ozer ZC, Efe E. Work-related stress, burnout and job satisfaction in Turkish midwives. Social Behavior and Personality: an International Journal. 2007; 35:(3)317-328

Page MJ, Moher D. Evaluations of the uptake and impact of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement and extensions: a scoping review. Sys Rev. 2017; 6:(1)1-14

Quick JC, Henderson DF. Occupational stress: preventing suffering, enhancing wellbeing. Int J Environ Res Public Health. 2016; 13:(5)

Rasool SF, Wang M, Zhang Y, Samma M. Sustainable work performance: the roles of workplace violence and occupational stress. Int J Environ Res Public Health. 2020; 17:(3)

Rezaei B, Falahati J, Beheshtizadeh R. Stress, stressors and related factors in clinical learning of midwifery students in Iran: a cross sectional study. BMC Med Educ. 2020; 20:(1)1-10

Roostaee F, Nikmanesh Z, Sharifi-Rad J, Kiani M, Shahnazi A. Relation of religious coping with occupational stress and quality of working life for midwives working in maternity hospitals in Zahedan, Iran. International Journal of Research in Medical Sciences. 2016; 4:(12)5329-5333

Sabooteh S. The survey of relationship between job stress and job satisfaction of midwives who working in Isfahan maternities. Journal of Health System Research. 2013; 9:(7)682-692

Sabzevari MT, Rad M. Resilience strategies against working pressures in midwives: A qualitative study. Journal of Education and Health Promotion. 2019; 8

Safaei M, Abedian Z, Mazlum R. Relationship between job stress and work ability of midwives working in health centers of Mashhad City in 2013. Journal of Torbat Heydariyeh University of Medical Sciences. 2016; 4:(1)30-35

Seňová A, Antošová M. Work stress as a worldwide problem in present time. Procedia-Social and Behavioral Sciences. 2014; 109:312-316

Stoll K, Gallagher J. A survey of burnout and intentions to leave the profession among Western Canadian midwives. Women and Birth. 2019; 32:(4)e441-e449

Vali L, Tabatabaee SS, Kalhor R, Amini S, Kiaei MZ. Analysis of productivity improvement act for clinical staff working in the health system: A qualitative study. Global Journal of Health Science. 2016; 8:(2)

Wright EM, Matthai MT, Budhathoki C. Midwifery professional stress and its sources: a mixed-methods study. Journal of Midwifery & Women's Health. 2018; 63:(6)660-667

The prevalence of occupational stress among Iranian midwives: a systematic review and meta-analysis

02 November 2021
9 min read
Volume 29 · Issue 11



Occupational stress is one of the undesirable risk factors found in the midwifery profession. It can lead to job burnout, job loss and negatively affect the quality of patient care. This study aimed to estimate the prevalence of occupational stress among Iranian midwives.


Through searching national and international databases, a total of 11 observational studies with full texts were extracted. Observational studies in Persian or English that reported the prevalence or frequency of job stress among Iranian midwives were included in the analysis. Irrelevant studies, those conducted on midwifery students and gray literature were excluded. The meta-analysis was conducted using the random-effects model.


11 articles reviewed occupational stress in 1196 midwives (an average of 108 midwives per study). Analysis of the articles showed that the pooled prevalence of occupational stress was 70.82% in Iranian midwives. Meta-regression analysis showed that the prevalence of occupational stress was not related to mean age, work experience, articles' publication year or sample size.


The prevalence of occupational stress is high among Iranian midwives and it can have harmful consequences for them and their patients. Therefore, the training of stress coping strategies seems to be appropriate for this group.

Occupational stress is a known risk factor that can cause behavioral, psychological, and medical problems (Quick and Henderson, 2016). As a result of their professional nature, the possibility of healthcare providers being exposed to stress is higher than in other employees (Bruschini et al, 2018).

Occupational stress causes absenteeism, early retirement, and reduced working years in health workers (Bernburg et al, 2016). It has been identified as a major concern around the world (Seňová and Antošová, 2014). Occupational stress can be associated with multiple problems. These can be psychological, including anxiety, depression, fatigue, irritability, aggression, impulsive behavior, overeating, inability to make decisions, poor focus and low attention (Jahromi et al, 2016; Favrod et al, 2018; Chegini et al, 2019). They can also be physical, including migraine, tachycardia, hypertension, musculoskeletal pain, rheumatoid arthritis, pulmonary and digestive disorders (Mollart et al, 2013). Organisational issues such as low productivity, conflicts with colleagues, job dissatisfaction, reduced commitment to the organisation, and poor quality of health services have also been found (Favrod et al, 2018; Rasool et al, 2020). These complications are non-specific responses that the body exhibits against unmet needs that it encounters (Masoumi et al, 2013).

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