Tag: pregnancy

Alone during pregnancy

We often talk about clients who are isolated, but you may be surprised at the number of women our Pregnancy Outreach Workers support who are alone during pregnancy. Many even face giving birth alone.

Living alone

Pregnant womanThere are many reasons that a person becomes isolated.

A lot of the women our POWs work with have recently arrived in Birmingham and have become removed from their family or friends. Many are fleeing war or violence in their home country and are obliged to take whatever housing they are given.

A large number of asylum seekers and refugees find themselves living with people they don’t know, and with whom they don’t share a language or culture. Anyone would find it isolating, but for those who are pregnant, it can be a particularly difficult time.

We have previously written about the ways in which pregnant asylum seekers and refugees are more at risk. The report When Maternity Doesn’t Matter concludes that social isolation, on top of the already complex social factors that women arrive with, means that they are at greater risk of perinatal death. So our support for vulnerable newcomers isn’t just a reaction to seeing people who need help – it’s proven that the right kind of support can prevent complications and even save lives.

For many women, the first thing POWs can do to help is often practical: making phonecalls and speaking to authorities and other professionals on their behalf.

Language is a big issue, but also understanding bureaucratic processes and systems, so it’s understandable that many people, especially those who’ve recently arrived, lack confidence, especially on the phone.

Catherine, one of the POWs, says, “the benefits system is hard to understand at the best of times, but with a language barrier it can be virtually impossible. It’s often a lot easier for the ladies to speak to us, face to face, and then for us to make the phonecalls or be there at meetings”.

When isolation is less obvious

For others, the isolation is not as immediately apparent. Catherine says: “many women I see are isolated despite living with other people. They may even live with their husband and extended family, but if they don’t have a bond and don’t feel that there’s anyone they can talk to about their pregnancy, they might as well be alone.”

Other factors that could cause someone to feel socially isolated also include mental health issues, or substance misuse. It is possible to be surrounded by people, but have no-one to rely on for impartial support.

Blossom’s client Baljit is from Pakistan and lives with her husband. During her pregnancy, the family had other distractions – they were going through the immigration process and looking for somewhere to live – so she relied on Blossom’s visits.

On the Impact Assessment App, Baljit said:

Because I am not from this country, I feel, although I have my husband, I can share problems with you. You help me, I am grateful, I don’t feel alone, I have a friend I can talk to.

Alone during the birth

POW Shazia has been a birthing partner for three of the women she’s worked with so far. All of them were alone or isolated in some way.

Kelly* was a drug user and, although she was in touch with her parents, they found it difficult to support her during her pregnancy, so her POW was an important influence. “Her mum found Kelly’s drug abuse very difficult, so their meetings were often very emotional,” explains Shazia. “It’s important to have some non-judgemental, honest, practical support at such a crucial time, and it’s not always possible for family to do that, however well meaning.”

In hospital and during birth Kelly was very emotional and often panicked, which could lead to her becoming violent. Shazia said, “I stayed with her at the birth because she found me to be a calming influence for her.”

On the day of the birth, Kelly gave this statement to our Impact Assessment App:

My POW was my birthing partner, she helped me through each stage. When I started to panic and think I could not go on she supported me and helped me through it.

Social isolation is hard for everyone who experiences it, but it’s especially hard for pregnant women. Most people have friends and family that they can turn to but, unfortunately, it’s not the case for all. At least for women in Birmingham who find themselves in this situation, we can go some way towards filling the gap.

*Names have been changed

Food and baby bank donations from Asda – thank you!


PLEASE NOTE: This blog post is from 2013 and we no longer run a baby bank at Gateway. If you have items to donate, you could try Birmingham Baby Bank Central.


asda1We were delighted to receive donations for our food and baby bank from two generous Asda stores this week.

Knowing that many of our POW (Pregnancy Outreach Worker) clients are in need of basic essentials, and to coincide with this year’s International Women’s Day, staff at Asda Cape Hill generously offered to organise an in-store food bank drive for Gateway.

