I’ve had my eyes opened recently to the reality lived by pregnant, asylum-seeking women in Britain. A year ago I volunteered for a Cardiff-based organisation, Birth Partners, whose aim is to provide a companion during birth for women who have no one to accompany them during birth. Almost all of the women referred to us by the specialist midwife are recently arrived asylum seeking women.
As a birth activist, I’m not a midwife or a doula. Most of my experience of childbirth, apart from my own three births, is very far from hands on. So I’ve had a crash course during this year in how to make a relationship quickly, create an instant antenatal course through pictures (photographs from Becky Reed’s Birth in Focus being a favourite), become a sensitive birth attendant and support a woman for eight weeks afterwards. A typical memorable moment has been disbelief when trying to explain the use of birth pools in the local unit over Google Translate while using the Albanian word for swimming pool. My knowledge of the maternity services gained through hundreds of hours of committee work, reading and listening to women has now been supplemented with first hand observation of the maternity services dealing with some of the most vulnerable women in the system.
When I came across an article on the views and experiences of asylum seeking women on UK maternity care I read it with great interest. The paper, by McKnight et al (2019), is a meta-analysis of studies which identifies six themes, grouped under the headings: communication challenges, isolation, mental health challenges, professional attitudes, access to healthcare, effects of dispersal and housing challenges. In many ways it echoes my own observations.
Communication is obviously crucial. I’ve been enormously relieved to see an interpreter arrive, and technology helps (and sometimes hinders), but the real key in childbirth is the presence of a familiar, kind person, ideally for most women a known and trusted midwife.
"Midwifery care and relationships with midwives were regarded by participants as predominantly positive, particularly in community and specialist services settings (Feldman, 2013; McLeish, 2005). The overwhelming experience of midwifery care reported was one of kindness (Briscoe and Lavender, 2009, Lephard and Haith-Cooper, 2016; McLeish, 2005; Nabb, 2006, Phillimore et al., 2010) with one woman likening her midwife to a member of her family (Lephard and Haith Cooper, 2016). Women reported a desire for midwifery care (McLeish, 2005) and described how this care acted as a factor in relieving feelings of loneliness (Lephard and Haith Cooper, 2016), in feeling less stigmatised (Nabb, 2006) and in being made to feel more comfortable (Briscoe and Lavender, 2009)." (McKnight et al 2019).
That's also why our presence as birth partners can be so deeply comforting. But I’ve been saddened to see how the midwife’s role has been so whittled down and confined by the conveyor belt of the obstetric unit. I’ve watched while a midwife enters the room where a woman is in established labour and has to exercise her considerable skill in achieving rapport, becoming a reassuring professional companion, reading the woman’s cues, often non-verbal, and accompanying her through her birth all within a few hours from a standing start. It’s a huge testament to the professionalism and dedication of any midwife that she can achieve so much in so little time but a desperate shame that she has to. On the postnatal ward I’ve watched while midwives have been unable to help women as they want to because they have to look after too many women with too little time to realistically be able to meet those women's need and that is also a tragedy.
The other themes are also very clear in our work except for the access to health care. We are in Wales and one of the ‘clear red lines’ that has been established since the Assembly was created is an attitude towards providing health care as a free and universal right that extends to asylum seekers too.
Overall, the review highlights that,
"It would appear there is much maternity services could do to improve access and the experiences of this isolated group. There is limited good quality research in this area and further research is required to examine women's experiences at different stages of the asylum-seeking process and the effectiveness of specialised services in improving access and clinical outcome." (McKnight et al 2019).
Migration is now a massive global phenomenon and will increase. This paper is a welcome and useful summary of work done in this field. More of us will need to know how to help in the future.