When you’ve got low self esteem and you’re trying to face lots of problems, giving up control of your life can be a tempting option – you just want someone to come in and make it all OK. But, unfortunately, there are no easy solutions. It’s rare that things go away or get resolved without making changes to your lifestyle… but to do this, you need to believe in yourself – and there we are, right back at the beginning, as self belief is something that you don’t have.
So how can Gateway’s Pregnancy Outreach Workers Service help people to break this cycle?
Admitting that you need help is a really positive step, but you have to be prepared to work towards the life you want, too. So our POWs are trained not just to give practical advice, but to help women take control of their own lives in order to move forward.
Saira was referred to the POW service by her midwife. She and her husband were living in a flat above a shop after having to move out of a shared house. But the flat was full of mice and cockroaches and its only access was via slippery fire escape steps.
Saira was clearly suffering from depression and low self esteem. In a recording made by her POW, Maria, it’s clear she didn’t believe she had any control over her situation. She says: “I’m pregnant; I have no family support. I don’t know what’s going to happen right now. It’s dangerous living here, but what can I do?” In a quiet voice, she asks, “Is there anyone out there who can help me?”
During Maria’s first visit, she explained to the couple how they would need to work together to sort things out. “I took them aside separately and said ‘we all need to work at this, and you will need a lot of patience, because it’s going to take time’,” Maria says. “No-one has a magic wand.”
Like many clients, Saira says she liked Maria because she felt that she wasn’t judging her. Maria’s help was practical and without prejudice.
“On the first visit, I phoned around and we started to apply for the various things that they were entitled to and needed to sort out,” Maria says. “For example, Saira had put off applying for income support because she thought it would affect her partner’s finances, so we worked that out, and got him to apply for working tax credit.”
But, as they unravelled some of the financial issues, Maria was also working towards raising Saira’s self-esteem.
For example, Saira was so self-conscious that she didn’t want to go to antenatal classes. She said she felt fat and didn’t want people to see her. Maria’s approach was to try and make her feel better about her body image in other ways. “I asked her to send me photos of herself on the days that I didn’t visit her – just for my benefit, so I could she she was OK,” she explains. “In the first few photos she sent, she’s looking down at the floor, but after a few weeks she’s smiling and looking into the camera. She’s starting to feel better about herself; she doesn’t mind the idea so much.”
They talked about the future. “I asked her to think about what she wants to achieve in life,” says Maria. “It’s something that many women forget to think about when so much else is going on. She told me lots of things, but I helped her to see that what it boils down to is taking more control. So we talked about that. I got her to realise that she is already very powerful – after all, she had carried a baby! – and we discussed how she must make sure to retain that feeling of power when she deals with everyday situations.”
Since Maria’s first visit, which was almost six months ago, Saira’s depression has started to lift. Now that they have split the practical issues into more manageable chunks, she is finding the confidence to ask for help with the things she needs. She asked a friend to help with the deposit on a better home – something she hadn’t wanted to do before. She’s making phonecalls herself. She takes her baby out and about to clubs and support groups and is even talking about going back to work.
“She doesn’t wait for permission as much as she used to,” Maria says; “she speaks out a bit more. And she’s gone from feeling tired, exhausted – and even threatened, worrying that her baby will be taken away – to realising that she is a good mom.”
In this audio clip, you can hear how Saira’s language has changed from where she was at the start. Rather than hoping that someone will step in, she talks about specific issues and sounds far more active. There’s still a lot to sort out, but she’s in control and – with support – she’s prepared to work for it.
listen to ‘Gateway Family Services: Saira’ on Audioboo
Some of the women our Pregnancy Outreach Workers (POWs) support are what we refer to as “complex clients”. They have many issues – they may be drug users or victims of domestic violence; they may be homeless – and so they tend to have had many interventions, usually over many years, from multiple agencies.
So how does a POW begin to build a relationship with a complex client?
Flexibility, availability, consistency
One of the main benefits of the POW setup is its flexibility. Sarah Samersinghe, a POW who has had some memorably complex clients, explains:
“As a POW, I can go to the client – she doesn’t have to come to me. If it’s not appropriate for me to visit her at home, I can meet her elsewhere, or pick her up in the car and take her out. And I’m always available; I don’t expect to only speak to clients at appointed times.”
Consistency is very important, especially when clients have otherwise chaotic lifestyles. “It’s important to do what I say I’m going to do,” says Sarah. “If I say I’m going to be there, I’ll be there.”
Pitching it right
How does she attempt to connect with women who find it difficult to trust new faces? How does a POW help a frightened woman to make quite dramatic lifestyle changes?
“It’s about trying to read people,” Sarah says. “Pitch it right. Choose your moment. When someone’s ready, they’re ready – you’ll just know. The way I personally do this – and not all POWs do, of course – is to talk about my own family; to find elements of my own life that chime with theirs. It often allows me to identify with the client – to show that we’re human too.”