Judah Griffith, who is a Community Life Champion for Asda, explained, “At the Cape Hill store, we wanted to celebrate International Women’s Day, which was on 8th March. Rather than just a day, however, we organised a whole week of activities.

“I was already aware of Gateway – they’ve helped me with my voluntary work in the past – so I got in touch and asked how we might best be able to help their POWS clients. Gateway responded with a list of items they’re most in need of and we got to work.”

Pregnancy Outreach Worker Caroline (second from right) with Asda's Community Life Champion Judah (right) and other Asda staff
Pregnancy Outreach Worker Caroline (second from right) with Asda’s Community Life Champion Judah (right) and other Asda staff

Staff at the Cape Hill store distributed leaflets with information about the POW service and asked customers to buy an extra item from a POW shopping list, which they could then drop in to a donations trolley on the way out.

The staff themselves then clubbed together to top up customers’ donations with their own, and asked their colleagues at the Small Heath store to do the same.

Thanks to the generosity of customers and staff, we now have some much needed parcels to give to our most disadvantaged families.

Where do donations go?

The donations have been made up into parcels which our POWs have already started taking out to their clients.

These food and toiletry parcels help us to help new mums and their families through particularly tough times.

There are lots of reasons that our POW clients find themselves in need of help to tide them over. Many women are eligible for benefits but experience delays in payment, especially during the move from Income Support to Maternity Allowance. Some women are between homes – fleeing domestic abuse, for example, or evicted from the family home. Some have fled their home country to seek asylum and have no recourse to public funds. All are trying to give their babies the best possible start despite their own vulnerability and needs, so a little help goes a long way.

We’d like to say a big “thank you!” to everyone who donated to the Asda drive.

If you’d like to donate…

We’re always very grateful for donations of food and baby essentials for our new mums and mums-to-be. If you think you might be able to help, please give us a call on 0121 456 7820.

"Thank you. The things you gave for the baby are going to come in handy as my claim for maternity grant was returned, so there will be a delay." - POW client Nikita
“Thank you. The things you gave for the baby are going to come in handy as my claim for maternity grant was returned, so there will be a delay.” – POW client Nikita

The things we find really useful for our food and toiletry bank are:

Tinned Food
Toiletries (baby/women)
Long life Milk
Dried spices

The toiletries that are especially appreciated include nappies and maternal sanitary pads, both of which are essential for new mums, but expensive to stock up on.

We also work closely with Narthex, who often provide food parcels to our clients. If you’re in the Sparkhill/Sparkbrook area and you want to give food to those in need, please consider taking donations to Narthex. We know they would be glad of them.

In fact there are many food banks operating in and around Birmingham.  If you’re interested in finding out more, The Trussell Trust have compiled a foodbank map showing what’s available.

Thinking About Sex Day

ladybirdsDid you know that 14th February is not just Valentine’s Day, but “Thinking About Sex Day”?!

Thinking About Sex Day was initiated by the Sexual Advice Association to encourage everyone to think about the physical and psychological issues surrounding sexual activity. The idea is that encouraging people to think about sex is the first step towards ensuring the public’s sexual health and wellbeing.

Gateway’s Pregnancy Outreach Workers often have to find interesting ways of tackling issues surrounding sexual health. Although it’s vital to make sure that clients are armed with the right information, it can be difficult to know the best way of approaching such a sensitive topic. So how do they do it?


All of our POWs are trained as C Card Scheme workers. The training means that, under this national scheme, POWs can give out free condoms to young people aged 13-24, together with the most appropriate advice.

We find that being able to give out free condoms is actually a useful communications tool. It makes it a bit easier to broach the subject of sex, as Sharon, one of our POWs, explains: “When I see a client for the first time, I put together a little pack that includes – amongst a lot of other things – condoms and contraceptive advice leaflets. Being able to give them this right at the start makes it a lot easier to revisit the topic once we’ve got to know each other a bit better.”

As the POW and client builds up a relationship, the client will often open up about more personal issues. The conversations can cover anything – not just about contraception and STDs, but also around the more emotional, psychological aspects of sex and relationships.

