I was a student midwife in the mid-nineties when I met her. She lay motionless, staring blankly at her new arrival, on a bed in the postnatal ward at the central London teaching hospital where I undertook my clinical placements. Surrounded by busy bays of families visiting their new arrivals, she was alone with her baby boy; her pain palpable among the joy that filled the ward.
She had recently arrived from Rwanda.
I do not know for a fact what her circumstances were but I suspected that the beautiful newborn who lay peacefully on the bed next to her might have been the result of rape.
Two years later, I was transported to the heights of a tower block in a lift stinking of urine, where I visited a new mother from Democratic Republic of Congo. This sturdily built woman wept and wept and wept upon my asking her in my naive fashion, “So, how are you today?”. I don’t recall any other details from that encounter, but I won’t forget the tears – tears of deep, scarring trauma.
In the years that followed, I met countless women and families who had fled from conflict zones to the security of London, each with their own stories and reactions to their journey up to that point.
Nothing prepared me for how to care appropriately for these women. I knew enough about the world, and followed global current affairs sufficiently to have a vague awareness of the atrocities that these women came from, yet felt unable to do anything other than listen (not in any way to belittle the power of listening, I might add). I didn’t understand their ‘apathy’ (which I now recognise to be profound powerlessness). I didn’t know what to do with their outpourings of grief. I had no awareness of services to which I could refer them for further support. I was acutely aware of how trite my words must have sounded.
Am I alone? I somehow suspect not. I wonder how many midwives feel prepared to support women who are victims of rape (sexual violence the weapon of choice in many conflict zones), or have been tortured, or who have made perilous journeys in search of a better life, or who have watched numerous loved ones die one after another, or who have only known a life of poverty and powerlessness as they watch their children suffer the consequences?
I do believe that simple compassion – a midwife who listens, acknowledges, sympathises and cares, is so very healing for these women. But is there more?
As the UK (potentially) prepares to take in tens of thousands of refugees, can maternity services also ramp up its preparedness? (It’s entirely possible that is work is already happening local and national levels. If so, please share this with us all! Additionally, I know that there are many existing outstanding examples both at Trust and individual levels.)
It may not be financially viable for each Trust to have a specialist midwife (although some do, and this should certainly be considered the gold standard for Trusts with large numbers of refugees and asylum seekers). But we can all increase our awareness of the journey that these women may have travelled and the potential consequences of that journey on her physical and emotional wellbeing, as well as the impact that it may have on bonding and attunement with her baby. Having some basic cultural insights (a valuable secondary outcome of the RCM’s Twinning Project, I suspect) coupled with knowledge of local relevant organisations can provide us with practical avenues of referral for ongoing support for these women. And of course, a greater investment in interpreting services is crucial.
But why is all this so important? After all, these are a small proportion of all women who receive maternity care in the UK.
There’s one reason. Because their lives matter.
Refugee Council – When Maternity Doesn’t Matter report
Maternity Action – Maternity rights & benefits: refugees
An exploration of midwives’ experiences of caring for women seeking asylum
Improving care for refugees and asylum seekers
Featured image credit: Zoriah, Flickr Creative Commons www.zoriah.net