Migrant women’s experiences of pregnancy, childbirth and maternity care in European countries: A systematic review

Background: Across Europe there are increasing numbers of migrant women who are of childbearing age. Migrant women are at risk of poorer pregnancy outcomes. Models of maternity care need to be designed to meet the needs of all women in society to ensure equitable access to services and to address health inequalities. Objective: To provide up-to-date systematic evidence on migrant women’s experiences of pregnancy, childbirth and maternity care in their destination European country. Search strategy: CINAHL, MEDLINE, PubMed, PsycINFO and Scopus were searched for peer-reviewed articles published between 2007 and 2017. Selection criteria: Qualitative and mixed-methods studies with a relevant qualitative component were considered for inclusion if they explored any aspect of migrant women's experiences of maternity care in Europe. Data collection and analysis: Qualitative data were extracted and analysed using thematic synthesis. Results: The search identified 7472 articles, of which 51 were eligible and included. Studies were conducted in 14 European countries and focused on women described as migrants, refugees or asylum seekers. Four overarching themes emerged: ‘Finding the way—the experience of navigating the system in a new place’, ‘We don't understand each other’, ‘The way you treat me matters’, and ‘My needs go beyond being pregnant’. Conclusions: Migrant women need culturally-competent healthcare providers who provide equitable, high quality and trauma-informed maternity care, undergirded by interdisciplinary and cross-agency team-working and continuity of care. New models of maternity care are needed which go beyond clinical care and address migrant women's unique socioeconomic and psychosocial needs

Improving pregnancy and birth experiences of migrant mothers: A report from ORAMMA and continued local impact

INTRODUCTION Migration is a growing phenomenon affecting many European countries, with many migrants being of childbearing age. Depending on the country of origin, poorer pregnancy and birth outcomes amongst migrant women have been reported. Providing appropriate culturally sensitive perinatal services is of paramount importance. METHODS The Operational Refugee And Migrant Mothers Approach (ORAMMA) was a three-site multidisciplinary collaborative research project, designed to develop and test implementation of a high-quality maternity care model including peer supporters for migrant women who have recently arrived in European countries. Community-based activities were undertaken to ensure ongoing local impact for maintaining supportive interactions amongst peer supporters and recently arrived migrant women in the UK. RESULTS The women who volunteered to become maternity peer supporters were motivated by their own experiences of being newly arrived migrants in the past or a sense of altruism. Forging links with multiple local community groups enabled the continuation of the support provided by maternity peer supporters, including during the COVID-19 pandemic. CONCLUSIONS Engagement of maternity peer supporters in supporting newly arrived mothers has multiple advantages of addressing social isolation and marginalisation of migrant communities, with potential benefits of improving access and enhancing health literacy and health outcomes amongst recently arrived migrant women as well as creating a self-supporting network for peer supporters themselves

Is There a Link between Wheezing in Early Childhood and Adverse Birth Outcomes? A Systematic Review

We aimed to provide a summary of the existing published knowledge on the association between adverse birth outcomes and the development of wheezing during the first two years of life. We carried out a systematic review of epidemiological studies within the MEDLINE database. Epidemiological studies on human subjects, published in English, were included in the review. A comprehensive literature search yielded 72 studies for further consideration. Following the application of the eligibility criteria we identified nine studies. A positive association and an excess risk of wheezing during the first two years of life were revealed for adverse birth outcomes

A more rational, theory-driven approach to analysing the factor structure of the Edinburgh Postnatal Depression Scale

We endeavoured to analyze the factor structure of the Edinburgh Postnatal Depression Scale (EPDS) during a screening programme in Hungary, using exploratory (EFA) and confirmatory factor analysis (CFA), testing both previously published models and newly developed theory-driven ones, after a critical analysis of the literature. Between April 2011 and January 2015, a sample of 2,967 pregnant women (between 12th and 30th weeks of gestation) and 714 women 6 weeks after delivery completed the Hungarian version of the EPDS in South-East Hungary. EFAs suggested unidimensionality in both samples. 33 out of 42 previously published models showed good and 6 acceptable fit with our antepartum data in CFAs, whilst 10 of them showed good and 28 acceptable fit in our postpartum sample. Using multiple fit indices, our theory-driven anhedonia (items 1,2) – anxiety (items 4,5) – low mood (items 8,9) model provided the best fit in the antepartum sample. In the postpartum sample, our theory-driven models were again among the best performing models, including an anhedonia and an anxiety factor together with either a low mood or a suicidal risk factor (items 3,6,10). The EPDS showed moderate within- and between-culture invariability, although this would also need to be re-examined with a theory-driven approach

Midwives’ experiences of cultural competency training and providing perinatal care for migrant women a mixed methods study: Operational Refugee and Migrant Maternal Approach (ORAMMA) project

Abstract: Background: The number of international migrants continues to increase worldwide. Depending on their country of origin and migration experience, migrants may be at greater risk of maternal and neonatal morbidity and mortality. Having compassionate and culturally competent healthcare providers is essential to optimise perinatal care. The “Operational Refugee and Migrant Maternal Approach” (ORAMMA) project developed cultural competence training for health professionals to aid with providing perinatal care for migrant women. This presents an evaluation of ORAMMA training and explores midwives’ experiences of the training and providing care within the ORAMMA project. Methods: Cultural competence was assessed before and after midwives (n = 35) received ORAMMA compassionate and culturally sensitive maternity care training in three different European countries. Semi-structured interviews (n = 12) explored midwives’ experiences of the training and of caring for migrant women within the ORAMMA project. Results: A significant improvement of the median score pre to post-test was observed for midwives’ knowledge (17 to 20, p < 0.001), skills (5 to 6, p = 0.002) and self-perceived cultural competence (27 to 29, p = 0.010). Exploration of midwives’ experiences of the training revealed themes of “appropriate and applicable”, “made a difference” and “training gaps” and data from ORAMMA project experiences identified three further themes; “supportive care”, “working alongside peer supporters” and “challenges faced”. Conclusions: The training improved midwives’ knowledge and self-perceived cultural competence in three European countries with differing contexts and workforce provision. A positive experience of ORAMMA care model was expressed by midwives, however clearer expectations of peer supporters’ roles and more time within appointments to assess the psychosocial needs of migrant women were desired. Future large-scale research is required to assess the long-term impact of the ORAMMA model and training on practice and clinical perinatal outcomes