The advice is usually very practical. “If someone has moved on from one partner to another, that’s a good time to talk about contraceptive choices,” says Sharon. “The training we get is really useful because there is a lot more choice than there used to be – implants, for example – so we are able to give women the most up-to-date information.”

The support is practical, too. In many cases, that means making appointments on behalf of clients, or accompanying them to visit a clinic or their GP.


The birth is a good opportunity to tackle the myths around contraception. Many women believe that if they have just given birth, or as long as they’re breastfeeding, they’re less likely to get pregnant. In fact, the opposite is true – so POWs try and ensure that their clients are aware of the facts.

Similarly, there are often misunderstandings around the use of the pill. “A lot of the women I meet say that they were on the pill when they became pregnant,” says Sharon, “so I make sure to talk to them about using it correctly. Are they taking it every single day? Do they know that the pill may not work if they have been ill? Being sick and taking antibiotics can both affect the way the pill works.”


A lot of the work around sexual health involves signposting women to other services. Agencies and organisations like BRASH (Birmingham Relationship and Sexual Health Service) offer specialised advice and support, particularly for young people. Midwives, too, offer some very down-to-earth, practical advice for new mums. So POWs work closely with services across the city to make sure their clients are able to access all the information and support that they need.

Budget Consultation: is it asking the right questions?

Here is an extract from the Budget Consultation for Adult Social Care. This is the proposal relating to Gateway’s Pregnancy Outreach Worker Service (POWS):

Proposal 15: Public Health – decommissioning pregnancy outreach

This proposal is to stop funding initiatives around pregnancy support. These services have been running as a pilot for some time and are awaiting evaluation. These services could be supported through the Health Visitor expansion, a responsibility of NHS England. Pregnancy outreach is not a traditional responsibility of the local authority. The cessation of these services will affect the most disadvantaged communities.

Question: Unless the evaluation shows good outcomes, should we decommission these services?

There are two important points I’d like to make about this consultation.

The first is that it refers to POWS as a pilot. The Pregnancy Outreach Worker Service is a contracted service that is performance-managed against a clear set out outcomes. It has been running for seven years and has consistently achieved its contract outcomes.

The second point – my main concern – is about the question you are asked to answer:

Unless the evaluation shows good outcomes, should we decommission these services?

It’s natural to read this and think, “of course a service should be decommissioned if it’s not shown to achieve good outcomes”. I certainly would. But is the public getting the full picture?

The outcomes in our contract cover things like safeguarding, housing, domestic violence, substance misuse, alcohol use and debt management. And we prove, every month, that we deliver on these.

In fact, we place so much importance on measuring our outcomes and impact that we devised a management information system for POWs, based on multiple national outcome frameworks for pregnancy and birth. This includes an Impact Assessment App that gathers direct feedback from the women we help.

But what is “the evaluation” the consultation refers to?

The evaluation that the question refers to – the evaluation upon which the future of POWS will depend – is a Randomised Control Trial (RCT) that took place in 2010-11, the results of which are not yet available.

An RCT, by its very nature, is a clinical trial. Generally, RCTs are set up to assess the effectiveness of medical interventions: drugs, or medical procedures. This one tested the impact of POWS on clinical, more than social, outcomes; things like postnatal depression, whether a mother had suffered an episiotomy tear during the birth, method of delivery (C-section or forceps) and length of stay in hospital.

But POWS is not a clinical service. The RCT couldn’t, and didn’t, cover social interventions … so it doesn’t measure the vast majority of the outcomes the POWs are contracted to achieve.

Why is Birmingham Public Health using an RCT to evaluate the Pregnancy Outreach Workers? Well, it’s the only type of trial they have – it’s the only evaluation method that has the required “academic rigour”.

I understand that RCTs are the gold standard for clinical research, and that the results will have academic rigour. My concern is that other evaluation methods, particularly those that assess social outcomes that are known to increase the risk of infant mortality, should be taken into account. At the moment this is not being considered.

