by Helen Beecher Bryant, Project Officer, Maternity Action.
One midwife told of meeting a Chinese woman selling counterfeit DVDs on a street corner. The midwife could see that she was pregnant and tried to encourage her to come to the hospital for some antenatal care. The woman refused, and so the midwife would go to wherever the woman was, usually in a doorway, to provide the antenatal care. When it was nearly time for her to give birth, the woman went to hospital, gave birth, and then disappeared. Her baby was taken into care.
This was typical of the stories told to me by the many midwives I spoke to as part of the training needs analysis for Maternity Action’s project Improving care for refugees and asylum seekers. Over 60 interviews were conducted with midwives who work closely with these groups. The report
The information gained fed the development of a training course which is currently being rolled out to midwives across the UK and is now accredited by the Royal College of Midwives. There are two courses, an introductory course for all midwives, and an advanced course for those who work closely with refugee and asylum seeking women. Each course provides 5.5 hours of Continuing Professional Development (CPD) for midwives.
Clear themes emerged from the interviews. Language and communication continues to be considered a barrier to providing care, despite the availability of language services in NHS Trusts. Midwives reported being unable to access particular interpreters, or discouraged from using them due to budget implications.
Late presentation of asylum seekers and refugees was another clear theme. Midwives found that some of the women fear authority due to the persecution they have experienced in their home country from people in authority. Misconceptions about charging for care may also prevent asylum seekers from presenting for maternity care. Failed asylum seekers may fear deportation and therefore not present at all.
The asylum system is complex and some midwives consider the system itself to be a barrier. Midwives reported feeling frustrated that they were not sure about rights and entitlements, or what advice to give. Stories were told of the difficulties midwives experience when they have to discharge women with newborn babies, knowing that they may be destitute and have nowhere to go. Poverty and destitution is another barrier to providing care. Midwives told of having ‘whip-rounds’ to fund travel for destitute women.
Dispersal is also considered a barrier to providing care. The quality of communication between UK Border Agency (UKBA) and midwives varies considerably across the country. Some midwives have a very good relationship with the UKBA, whereby they have a named person to call and request information from. Others spoke of bad experiences of women not being where they are expected to be, and of being dispersed without notice, away from their communities, with a newborn baby.
Ultimately, midwives need more time to spend with refugees and asylum seekers, because they may be facing a series of issues which require specialist support. There is a profound need for more specialist midwives in this area, as asylum seeking women are often grouped into a category of ‘vulnerable women’, which covers numerous types of vulnerability.
None of the midwives interviewed had received any training on working with refugees and asylum seekers, hence the need for Maternity Action to deliver this training package.
barriers midwives face when providing care for these groups, on what can be done to overcome these barriers, and considers some examples of good practice from across the country.
If your maternity service is interested in hosting a course, please email firstname.lastname@example.org for further details.
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Contributor: Helen Beecher Bryant, Maternity Action
Photo credit: beror – Fotolia.com