Background The majority of maternity care is provided in the community, yet there is little information regarding the workload, stress level and performance of the community midwife (CMW).

Method Survey of 278 CMWs serving six large maternity units with a total annual birth rate of ca. 35 000. Anonymous, semistructured questionnaires were used to obtain both quantitative and qualitative data.

Results 213 questionnaires were returned (response rate 77%). The average caseload of respondents was 154. High or very high stress levels were reported by 118 respondents (57%). They also tended to have long working days, with an additional 5 h worked per week. 97 (47%) were dissatisfied with support received from their own Trust. Many expressed difficulty in performing well, achieving only a suboptimal level of service for the women they were caring for: only 63 (31%) felt able to prepare women appropriately for birth and 113 (54%) thought that they were able to give sufficient support to breastfeeding mothers.

Conclusion CMWs appear to work under substantially high caseloads, which in this survey was more than 50% above the recommended level.1 This was associated with long working weeks, high stress levels and a feeling of insufficient support from the employing Trust. There was a wide perception by CMWs that the level of care they provided was suboptimal as a result. Quality maternity care requires better attention to appropriate workforce levels and support for midwives working in the community.