It’s also worth mentioning that we had to change the service to fit the requirements of the trial; it was restricted to first time mothers and we could only work with women already booked with a midwife. After the trial we were able to work with women who had had other children (many in care) and referrals from other agencies, such as hostels, refugee and asylum support services – but we were unable to do this during the evaluation period.

We’re still fulfilling our original aims

The Pregnancy Outreach Service was originally set up as part of Birmingham’s efforts to reduce infant mortality. Of course, no-one can directly reduce infant mortality; all you can do is to try and reduce the risks associated with a poor pregnancy. Some of the risk factors are things that we can’t do anything about, like the age of the mother – but some, like nutrition, or smoking, are factors we can address, so we concentrate on those.

We soon realised that there are social barriers many of our clients need to overcome before we can address their health issues – domestic violence, debt, or homelessness, for example – so we tackle those first and achieve our original outcomes via a slightly longer route.

risks Over the years the service has been running, we have worked collaboratively with commissioners to take these social issues into account and design our outcomes. The screenshot on the left shows just some of the current risks that our POWS are working with.

Reducing these risk factors is what helps to reduce infant mortality. And so, of course, we believe these are the outcomes we should be tested on when the future of the service is being decided.

All services commissioned by the council should be constantly evaluated and we are constantly evaluating ourselves. But it’s frustrating that the future of the service is dependent on one evaluation, which assesses us on a very small area of our work.

We WANT to be evaluated. We want to prove our worth. We deliver on our outcomes every month and we’re proud to show that. I’m not dismissing the RCT – it is important as part of a fair evaluation of the worth of the service. But we are so much more than this.

If you would like to give your views on POWS being decommissioned, you can take part in the Budget Consultation for Adult Social Care by filling in the online consultation questionnaire.

The Proposal relating to POWS is Proposal 15, on page 21 of the Budget Consultation 2014 pdf.

Birmingham Budget Cuts – we need your views

Public consultation on the budget cuts for Birmingham include cutting the Pregnancy Outreach Worker (POW) service in 2015. If you have a view on this, please contribute:


You can fill in the online survey here

Or use the public computers at one of the libraries

– Submit comments by text at SMS by texting ‘Budget’ followed by a space and your message to 07786 200 403
– Write to Budget Views, Room 221, Council House, Victoria Square, Birmingham B1 1BB

Baby banks – not just for Christmas


PLEASE NOTE: This blog post is from 2013 and we no longer run a baby bank at Gateway. If you have items to donate, you could try Birmingham Baby Bank Central.


Food banks have been in the news more than ever this year and recently the papers have picked up on the idea of “baby banks”, like ours, which collect and distribute baby products to families in need.

baby-parcelOur Pregnancy Outreach Workers have been busy this week making up Christmas hampers for their clients… but they don’t just give out parcels at Christmas. There’s an increasing need for donated toiletries, nappies and baby food all year round. Many families are on a low income that has stayed low as prices have gone up. Many are eligible for benefits but experience delays in payment. Some are between homes – fleeing domestic abuse, or seeking asylum. All are trying to give their babies the best possible start despite their own vulnerability and needs.

Here are some comments from clients who have been helped by parcels from our POW service over the last few months, whether that’s from our own bank of donations, or with a lift to one of Birmingham’s other foodbanks, like those at Narthex’s Sparkhill Food Bank or the Trussell Trust’s Birmingham Central Foodbank.

Making a difference – in our clients’ own words

In August, Daniele* said:

You accompany me to charity to get food parcel and baby things and which was very helpful thank you so much.

Diane* said:

today you came to my new flat that i moved into on saturday an brought me lots of baby things an a food parcel thankyou for everything you have done im realy greatful.

and Nishat* said:

You gave me book on pregnancy and leaflets on healthy diet. You have also informed me that you have been able to obtain a moses basket and will drop it of later. I feel so much better knowing that my child will have the necessary items. I was worried because i have left work and made a claim for benefits just recently. My claim is still being assesed and at the moment i have no money. You have been kind enough to supply me with a food parcel aswell. I feel so much better knowing that you are their to support me.