The flexibility of the role means that the POW isn’t necessarily restricted by a time limit for each case.
“Our aim is a healthy outcome for all concerned,” Sarah says. “So if I can justify it, I’ll keep the case open for as long as I feel is necessary to achieve that. For example, a social worker might have to close a case once a child is placed elsewhere, but I feel fortunate that my role allows me to stay with the mother.”
Case study: Hayley
One of Sarah’s most complex clients is Hayley (not her real name).
“Hayley’s had many issues but, when I met her, the main problem was housing. The flat where she lived was pretty much uninhabitable. It was cold and dark all the time and the building was infested with rats and mice. There was no gas supply, and the wiring was downright dangerous. There was no way of cooking, or even making a hot drink, and there was only cold water to wash in. Not good for anyone, but particularly not for a pregnant woman.”
However, the flat, owned by Hayley’s boyfriend, was her home – and it wasn’t easy for her to make the decision to move away. She was scared.
It took a long time for Sarah to persuade Hayley that she should apply for temporary accommodation elsewhere. One day she finally agreed, largely because the weather had become very cold.
In the video below, Sarah and Hayley are on their way back from the appointment with Housing Services to pick up Hayley’s ID and other paperwork she needed for the move to go through. Hayley reflects on how far she’s come. And, poignantly, she tells Sarah that she thinks this is the type of support she’s always needed.
POWs can support women all the way through their pregnancy and then for a short time post natally (usually a maximum of 8 weeks). In total the support can last for almost a year. This gives the POW the time they need to tackle the woman’s issues, but equally it gives them the opportunity to forge a useful and trusting relationship.
However they always have an eye on when their support will end – and much of what they do is to prepare the woman for this. Ideally she will be on a more stable footing and well able to be independent. For some women the journey is longer so there will still need to be a support network in place that adequately meets her needs. The aim to to ensure there is a seamless transition and that she doesn’t get lost in the system.
Michelle POW Programme Manager explains; “Ideally handover is something that is thought about before baby comes along. We like to ensure that every woman has at least one professional to turn to, should they need them. Frequently the handover is to a Family Support Worker so what we’ll try and do is arrange a visit to the local Children’s Centre while mum is still pregnant. Not only do they get to meet their Family Support Worker and begin to establish a relationship but they see what’s on offer and what they can tap into, so classes, groups etc.”
Michelle continues: “Sometimes mums-to-be, particularly those pregnant with their first baby, may worry about where to get support if they should need it once the POW is no longer around. This shows them that it’s there. It’s one less thing to worry about. It also means that they get familiar with the facilities before baby comes along, which is always a busy time, and it won’t all be new to them.”
Natasha’s coming to the end of her support from Rachael, her POW. She’s made real progress and it’s hoped that in a few months she’ll be ready to apply for her own house so she and her baby can live independently. For now, though, Rachael feels Natasha still needs some extra help – which is why she’s introducing her to what her local Children’s Centre can offer – and Natasha’s already applied to do their Positive Parenting course.
Some of the women we support are going to need more help than others. In many cases the POW has been able to solve the problems the woman was referred to us with, but in some complex cases this isn’t possible. In this situation it’s about working in partnership with other professionals and ensuring that everyone knows the part they have to play.
Miriam, one of our POWs, has concerns about one of the women she’s supporting: “She had her baby six weeks ago but due to some recent changes both she and I feel she needs some specialist help. So I’m going to initiate a CAF (Common Assessment Framework). I’m just filling out the paperwork to get things underway because my aim is to make sure the initial meeting happens before my support ends. I’d like to see who’ll be responsible for doing what and make sure someone takes over the role I’ve been doing which has been sort of co-ordinating things”
Michelle adds: “It depends on the woman. We take a lead from her and how well she’s coping. What is set is that handover must happen. There are things we do as part of it that are standard, like making sure mum knows how to register the birth, that she’s getting the benefits she’s entitled to and that immunisations are booked in, but what support remains is a unique thing; it’s tailored to the individual.”
In the last quarter of 2012, 65 babies were born to clients of our Pregnancy Outreach Workers team, and 55 of those women initiated breastfeeding.
That’s 85%, compared to an average of 65% in the wider community*.
In December alone there were 17 births and 16 of the women initiated breastfeeding – a whopping 93%.
Increasing the rate of breastfeeding is something that’s important at both a national and local level, so we’re delighted to be doing our bit to reach the city’s targets.
Most clients want to breastfeed – they know it’s the natural thing to do and the benefits it brings – but sometimes they need just that extra bit of help. That’s why all of our POWs are trained in breastfeeding support as part of
Unicef’s Baby Friendly Initiative.
