Exploring working conditions and job stability of midwives in Spain: results from a National Survey

Background Midwives are essential to perinatal care in Spain's healthcare system, with roles expanding due to demographic changes to encompass technology integration, multidisciplinary collaboration, and pharmacotherapeutic management. Challenges persist, including suboptimal remuneration, competency misalignment, and employment precarity (92.7% temporary contracts in 2024), aggravating professional dissatisfaction, reduced job satisfaction, and well-being deficits. Influential factors include workload, contractual stability, and work–life balance, emphasizing the imperative for empirical analysis of labor conditions. This study describes midwives' perceptions of Spanish work environments and assesses contract-type variations. Methods We conducted a cross-sectional, quantitative survey of registered midwives in Spain using a self-administered, 23-item web questionnaire (five domains) on EUSurvey to assess working conditions, capturing demographics, job characteristics, training/competence, and entitlements, and evaluating differences in professional perceptions by contract type. Results Of the 2,499 responses, 2,310 met the requirements (27.8% of practicing midwives in Spain). The majority worked in public hospitals (66.1%); 43.4% had permanent contracts, a figure that increased with age and experience. Temporary contracts, more common in the private sector, were associated with lower salaries and less salary satisfaction (4.0–4.1 vs. 4.6/10; p < 0.001) and greater exposure adverse employment actions due to staff shortages (requests for off-hours shifts: 90.2%, denied leave: 55.4%, approved leave canceled: 22.8%; p < 0.001). Role intrusion was frequent (77.1%). Despite widespread participation in continuous training, only 15.8% felt fully competent in all core competencies. Conclusions Temporariness and staffing shortages worsen conditions, enable role intrusion, and reduce pay satisfaction. Despite accessible continuous training, key developed competencies remain unimplemented in the health system; job stability, adequate coverage, and equal opportunities to professional development are needed to protect quality and equity.