In September, Fozia* said:

Mariam came and brought me food parcel which is good as i have had no benefit for 2 weeks.she also brought me a moses basket changing mat, bath bouncer and clothes for baby thank you very much for everything

and Husna* said:

You gave me a food parcel. This has helped me so much as i live by myself these food parcels will last about a week. I cant thank you enough, now i can use the little amount of money i have to pay a instalment on the water, gas and electric bill.

in October Tamsin* said:

You went with me to Narthex for clothes and items for baby such as blankets, coat, moses basket, bath, baby gym, toiletries for my hospital stay, steriliser, nappies and changing mat. You also went with me to a charity shiop to buy a car seat and bouncer from gateway hardship fund. Thank you so much Miriam I do not know what I would have done without you’re support.

in November, Laila* said:

My benefit claim is still in process. I did not have much money, my pow has bought me two bags of food aswell as baby items such as clothes. God bless you all. In hard times you were there

and, just two weeks ago, teenager Gemma* said:

Im really worried about my baby being taken off me by social services. Im worried about everything and now I got to go behind my partners back and leave him. I’m scared but know its the right thing as my baby comes first. I haven’t got much money and today my POW gave me baby clothes, toiletries, blankets and food and I really appreciate it and making me excited for my baby to arrive.

hampers2Our baby bank is in demand all year round – but, at Christmas, we try and give some of our clients a bit extra with a Christmas hamper. The hampers contain not just food and baby essentials, but some gifts for mum and any other children in the family.

The bank holidays and delayed post mean that it can be more difficult to get help over the Christmas and New Year period; many of our clients find themselves in need over the holidays. So, even if a family doesn’t celebrate Christmas, the hampers are welcome.

In the video below, Catherine is putting together a hamper for her client Maya*. Whilst recovering from a C Section, Maya’s benefits were stopped due to a mix-up at the Jobcentre. “She signed something she didn’t understand, because her English is very limited and there was no interpreter,” Catherine says, “and it stopped her benefits. When she realised what had happened, she made lots of attempts to appeal and, finally, I wrote a long letter in her support.

“But, even once it had been agreed that her benefits should be reinstated, it took another two weeks for her to receive them. It was a real mess, because of course she’d got a new baby and she was still recovering from the birth, and suddenly found herself with no money. We had to give her and her family some food, from our own donations and from Narthex, during those weeks. She’s had a really tough time, so this is just a little gesture from us.”

Thank you to everyone who donated – and continues to donate – to the Gateway food and baby banks. We wouldn’t be able to give out our Christmas hampers without the donations we receive from Healthy Minds, Birmingham Registry, Vineyard Network Church and The Samaritans Purse, who’ve provided us with lots of hand knitted baby clothes and blankets.

*names have been changed

Stopping the spiral

When you’re living precariously, from day to day, the smallest changes and delays have a much bigger effect than they would on someone with a solid support network and a safe, structured lifestyle.

scales-smWe find it particularly frustrating to hear when clients tell us about issues they’re facing that could have been avoided. Often, it’s down to a client leaving things late or not having the confidence or knowledge to assert themselves. But, equally as often, organisations put unnecessarily bureaucratic processes in place that can make matters considerably worse. Many times, a little consideration – some human understanding of a personal situation, or a small tweak to a process, could quickly make things better and stop things spiralling before they start.

Everyone’s situation is unique and there is usually good reason when things don’t run smoothly. But at Gateway we often find ourselves asking: why should a Pregnancy Outreach Worker’s intervention be necessary? Why does it always seem to take an advocate to step in before things can get moving?

Claire* is a vulnerable teenager who lives in temporary accommodation and has no immediate family. She’s pregnant by her ex-partner, who was violent towards her.

When Claire wanted to apply for Housing Benefit, she needed to show three months bank statements. She didn’t have a phone, so she couldn’t just call the bank and ask… but she also didn’t have the money to travel there in person. And the longer she left it, the further into debt she fell.

Seeing that Claire was at risk of eviction, her POW took her to the bank herself. There, Claire requested the relevant information, only to be told that her account had been closed, and that the statements would have to be posted out. It was only after the POW explained the urgency of the situation that the bank supplied printed statements for Claire to use. But why should we have had to step in?

