We know two things that are proven ingredients to a healthy pregnancy are early booking and continuity of care (that’s regularly seeing a midwife – and ideally the same midwife). The absence of either of these things is seen as a risk.
Women who have recently arrived in Birmingham, such as those seeking asylum, are far less likely to be able to book quickly, due to them not being able to navigate the system in a new country – so being a late booker makes continuity of care even more important.
But continuity of care during pregnancy is difficult when asylum seekers are moved around so often.
The UK Border Agency’s policy of “dispersal” spreads asylum seekers around the country on a “no choice” basis, often moving people many times.
As well as the medical risks for pregnant women, there are the social risks of being moved away from their support networks. This can be socially isolating, but can also have an impact on their ability to get to appointments and understand what they’re being told.
Winta – a refugee from Eritrea – had only been in Birmingham for six months, but this was long enough for her to have formed relationships and make friends. She had joined a local church and her 11-month-old daughter attended a nursery. Winta had a regular midwife and had been going to antenatal classes, where she’d met other mums-to-be.
She shared a house just north of the city centre with another woman, also an asylum seeker. However, just three weeks before Winta was due to give birth, her housing provider decided to shut the accommodation down and move the two women elsewhere.
Under the policy of dispersal, asylum seekers are accommodated wherever there is “a ready supply of housing”. In Winta’s case, she was told that she’d be moving to Wolverhampton – a place she didn’t know at all.
She would have to leave all the support networks she’d formed – and instead start from scratch, finding a new GP, new midwife, new antenatal clinic and new nursery for her 11-month-old, in a city where she knew no-one and struggled with the language, when the baby could come at any time.
“She was due to move on the Monday, but I only found out on the Friday,” says Winta’s Pregnancy Outreach Worker, Jacqui. “So I had to move fast. I phoned the Refugee Council and explained the situation: she was three weeks from her due date – could they help me to find a way for Winta to stay, at least until the baby was born? They said they would do what they could.
“I explained to the housing provider that we were appealing the decision but, initially, they insisted that the move would still go ahead. It was quite a battle to get them to wait for the process to complete. Meanwhile, the Refugee Council had phoned the UK Border Agency, to be told we’d have to appeal in writing. So the Refugee Council had to write a letter and fax it over to them. Once that was done, we just had to hope the UKBA would take it from there. It was a stressful weekend.”
Why did this happen?
A recent report from the Refugee Council concluded that “
the UK Border Agency’s dispersal policies are putting the health of pregnant women and their babies at risk. By moving them to accommodation around the county, women are uprooted from essential healthcare and their support networks, leaving them isolated and vulnerable.”
Guidelines introduced by the UKBA last year already stipulate that
pregnant women should not be dispersed within a protected period; normally from four weeks before the estimated date of delivery until four weeks after the birth. However, it doesn’t look like this is communicated in all circumstances.
Luckily for Winta, Jacqui’s intervention meant that the UKBA were able to act quickly enough to save her from a stressful move. The housing provider told her she could stay in the house until the baby arrived.
A few days after the baby was born, the housing provider told Winta that they still wanted to refurbish the house. But instead of moving her to Wolverhampton, they found her another shared house, just a couple of miles away. Winta now lives with another woman who has a baby – and has been able to keep in touch with the support network she already had.
“I’m so pleased for her – they get on brilliantly,” says Jacqui. “I’m glad she was able to get the continuous support she needed.”
The Dignity In Pregnancy campaign
The Refugee Council has produced a short film about the risks facing pregnant women in the asylum system in the UK: Dignity in Pregnancy for Asylum Seeking Women.
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.
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.
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.
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.
Being a parent for the first time can be daunting….
Mohammed and his partner Leah are both under 19 years old and have just become proud first time parents to a baby girl.
Mohammed is a full time student studying sports, Mohammed said ” I was scared when I found out that I was going to be a dad, as I did not know what was expected of me to become a good dad”.
Pregnancy Outreach Worker Dee helped and supported Mohammed in making him understand what is entailed in becoming a father. Dee enrolled Mohammed onto Parent craft classes in order to help him understand how to bath and change a baby, how to hold a baby, the benefits of breastfeeding and much more.
Dee helped and supported Mohammed and his partner in various ways, such as; by practically taking them to their appointments in his car, enrolling Mohammed onto Parent craft classes in order to help him to educate himself in raising his baby to the best of his ability. Dee also helped Mohammed in finding a job by referring him to the Concorde centre which is a youth organisation, to help people with voluntary work.
Mohammed is a lot more confident in looking after his baby and is very proud to be a dad, Parent craft classes have increased his confidence and ability to become a dad. Mohammed said he can know tell his friends that being a dad is not so difficult.
Always keen to be up to date on what is going on in their local area, 2 of Gateway’s
Pregnancy Outreach Workers accompanied their clients to have a look around at the new facilities for mums at the Women’s Hospital in Birmingham to see what mothers-to-be can expect during a very special time in their lives.
The Birthing Room -
Complete with gas and air, there is also a private bathroom and kitchen area for mothers to enjoy in privacy. Mums also have access to exercise equipment to help them remain healthy ready for their labour.
There is also a seperate quiet area for when things get too much!
The Birthing Pool
And for mothers who have decided to take the water birth option, there are new birthing pools, complete with sensory lighting to make the whole experience a little less intimidating.
The atmosphere, described by our pregnant moms as less sterile and more homely, means that women have more chance of feeling relaxed and prepared, ready for their big day .
Colette was supporting a client who was using drugs and alcohol. Her dad had been an alcoholic and her mum left the family when she was very young. She also had a brother who was using drugs.
After her dad died she took over the tenancy of what had been the family home for 30 years. It had never been decorated or had a repair in that time so was in a bit of a state.
Colette visited the client on a weekly basis. She has a lot of issues to deal with so Colette broke them down in to small chunks and dealt with them based on the clients need.
Colette supported her to attend appointments both medical and social, she would meet her at the hospital or at case conferences. When they were at core group meetings the client and her partner would get upset when everyone was talking about their case. They were at risk of Social Services removing the baby at birth.
Colette worked hard to get the housing to fix the repairs such as, fitting a new kitchen, installing a new boiler and getting the steps at the front of the house repaired.
Once the repairs had been done the couple started to redecorate and this is when Colette started to see a change taking place. The client’s partner went into rehab and she stopped using drugs and alcohol. They have kept their baby and would not have achieved this without Colette’s help.