CM Report – ‘What’s it really like for foreign women giving birth in UK hospitals? ’

Think you have it hard during labour?  Imagine you were thousands of miles away from your family and the midwife spoke a different language from you …

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When 25-year-old Ewa Satro gave birth to her daughter Maja 15 months ago, she was 1000 miles away from her home in Poland. “It was really strange to be having my first baby with no family around,” admits Ewa, “I missed my mum so much.”

Not only was Ewa a long way from home, she also had to learn a whole new vocabulary to do with pregnancy - simply to try to understand what was happening to her and her baby, to be able to access and make the most of pregnancy care, and to cope with the birth.

Ewa also found maternity care very different to how it is in Poland. “When my sister had her baby she saw a gynaecologist throughout her pregnancy and had more scans and checks than I did,” says Ewa. “I was shocked that here you just see a midwife.”

Ewa’s three-day marathon of a labour was, she admits, “very stressful, very painful.” But – thankfully - little Maja finally arrived safe and sound.

Ewa is just one of many foreign mums having their babies here in NHS hospitals - recent government figures show that over a fifth of births in England and Wales are now to mums born outside the UK.

Although it was hard for Ewa being far from home, her pregnancy and labour had no complications. But not all foreign mums are so lucky. And despite the raging headlines bemoaning the amount of money spent on foreign mums’ care, many of these mothers really have it tough.
 

Picture this…

Try to imagine yourself in a strange country, where you can’t understand the lingo, let alone the complicated process of finding your way through the maze that is the National Health Service. You’re far away from your home, from your own mum, from everything that’s familiar. You’re having your first baby and you feel all alone in the world.

Ghazal Maryam Ali is an interpreter with an Afghani women’s group. For young women in her group, she says, “Having their first baby here is very frightening. There’s the language barrier and the problem of isolation with no family around them.” Plus there are cultural differences. “For example they do not want care from a male doctor, but medical professionals often don’t understand this and just think, ‘So what?’”

“At home in Afghanistan most women would have their babies at home supported by female relatives,” continues Ghazal. “Their experience over here is so different... ”

There’s no doubt it’s hard emotionally. But there are also practical reasons why it’s tough for mums from overseas. Some aren’t registered with a GP, so their first port of call in pregnancy is missing. Some aren’t aware of what maternity care is available. And some fear that racism (fuelled by those scare-mongering headlines) will turn medical staff against them.

Safeguards exist to try to make sure mums here legally are well looked after. According to a spokesperson from the Department of Health, hospitals should: “strengthen services for women from disadvantaged and minority groups” by employing staff from the same background as the local population. They should also provide “translation, interpreting and advocacy services” and make sure antenatal, labour and postnatal care is provided “in a culturally sensitive way”.

So much for the theory. But these are just recommendations, rather than legal obligations, and simply aren’t always followed. The result? Many foreign mums don’t get the care they need in pregnancy and labour, leading to serious problems.

High health risks

Babies born to foreign mums are more likely to be underweight, sickly or premature, and – tragically -infant mortality rates are higher, too. Plus, although death in childbirth is rare today, mums from overseas are much more at risk than others.

“Maternal death rates for black and minority ethnic women are significantly higher than the average,” says Rosalind Briggs of the health charity Medact. “Black African women giving birth in the UK are six times more likely to die in pregnancy and childbirth than white women.
 
“Women who receive no antenatal care or commence care late in pregnancy face higher risks of things going wrong,” continues Rosalind, “for example missing out on treatment for life-threatening conditions such as pre-eclampsia.”
 
Occasionally women don’t even get care when they go into labour. A report by Medact mentions the case of an 18-year-old Chinese woman who spoke no English. She arrived in labour at the hospital with just a piece of paper with her name written on it. They turned her away. Only when an ambulance finally took her back to the same hospital was she admitted to give birth.

On the front line

All this is tough on the midwives too, who may have little training in how to deal with mums from overseas, and minimal funding for interpreters.

When no interpreter is available, relatives are sometimes asked to translate, but this isn’t ideal. Mums may not want to reveal intimate medical details in front of an uncle or cousin, and the relative translating will probably have little medical knowledge, which can lead to mistakes.

But in one part of the UK these marginalised mums do have a bit more support. Sheffield midwife Dot Smith recently won a top award from the Royal College of Midwives for the service she gives the most vulnerable of all mums, including asylum seekers who have suffered great hardship.

“These mums often don’t get care because of fear – fear of prejudice, fear of being judged, fear of not being understood,” says Dot Smith. “They are in a spiral of learned helplessness, afraid to trust anyone because of their experiences.”

So Dot Smith takes antenatal care to them, meeting them at drop-in sessions wherever they feel comfortable – even in McDonalds if necessary – and using interpreters to overcome communication problems.

She doesn’t usually deliver their babies – there are too many mums for Dot to be there for all of them – but when they go into labour they know that, because of Dot, they have been cared for during their pregnancy and will be cared for during labour.

“One family,” says Dotty Watkins, Head of Midwifery, “with no money at all, recently walked four miles to find Dot and to give her some flowers to say thank you.”

Which just goes to show how much all mums – British or otherwise - care about their pregnancy, their birth and their babies.

*Box: What are the latest birth trends*?

Proportion of babies born to mothers from outside the UK:

1996: 12.8%
2006: 21.9%

Fertility rates: On average, how many babies do different women have?

Women born in the UK each have 1.8 babies
Women born in Pakistan each have 4.7 babies
Women born in Bangladesh each have 3.9 babies

*Figures for England and Wales from the Office for National Statistics