Most people take a phone for granted. Claire has had to buy a phone – spending money that she really needed for food – in order to manage the basic things in her life. But having a phone doesn’t mean you have it easy – dealing with multiple organisations and agencies can mean long periods of time on hold, and that can quickly use up all the phone credit you have.

Claire’s claim for Housing Benefit eventually went in, but more than four weeks went by before she heard anything more about it. We chased up Claire’s Housing Benefit claim three times before finding out that it had been suspended as they awaited information from her landlord. It took another call from the POW – this time to the landlord, asking him to provide the evidence that the Housing Benefit department needed – before things got moving again.

All these issues create unmanageable stress for someone like Claire. She is already at a high risk and delays like this just make things impossibly difficult. During the time she was waiting for housing benefit, Claire phoned her POW, in desperation, to ask for food parcels – she had no means of buying food or even travelling to other food banks.

Last week, Claire said she is beginning to feel more in control. “I have been to St Basils and they are going to place me in a flat within a week. I feel so much calmer and happier away from my ex. Today you called Healthy Start vouchers and gave them my new address and sorted out my claim for Income Support. We spoke about what I need to get for the baby and you will help with trying to find donations for me. I’m glad I was able to tell you how I felt today.”

But the little things that most people take for granted will continue to be an issue for Claire. Her new flat is safe, but it’s unfurnished, so the POW is helping her to find basic household items from charities and donations. She’s still unable to get a bank account so, even if her life does begin to settle down and she finds she has money left after paying for food, gas and electric, she has no way of saving her cash. And – somewhat ridiculously – because Claire can’t have her benefits paid into an account, she has to spend vital pounds on travel each week just to pick it up.

Sometimes people just need help. It would be great if services could take that into account sometimes and just be a bit more human.

*Names have been changed.

Maintaining a healthy weight during pregnancy – with Maternal Lighten Up

Maternal Lighten UpOne in five pregnant women in Birmingham is overweight and so run a higher risk of complications during pregnancy. So the Maternal Lighten Up service is here to help women maintain a healthy weight in the months leading up to birth.

Unlike the general Lighten Up service, Maternal Lighten Up isn’t about weight loss – as Liz Barber, the Maternal Lighten Up Administrator, explains: “It’s probably a bit weird to be told ‘you’re overweight, but you can’t lose it’ – but, during your pregnancy, it’s all about helping you limit your weight gain. The services we refer our clients to can help them to do that in a healthy way.”

The city-wide service gets the majority of its referrals – women who are up to 28 weeks pregnant with a BMI of over 30 – from midwives. Clients are given the choice of three services to take up:

  • Maternal Health Trainers give one to one advice and a tailored programme of healthy eating and exercise to help maintain healthy weight gain during pregnancy
  • Birthfit is a programme of gentle exercise tailored to each stage of pregnancy and to individual needs, including specific advice about preparing for the birth
  • Slimming World offers classes for general weight loss, but pregnant women can join the classes to learn general healthy eating and exercise tips

Liz says, “going by the latest figures, nearly half the clients choose to go with the Maternal Health Trainer service. But whichever path they take, we will offer regular calls to see how they’re getting on and to offer extra support should they need it. Sometimes, if there are other issues besides their weight, this can mean putting them in touch with other services, such as our Pregnancy Outreach Workers”.

And after the other services finish, the support from Gateway continues. “Even after the birth, we encourage mums to carry on their healthy regime, and lose weight, by joining our general Lighten Up service”.

Kerry’s story

Kerry started with the Maternal Lighten Up programme in December 2012, at 13 weeks pregnant, after being referred by her Midwife for support with her weight management.  Pregnancy was nothing new, as this was her third baby, but in previous pregnancies she had put on a lot of weight and this time round she wanted to be better prepared.

After a discussion with Liz about the options available, Kerry opted for Birthfit, a weekly antenatal exercise class run by a former midwife, that would help keep her active during her pregnancy.

