Inclusiveness of Access Policies to Maternity Care for Migrant Women Across Europe: A Policy Review

Introduction Despite the interconnectedness of the European Union, there are significant variations in pregnant women’s legal status as migrants and therefore their ability to access maternity care. Limited access to maternity care can lead to higher morbidity and mortality rates in migrant women and their babies. This study aimed to investigate and compare maternal health access policies and the context in which they operate across European countries for women who have migrated and are not considered citizens of the host country. Methods The study adopted a mixed-methods research design exploring policies on migrant women’s access to maternity care across the migration regimes. Data were extracted from legal documents and research reports to construct a new typology to identify the inclusiveness of policies determining access to maternity care for migrant women. Results This study found inconsistency in the categorisation of migrants across countries and significant disparities in access to maternity care for migrant women within and between European countries. A lack of connection between access policies and migration regimes, along with a lack of fit between policies and public support for migration suggests a low level of path dependency and leaves space for policy innovation. Discussion Inequities and inconsistencies in policies across European countries affect non-citizen migrant women’s access to maternity care. These policies act to reproduce structural inequalities which compromise the health of vulnerable women and newborns in reception countries. There is an urgent need to address this inequity, which discriminates against these already marginalised women

An Unreported Uterine Rupture in an Unscarred Uterus After Induced Labor With 25 μg Misoprostol Vaginally

Uterine rupture without a former history of cesarean delivery or uterine scarring is an exceedingly rare complication in pregnancy and labor. Misoprostol is widely used to induce labor but there is a lack of knowledge about serious adverse effects. It is especially challenging to collect reports on side effects because misoprostol is not a registered drug. We report a case of a woman induced by one dose 25 μg misoprostol vaginally. Her pregnancy was uncomplicated and she had an unscarred uterus. Her labor progressed rapidly and she experienced hyperstimulation, meconium stained amniotic fluid, uterine rupture, and excessive blood loss of approximately 14 l. The child survived but is diagnosed with cerebral palsy. The case was never reported as an adverse event. This case questions the safety of misoprostol even in low dosage. It also underlines the need to report side effects to national reporting systems

Ženy v pohybu: hledání preferované porodní péče

Ženy a porodní asistentky cestují na dlouhé vzdálenosti nebo do zahraničí, aby získaly nebo poskytly porodní služby. Cestování za porodními službami není v dosavadní literatuře zastoupeno, a to navzdory rozsáhlému výzkumu o medicínském turismu. Cíl: Zkoumaly jsme perspektivy žen, které hledaly lepší služby mimo své bydliště a porodní asistentky, kteří cestují za účelem poskytování těchto služeb. Metoda: Následovaly jsme principy kvalitativního přístupu a uskutečnily jsme 13 kvalitativních rozhovorů se ženami z různých evropských zemí, čtyřmi porodními asistentkami a jednou aktivistkou. Byly použity principy tematické analýzy. Závěry: Rozhodnutí, zda cestovat, je důsledkem dlouhodobého procesu, který je ovlivněn různými motivujícími faktory. Cestující ženy a porodní asistentky sdílejí hodnoty; věří schopnosti žen porodit; oceňují respekt a rovnost v komunikaci; hledají důvěryhodné vztahy a přátelské prostředí bez zbytečných zásahů. Důvěra a nedůvěra na interpersonální a institucionální úrovni ovlivňují rozhodování žen a formují příběhy o jejich zkušenostech. Závěr: Cestující ženy a porodní asistentky do velké míry sdílejí hodnoty obsažené v péči dle modelu porodní asistence. Ženy a porodní asistentky jsou ochotné vzít věci do svých rukou, aby dosáhly preferovaných porodních zkušeností.Background: Women and midwives travel long distances, or abroad, to receive or provide birth services. Travel for birth services is not represented in the existing literature, despite the wide scale research available on medical travel. Aim: We explored the perspectives of women who were seeking better services outside their places of residence and midwives who travel to provide these services. Method: We followed a qualitative descriptive approach. We conducted 13 qualitative interviews with women from various European countries, four travelling midwives and one activist. Principles of thematic analysis were used. Findings: Deciding whether to travel is the result of a long-term process, influenced by various push and pull factors. Travelling women and midwives share values; they trust the capacity of women to give birth; they value respect and equality in communication; they search for trusting relationships and friendly environments without unnecessary treatments. Trust and distrust on interpersonal and institutional levels influence women's decisions and frame narratives about their experiences. Conclusion: To a great extent, travelling women and midwives share the values embedded in the midwifery model of care. Women and midwives are willing to take matters into their own hands to achieve their expected birth experiences

Quality assessment of patient leaflets on misoprostol-induced labour:does written information adhere to international standards for patient involvement and informed consent?

OBJECTIVES: The need for thorough patient information is increasing as maternity care becomes more medicalised. The aim was to assess the quality of written patient information on labour induction. In most Danish hospitals, misoprostol is the first-choice drug for induction in low-risk pregnancies. Misoprostol has been associated with adverse side effects and severe outcomes for mother and child and is not registered for obstetric use in Denmark. SETTING: Secondary care hospitals in Denmark. DATA: Patient information leaflets from all hospitals that used misoprostol as an induction agent by June 2015 (N=13). DESIGN: Patient leaflets were evaluated according to a validated scoring tool (International Patient Decision Aid Standards instrument, IPDAS), core elements in the Danish Health Act, and items regarding off-label use and non-registered medication. Two of the authors scored all leaflets independently. OUTCOME MEASURES: Women's involvement in decision-making, information on benefits and harms associated with the treatment, other justifiable treatment options, and non-registered treatment. RESULTS: Generally, the hospitals scored low on the IPDAS checklist. No hospitals encouraged women to consider their preferences. Information on side effects and adverse outcomes was poorly covered and varied substantially between hospitals. Few hospitals informed about precautions regarding outpatient inductions, and none informed about the lack of evidence on the safety of this procedure. None informed that misoprostol is not registered for induction or explained the meaning of off-label use or use of non-registered medication. Elements such as interprofessional consensus, long-term experience, and health authorities' approval were used to add credibility to the use of misoprostol. CONCLUSIONS: Central criteria for patient involvement and informed consent were not met, and the patient leaflets did not inform according to current evidence on misoprostol-induced labour. Our findings indicate that patients receive very different, sometimes contradictory, information with potential ethical implications. Concerns should be given to outpatient inductions, where precise written information is of particular importance