This is the first-ever investigation of the empathy ability of midwives in China, and our findings form the basis for future research. In the present study, 65.3% of the midwives met the high-empathy level while the remainder professed middle-empathy levels. The effects of the midwives’ childbirth experiences on their empathy levels was a highlight of this study, as we found that the number of births experienced by midwives and the age of their children were highly correlated with high levels of empathy.
Our results suggested that midwives who underwent two deliveries themselves had a two-fold higher level of empathy than those with fewer personal delivery experiences. These data were consistent with those of previous studies [19-22] that showed that midwives who had undergone labor pain were more likely to demonstrate more empathy to the laboring women under their care; and that empathy was built upon shared experiences and connections [23]. Midwives who had experience in childbirth were willing to share their own experiences, and provided guidance, encouragement, and support to other women. This interactive approach creates a positive atmosphere for puerpera, promoting sufficient progress in labor.
However, our results depicted no significant difference in empathy between midwives who gave birth once and those who did not, and this was consistent with earlier findings on empathy measures and estimates of patient pain [20]. These authors demonstrated that midwives’ personal characteristics could skew the estimation of pain in woman in labor. For example, a midwife who manifested abundant personal childbirth experience estimated labor pain as higher, while pain estimates were even higher for midwives who had elevated scores on empathy. This suggested to us that empathy for the laboring woman could be effectively targeted, but that it might also be related to labor analgesia. Epidural analgesia is known to be a highly effective way to improve comfort in women, and this might affect the stimulation of the midwives' empathic abilities to an extent. In addition, it is a common phenomenon that women with a parity of two or more are less likely to receive epidural analgesia than uniparas; and this might constitute one of the reasons as to why midwives, doctors, and anesthesiologists posit that multiparas require lower pain relief due to their shorter labor duration [24]. Thus, midwives who bore two children might suffer greater labor pain. In addition, “memory of labor pain” is another intriguing issue with respect to in-labor pain intensity at an individual level [24,25]. Previous studies, e.g., showed that women’s labor-pain memory might develop within five years after childbirth and wield an impact on maternal labor pain in later childbirths. Epidural analgesia also appears to lead to a 15% to 20% reduction in recollected pain intensity [26].
Our results indicated that the age of the midwives’ children impacted empathy levels significantly, as midwives who had children at the infant stage (< 3 years) exhibited higher levels of empathy. We hypothesize that this could be due to the fact that parental care is an ancient root form from which more complex forms of empathy have emerged [27,28]. Hodges, S.D. compared the empathy of new mothers, non-mothers, and pregnant women, and showed the greatest empathy and understanding in new mothers [19]. Immediately after childbirth and during the first few neonatal months, mothers as the primary caretakers of young infants often synchronize their own biologic cycle and daily activities with the infants’ physical and psychological needs [29]. Empathy might then be heightened in parents as it favors caregiving and the perception of non-verbal needs from infants, as well as increased infant survival [29,30]. Multiple studies have, for example, shown the effects of oxytocin in promoting empathetic abilities [27,28,31,32]. Oxytocin is an endogenous neuropeptide associated with bonding and nurturing behavior, and oxytocin is therefore considered to be a robust mediator of empathy. This concept stems from observations of the beneficial effects of intranasal oxytocin on cognitive aspects of empathy—including the processing of social information, mind reading, and emotion recognition [31,33,34]. During pregnancy and the postpartum period, hormones such as prolactin, oxytocin, and progesterone increase and prepare the body for childbirth, nursing, and child rearing [35,36]. Also previous investigators have proposed that pregnancy and the postpartum period mediate an elevation in maternal sensitivity [35,37]. These changes affect how women respond to emotional information in their surrounding environment and shape their behaviors in response to exclusive stimuli in motherhood or mother-baby interactions [35]. The sensitivity used by parents to tailor their behaviors to those of their immature offspring is not only found within the mother–infant relationship, but also with respect to other group members [28,38].
Based on our multivariate logistic analysis, similar independent variables were associated with empathy; for instance, shift work was associated with a lower empathy level. These findings were congruent with previous evidence showing that sleep deprivation and mood disorders exerted a detrimental impact on cognitive processing and might reduce a persons’ capacity for empathy [30,39,40]. In addition, owing to the nature of midwifery work, midwives have more frequent night shifts compared with general nurses; and being “on-call” was the greatest hindrance to sleep. Sleep deprivation thus exerts a negative impact on a midwife’s individual health and well-being, as well as on the health of the woman under the midwife’s care. Numerous strategies have been employed to increase the quality and amount of midwives’ sleep—including schedule modifications, structural changes, and altered staffing ratios within their practices [1].
Limitations
There were limitations to the present study. While we collected data on whether midwives experienced pain during childbirth, we did not apply the pain rating scale to evaluate their pain levels during childbirth. Longitudinal studies should therefore focus on further exploring the effect of pain level on empathic elasticity. We additionally did not use the same scale to compare the empathic levels between the midwives and other health professionals; and, therefore, future studies need to target multiple informants. Finally, the results from this study might not be generalizable to all Chinese midwives, as we only collected samples from Guangdong province; the data are, therefore, not representative of all midwives in China. More studies are required to determine whether empathy is enhanced or suppressed during the important transition from a girl’s adolescent period to motherhood. Thus, replication of our research on midwives is a necessity for other provinces and countries.