When Kerry began the course with Birthfit in January she was nearly 17st and, after attending every week, her weight gain remained stable. At 35 weeks she had gained just under a stone.

In April, Kerry said “I wish this service had been around in my previous pregnancies, where I put on two or three stone”. She says that the support from Maternal Lighten Up was “brilliant”, and that the tailored exercises she practiced through Birthfit helped her back problems more than physiotherapy sessions had done.

Kerry, who had her baby in June, also said that, being a third time mum, she really didn’t expect to learn anything new, but “I was amazed to be learning new things every week. I thought the programme was brilliant and would recommend the service to any mums to be”.

Rachel’s story

After Rachel was referred to Maternal Lighten Up, she chose to work with a Maternal Health Trainer, Richard McKenzie, who helped her to come up with her own healthy eating and exercise plan. She saw the benefits straight away, and made this statement just two weeks after her initial appointment: “I’m finding it motivating keeping the behaviour diary and monitoring my food and activity. I feel that my diet and exercise level has been good over the last two weeks and in balance.”

Richard has helped Rachel to stick to her healthy eating plan and regular sessions of yoga, and now she’s on track to give birth without having put on too much extra weight. In this video, taken just last week, she tells us, “I’m feeling really positive!”

Tackling the teenage pregnancy myths

The media image of teenage pregnancy – that rates are soaring; that teens are getting pregnant to try and play the system; that they then make bad parents – is far from the truth.

For example: according to a recent MORI poll, the British public think teenage pregnancies are far more common than they actually are. The Independent reports that:

Teen pregnancy is thought to be 25 times higher than the official estimates: 15 per cent of of girls under 16 are thought to become pregnant every year, when official figures say the amount is closer to 0.6 per cent.

But these myths just makes things even more difficult for those who find themselves in this situation and have to deal with it.

At Gateway, Pregnancy Outreach Worker Caroline works exclusively with teenagers. She says the mums-to-be that she works with battle against these kinds of misconceptions every day.

“People think that teenagers get pregnant on purpose, so that they can get a house or extra benefits. But that’s just not true. For the girls I work with, pregnancy is usually an accident and it can be a big shock for the whole family.”

Fifteen year old Megan is a good example of a teenager who challenges these perceptions. Like many teenagers who become pregnant, she lives at home with her family and intends to stay there. So in terms of benefits she’ll get Healthy Start vouchers, which concentrate on enabling her to feed her baby, but any state support goes to her parents – and that’s only if they’re entitled to it. If they’re working, they’re entitled to very little.

Caroline says that the biggest myth her clients face is that, simply because they’re young, they’re going to be a bad mum. But there’s no reason that that should be the case. Megan’s got the makings of a responsible parent. At 15 she’s already knowledgeable and interested in what will be good for her baby.

“As well as all the worries that every pregnant woman has, teenagers are also up against the constant assumption that they’re going to be a bad mum,” says Caroline. “But Megan’s really keen to do what’s best. So a big part of my work with her, and the other teens I see, is helping to build her confidence. Armed with the right information, she can go on to make good decisions for her and her baby.”

In this video, Megan talks about how she’s preparing for labour and life with baby.

What Megan does acknowledge is that she needs support, reassurance and access to information – and Gateway, along with a couple of other services across the city – are providing that. As for the cost, Caroline’s support to date works out to be well under £100; if it plays a part in ensuring that Megan can give her baby a good start, then it demonstrates good value for money.

In many ways, Caroline’s support is very similar to the work that all our POWs do, but she often finds she has to approach things slightly differently.

“I think I have to offer quite intense support,” she says. “These girls are still at school, where they’re used to being taught, but that means they’re taking in a lot of information at once. I have to work out the best way to make sure it all sinks in. I do a lot of role playing, a lot of visual stuff, and I repeat the same things in different ways. I have to try and keep it interesting without being overwhelming.”

Caroline’s support doesn’t just cover preparation for the birth. She is there with a non-judgmental ear when teens need to talk, and she also gives a lot of practical help and support with the life skills that most young people won’t yet have had much experience with, like budgeting.