Before the baby arrives, POWs give their clients lots of information, including leaflets and DVDs from the World Health Organisation and Unicef. Often, POWs will watch the DVD with the client so that they can explain or interpret it, talk about it and answer questions. We also run group sessions where POWs can demonstrate different breastfeeding techniques using dolls.
Sophia and Khadijah run a session at Springfield Children’s Centre. “It’s a six week course, where we show the DVD and give out handouts, as well as giving demonstrations of things like how to help baby latch on,” says Sophia. “We answer questions and discuss worries so that the mums are as prepared as possible. Then, for up to eight weeks postnatally, we visit mum and baby to give some extra support when they need it most.”
In this video of a typical breastfeeding group session run by the POWs, Colette uses a doll to show some different techniques for breastfeeding:
Another POW, Jacqui, says, “At the time of the birth, breastfeeding support is vital. We find that if the mother doesn’t get enough help and encouragement straight away, in the hospital, she’s more likely to start bottle feeding. That’s where POWs can really make a difference.”
Jahanara’s client had her baby on Sunday. “I was her birthing partner,” she explains. “Before the baby was born, the mum had told me that she wanted to breastfeed; this is her second child and she’d already told me how difficult she found it when she bottle fed her first baby. So I knew it’s what she wanted – but, after giving birth, she was so tired, she just didn’t want to do it. She wanted to give the baby a bottle. So I gently reminded her of everything she’d talked about before, and encouraged her to try again. Now she’s very happy to be breastfeeding.”
*published average breastfeeding rates for 2012 in the wards we cover. Source: Birmingham Public Health Health Inequalities Action Plan 2012.
Pre Natal Infection is one of the major causes of infant mortality. Our Pregnancy Outreach Worker Service (POWs) works hard to reduce infant mortality here in Birmingham, so today, the first day of Pre Natal Infection Prevention month seems the ideal time to explain what we do to help.
If women miss their ante natal appointments they and their babies are at more significant risk. We see that part of our role is to get this message across but then it’s about taking practical steps to make sure they get there. Many of the women we work with have missed appointments, in fact this is one of the reasons midwives refer people to us as they know we can be relied upon to tackle this issue. We understand why what appears to be a routine thing can be a problem for some women. Recognising the issues helps us put in place practical steps as Shazia one of our POWs explains:
Over the past 6 months we have supported 150 of the women we work with to attend their ante natal appointments, whether that be by helping them get them booked in, ringing them the day before to remind them, explaining in advance what they can expect, or accompanying them to give them some morale support (even giving them a lift if they’re stuck for transport).
The last few weeks have seen Gateway staff go into overdrive collecting food and other essentials for our food banks. We’ve been overwhelmed by the generosity of our donors, including many of our partner organisations, like Narthex, Healthy Minds and Birmingham Registry Office, as well as our own staff and members of the public.
In the video below you can see how Gateway staff used many of the donations to put together personalised Christmas hampers for their clients. We also hear from Shanaz, with her new baby, talking about what the donations mean for her.
The hampers include food, but also essentials such as toiletries, nappies and baby clothes; and some small wrapped gifts, so that older children have something to open on Christmas day.
The arrival of a baby should be an exciting time and something to celebrate, but financial issues can make it a time of worry. For families below the breadline, having a baby puts a immediate pressure on already unmanageable finances, so we want to do what we can to ease these concerns. Whether the situation is short term or not, a one-off parcel like this provides food and other essential items to bridge a gap.
“Equality of opportunity” doesn’t just refer to having enough money or food; we think everyone has the right to be happy, too. We hope that by providing some practical help, along with the emotional support that our Pregnancy Outreach Workers already offer, we can take away some of the stress and give families the chance to enjoy bonding with baby.
In the run up to Christmas, there’s been a lot of talk of food banks in the press and on the television. Although there are quite a few food banks across Birmingham, Gateway’s is slightly different.
Often, heavily pregnant women and women with young children can find it difficult to do the food shop – many don’t have access to a car, so it means carrying everything on the bus. Then, of course, there’s the cost.
Our pregnancy outreach workers, who visit young mums and mums-to-be, can often find out at the last minute that their client is going hungry. Sometimes a POW will make a visit to a new client at 4pm on a Friday and only then find out that she’s going to be hungry over the weekend.
So our food bank is in the office and immediately accessible to POWs for use in an emergency. They’ll put together a couple of meals from whatever’s on the shelves to take back to the client. Often staff will complement this by donating fresh goods – milk, bread, fruit and veg – themselves.
Like most food banks, our shelves are stocked by donations. Most are from our own staff. Some are from staff at other organisations. We also appeal via Facebook and Twitter and are very grateful for donations from friends and members of the public.
