‘We Have No Choice’: An ethnographic study of emotional labour among midwives in first-referral hospitals in South Africa
1
Public Health, University of the Witwatersrand, Parktown, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1723
ABSTRACT
INTRODUCTION:
nurses and midwives working in first-referral hospitals in South Africa occupy a critical position in maternal and newborn care, yet they do so within constrained health system environments marked by staff shortages, high workloads, and resource scarcity. emotional labour is a central yet under-examined component of quality maternal and neonatal healthcare in these settings, with implications for health system resilience.
METHODS:
this ethnographic study draws on the 2025 baseline study conducted in five sentinel hospitals across five South African provinces as part of a larger multi-country health systems research project. methods included participant observation in maternity and neonatal wards, assistance with health workforce survey administration, and publicly expressed reflections from nurses and midwives. data were analysed thematically, with attention to how emotional labour is shaped by institutional contexts and everyday clinical contexts.
RESULTS:
nurses and midwives described emotional labour as an unavoidable aspect of their work, often expressed through the recurring expression, “we have no choice but to do it.” they were required to manage fear, grief, and moral distress while simultaneously performing composure and compassion during high-risk and traumatic clinical situations such as stillbirths, neonatal deaths, and obstetric emergencies. systemic inequities, including chronic understaffing, limited managerial support, perceived unfairness in professional development opportunities, and resource inadequacies, intensified emotional labour. the phrase “we have no choice” reflects constrained agency, functioning both as a coping mechanism and highlights the systemic pressures embedded in daily practice. the cumulative nature of emotional labour contributed to exhaustion, moral distress, and ongoing psychological strain with implications for workforce retention and the sustainability of maternal and neonatal services.
CONCLUSIONS:
health policy responses must move beyond resilience-focused narratives to address the structural conditions that compel nurses and midwives to carry emotional burdens. this includes investment in adequate staffing, supportive supervision, and enabling practice environments.
nurses and midwives working in first-referral hospitals in South Africa occupy a critical position in maternal and newborn care, yet they do so within constrained health system environments marked by staff shortages, high workloads, and resource scarcity. emotional labour is a central yet under-examined component of quality maternal and neonatal healthcare in these settings, with implications for health system resilience.
METHODS:
this ethnographic study draws on the 2025 baseline study conducted in five sentinel hospitals across five South African provinces as part of a larger multi-country health systems research project. methods included participant observation in maternity and neonatal wards, assistance with health workforce survey administration, and publicly expressed reflections from nurses and midwives. data were analysed thematically, with attention to how emotional labour is shaped by institutional contexts and everyday clinical contexts.
RESULTS:
nurses and midwives described emotional labour as an unavoidable aspect of their work, often expressed through the recurring expression, “we have no choice but to do it.” they were required to manage fear, grief, and moral distress while simultaneously performing composure and compassion during high-risk and traumatic clinical situations such as stillbirths, neonatal deaths, and obstetric emergencies. systemic inequities, including chronic understaffing, limited managerial support, perceived unfairness in professional development opportunities, and resource inadequacies, intensified emotional labour. the phrase “we have no choice” reflects constrained agency, functioning both as a coping mechanism and highlights the systemic pressures embedded in daily practice. the cumulative nature of emotional labour contributed to exhaustion, moral distress, and ongoing psychological strain with implications for workforce retention and the sustainability of maternal and neonatal services.
CONCLUSIONS:
health policy responses must move beyond resilience-focused narratives to address the structural conditions that compel nurses and midwives to carry emotional burdens. this includes investment in adequate staffing, supportive supervision, and enabling practice environments.
| eISSN: | 2654-1459 |
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