Family dynamics are important, too. “Sometimes they tell me things that it would be difficult to talk to their parents about,” says Caroline. “It can be a stressful time, so it’s often better for them to speak to me impartially than to risk conflict, however well-meaning, at home.” Caroline works with the whole family – the parents, too, have her number to talk things through if they want to.

The support Caroline gives is complemented by that from other agencies. “The FNP (Family Nurse Partnership) is great,” says Caroline. “It’s a structured educational programme for 16-19 year olds, with support from a Family Nurse until the child is two. Then Megan has a specialist Teen Midwife. We work really closely; they cover the clinical side of things and we focus on the social issues. That way we’ve got it all covered.”

Working together means that, once Caroline steps out, the client is fully integrated into services that will support her going forward.

To find out more about the benefits available to teenage mums, have a look at this benefits calculator from Gingerbread.

Gateway POWs: breastfeeding figures are up again

Our figures for last year show that women supported by a Pregnancy Outreach Worker are more likely to breastfeed than the regional and national averages. Have a look:

Average number of new mothers who initiated breastfeeding:

Gateway clients 79%
Within the wards we cover 65%
Birmingham 69%
West Midlands 78%
Nationally 81%


Of those who initiated, those who continued to breastfeed at a week after birth:

Gateway clients 89%
Nationally 69%


Of those who initiated, those who continued breastfeeding after 6-8 weeks:

Gateway clients 69%
Birmingham 44%
West Midlands 31% – 54%
Nationally 55%

– Out of the 578 women we were supporting last year 197 had given birth by the end of March.  This is the data set used.

– Ward figures are taken from the Birmingham Health Inequalities Action Plan 2012, Birmingham.

– “Birmingham” is an average of the rates achieved in Birmingham’s three former PCT areas.

West Midlands figures are taken from Initiation, Uptake and Sustainability of Breastfeeding,  West Midlands Public Health Legacy Series, 2012,  Dept of Health.

– National figures are taken from the Infant Feeding Survey, 2010.

Why does POW support make a difference?

We think there are a number of reasons that support from a Pregnancy Outreach Worker results in an increased likelihood of a woman breastfeeding.

  1. Practical advice and training before the birth

    Unlike other services, POWs support most of their clients for the best part of a year. It means that they have plenty of time pre-natally to talk about breastfeeding and, where necessary, persuade mum to give it a try.

    All our POWs are UNICEF Baby Friendly Initiative trained, so they can put on impromptu one-to-one or group training as required.  As they build relationships with their clients, they try and make sure that everything’s in place for the mother to be comfortable with the practicalities of breastfeeding well before she gives birth.

  2. The POW can be there immediately after the birth, even in the hospital

    Pregnancy Outreach Worker Sylvia says, “if they don’t try and breastfeed in the hospital, straight away, it’s much more difficult to start”. Caroline, who works with teenage mums, agrees: “We try and do as much preparatory stuff as we can before the birth – because it all gets so much harder afterwards.”

    The POWs know when their clients’ babies are due, so they check in regularly with them around the time. They aim to speak to them as soon as possible after the baby arrives, so they are there to answer questions. Many go to visit while mum is still in hospital and frequently, whilst there, they will give practical breastfeeding support.

    Once mum and baby are home, POWs can continue to give practical, hands on advice. They’ve already built up a relationship with the mother, which makes it much easier to offer this kind of help. They can also also provide lots of advice over the phone and often do this out of hours.

  3. Introducing clients to more support networks

    The ideal circumstances for a mother to breastfeed include the feeling that she has plenty of support from likeminded people. So POWs always  try and introduce their clients to the various networks and groups that are available to new parents – often taking them along to clinics themselves.

    Sharon, a POW, recently took a client to the Women’s Hospital breastfeeding workshop. Sharon says “It’s a good network to be part of – very informative and very pro-breastfeeding. At the drop-in clinic they can meet the breastfeeding co-ordinators and other mums for practical advice, and talk about their fears as well as the pros and cons of breastfeeding. They get the contact numbers of counsellors to phone for support. It gives them some structure as well as social support.”