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

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          Abstract

          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.

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          Most cited references5

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          Psychological science on pregnancy: stress processes, biopsychosocial models, and emerging research issues.

          Psychological science on pregnancy is advancing rapidly. A major focus concerns stress processes in pregnancy and effects on preterm birth and low birth weight. The current evidence points to pregnancy anxiety as a key risk factor in the etiology of preterm birth, and chronic stress and depression in the etiology of low birth weight. Key mediating processes to which these effects are attributed, that is neuroendocrine, inflammatory, and behavioral mechanisms, are examined briefly and research on coping with stress in pregnancy is examined. Evidence regarding social support and birth weight is also reviewed with attention to research gaps regarding mechanisms, partner relationships, and cultural influences. The neurodevelopmental consequences of prenatal stress are highlighted, and resilience resources among pregnant women are conceptualized. Finally, a multilevel theoretical approach for the study of pregnancy anxiety and preterm birth is presented to stimulate future research.
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            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.
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              Motivations for Entering the Doula Profession: Perspectives From Women of Color

              Introduction The imperative to diversify the healthcare workforce is evident: increased diversity contributes to the overall health of the nation. Given persistent racial and ethnic disparities in birth outcomes, workforce diversity is particularly urgent in the context of clinical and supportive care during pregnancy and childbirth. The goal of this analysis was to characterize the intentions and motivations of racially and ethnically diverse women who chose to become doulas (maternal support professionals) and to describe their early doula careers, including the experiences that sustain their work. Methods In 2014, 12 women of color in the Minneapolis, MN metropolitan area (eg, African-American, Somali, Hmong, Latina, and American Indian) applied and were selected (from a pool of 58) to receive doula training and certification. In January and February of 2015, we conducted semi-structured interviews (30–90 minutes) with the newly-trained doulas. We used an inductive qualitative approach to analyze key themes related to motivation and satisfaction with doula work. Results For many of the women of color we interviewed, the underlying motivation for becoming a doula was related directly to a desire to support women from the doula’s own racial, ethnic, and cultural community. Other key themes related to both motivation and satisfaction included: perceiving birth work as a “calling;” easing women’s transitions to motherhood by “holding space;” honoring the ritual and ceremony of childbirth; and providing culturally-competent support, often as the sole source of cultural knowledge during labor and delivery. Discussion Doulas of color have a strong commitment to supporting women from their communities. Given the evidence linking doula support to improved birth outcomes, successful recruitment and retention of women of color as doulas may support broader efforts to reduce longstanding disparities in birth outcomes. Women of color become doulas to support women from their communities. Their experiences offering culturally-competent support motivate and sustain their work.
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                Author and article information

                Journal
                Eur J Midwifery
                Eur J Midwifery
                EJM
                European Journal of Midwifery
                European Publishing
                2585-2906
                02 December 2020
                2020
                : 4
                : 47
                Affiliations
                [1 ]College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
                [2 ]Friendly Mothers, Sheffield, United Kingdom
                [3 ]Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
                Author notes
                CORRESPONDENCE TO Hora Soltani. College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, S10 2BP, United Kingdom. E-mail: H.soltani@ 123456shu.ac.uk
                [*]

                The ORAMMA Team members: M. van den Muijsenbergh, M. Papadakaki, M. Jokinen, L. Raben, E. Sioti, E. Shaw, E. Triantafillou, D. Aarendonk, D. Castro Sandoval, T. Mastroyiannakis, A. Markatou.

                Article
                47
                10.18332/ejm/130796
                7839120
                33537648
                59a21573-e466-473d-9a56-0d1ea674fa61
                © 2020 Soltani H. et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non Commercial 4.0 International License.

                History
                : 16 November 2020
                : 19 November 2020
                : 23 November 2020
                Categories
                Policy Case Studies

                pregnancy,migrant mothers,maternal health,peer supporters

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