Norwegian midwives' perceptions of their practice environment: A mixed methods study.

Psychometric analyses yielded five subscales: Quality of management; Resource adequacy; Midwife-doctor relations; Opportunities for development; and Midwifery foundation for care. Content analyses identified four main themes: Lack of resources; Insufficient support; Staying in midwifery; and Lack of influence. Subthemes only found in the qualitative analysis were as follows: Fear of adverse events and The strain of shift work. Most midwives rated the PES subscales Midwife-doctor relations and Quality of management favourable. In contrast, the theme Lack of influence showed that midwives felt powerless in a constantly changing work environment and ruled by the medical model of care.