Our wish list: not just food
The bulk of donations that we get are non-perishable foodstuffs. These are vital, of course, because they might need to stay on our shelves for more than a few days. When they’re given out, they may have to last a family over a weekend. We are always grateful for cans and cartons of long-life food and drink.
It’s also non-food items we’re desperate for. Our mums-to-be, getting bigger by the day, and new mums, recovering from childbirth, are often short on other essentials.
On our current wish list are:
Maternity clothes – we’re crying out for these!
All types of toiletries (shampoo, shower gel, toothpaste) and toiletry bags to put them in
We try and make it as easy as possible for people to donate. If someone offers a donation, but can’t get over to our offices in Edgbaston, we will go out and pick it up.
And any donations that Gateway can’t use – for example, the types of toys that need to be safety checked before we can give them away – are sent to Narthex at St John’s Anglican Church in Sparkhill. (Here we should mention what a great partner Narthex is. They run their own food bank so, if we are low on stocks, we will often nip over to them – or even send the client into there to pick up a parcel.)
If you think you might be able to help by donating, give us a ring on 0121 456 7820.
And if you’d like to read more, Gateway’s food bank was featured in the
Birmingham Mail and on ITV Central News in April.
Pregnancy Outreach Workers have been supporting women for many years. Over this time they have supported them with all sorts of problems. The key thing is that they are able to listen to what the real barriers are, help to overcome them and stay with them throughout – that is why the service is really led by the pregnant women themselves. We asked some of the women to share their experiences with us – their lives are complex and difficult and it’s important to hear another perspective.
Pregnancy Outreach Workers, or POWs, provide support to women for their social and emotional needs. Social needs can mean anything from a little housing support, to very complex issues such as child protection or domestic violence.
One of the areas in which we offer support is attending appointments, both medical and non-medical. By supporting clients to attend their medical appointments we can ensure that they are receiving the best medical care for themselves and the unborn baby. In this video, Farzana is going to a hospital appointment with her client.
Some of the women who are supported to attend appointments lack confidence to attend by themselves, or need someone with them who can explain what is happening during the appointment. Some of the women are isolated and do not have anyone who could accompany them to hospital or other non-medical appointments. The POW acts as a befriender in these situations so that the woman does not feel like she is alone.
Many of the women that we support are in financial difficulties, for any number of reasons – it could be a delay in benefits, or moving from a paid job to benefits, or having no recourse to public funds. As a result, some pregnant women can go days without food; especially those who are isolated or estranged from family.
Gateway Family Services operates a
food bank of non perishable items. We rely on donations to the food bank. In the video above, Farzana delivers a food parcel to one of her clients who was in desperate need of some help. As you can imagine, being pregnant and hungry is very unpleasant; not to mention the effects that this could have on the unborn baby.
These are just a couple of the things that POWs do every day. No two days are the same, just as no two cases are the same.
We have been working with pregnant women in Birmingham over a number of years. Many have difficult and complicated lives and while we primarily want to support them, we also want to help people understand how systems and services can let them down at times. In particular we want to urge commissioners, policy and decision makers to examine if their services really support people who have greatest need.
Pregnancy Outreach Worker service is increasingly showing us where there are gaps in services, these gaps lead to exclusion, inequality and injustice. The picture we see is in contrast to the Troubled Families Unit report - which was compiled after talking to 16 families in poverty. This report does not challenge services but does seem to lay blame firmly at the door of the poor.
I reviewed the case of a current client we are working with, her circumstances prompt a number of questions about the way support services are structured :
Jodie was referred to us when she was 14 weeks pregnant, 22 years old, living in a hostel, an unplanned pregnancy, the father unwilling to be involved. Jodie suffers from depression and self-harms, she has debts and is on medication. Her baby is due in December – her life is chaotic.
Jodie was referred to mental health support service by her GP, however she did not turn up for several appointments and so was discharged from their service. She has not seen her named Midwife in 4 months.
Jodie has mental capacity and therefore does not meet the definition of a Vulnerable Adult, which would entitle her to support from Adult Social Care.
Jodie’s baby is unborn and does not have a Social Worker involved – the baby, when it is born, may generate Social Worker involvement.
Jodie has been re-housed but does not have any money for food – she is in receipt of food parcels
Jodie’s chaotic lifestyle did not start when she became pregnant and will not end when the baby is born – It appears that statutory support services will begin when the baby is born and considered at risk or in need. The work we are doing with Jodie is to prepare her for parenting and being able to support a child, but crucially to understand causes of her chaotic life. We are examining the gap with what is available to her and why she is not engaging with services.
We believe that investing time in her may prevent her child becoming at risk or in need. Our aim ultimately is that Jodie and her child will be able to function well as a family unit. - Jodie is one of over 200 pregnant women we are currently supporting in Birmingham
(names have been changed)
Nina Matthews Photography