When maternity doesn’t matter: Dispersing pregnant women seeking asylum

This is an extremely important and eye opening piece of research. Much of the discussion that is entered into about maternity services focuses on the need for us to improve services from good to excellent. This report however shows very clearly that there are groups of women who are receiving care that is way below even minimum expected standards. The sad truth is that, as in other areas of health care, disadvantaged women experience the worst outcomes in pregnancy and childbirth. In this paper, the women who have provided their stories for the researchers are from the most vulnerable groups in pregnancy who actually need the highest standards of care if they are to experience good outcomes. Midwives and other health care workers know this and are doing their best to improve the care that vulnerable women receive but this report highlights that the system is working against them and failing to heed their advice or recognise their knowledge and expertise. It is shocking that in a country which, arguably, has one of the best maternity services in the world more is not being done to prevent such vulnerable women being denied high quality care.

High quality care in maternity services is about far far more than recognising major complications of pregnancy. Of course this is important but it is also about recognising the emotional component of pregnancy. Women need support in pregnancy. They need to be surrounded by a network of friends and family. They need stable and adequate housing. They need good nutrition, rest and exercise. Not only does stress and isolation impact negatively on the mother herself but it is now well known that it impacts firstly on the developing brain of the baby and secondly on the health of the baby after birth. A woman’s mental health impacts on her child’s future life chances. Our society has, I believe, a duty to both the mother and her baby to reduce the stress and anxiety caused by frequent dispersal of asylum seekers. This tears the woman away not only from her social network but from midwives with whom she needs to build a trusting and compassionate relationship.

All of these vulnerable women have social problems and many of them also have medical problems, such as HIV or other serious infections, complicating their pregnancy. When it comes to such disorders women need skilled input from multidisciplinary teams. It puts women at serious risk if they do not know who to turn to for care or if having started their treatment they find themselves having to form a new relationship with a new team. It is hard enough for those of us who understand the system well and are confident to negotiate these sorts of changes. Many of this group of women have little idea how services work and often will not speak English. If these women or their babies are not to suffer serious consequences we must offer them the chance of continuity of care throughout pregnancy and childbirth from a team who understands their needs.