• Asylum seekers and refugees: A cross European perspective

      Balaam, M-C.; Haith-Cooper, Melanie; Korfker, D.; Savona-Ventura, C. (2017-06-13)
      In this chapter we explore issues of psychosocial resilience and risk related to asylum seeking and refugee women during the perinatal period, drawing on experiences from three diverse European countries; the United Kingdom (UK), Malta and the Netherlands. First we define the terms asylum seekers and refugees to allow us to focus on the issues that pertain specifically to women experiencing this form of migration. We also note the prevalence of migration in contemporary society. We explore recent research on asylum seeking and refugee women in the perinatal period to identify; the barriers women face in accessing care in their reception countries and their experiences of perinatal care. Through this work, the challenges faced by healthcare professionals to provide culturally appropriate and high quality care to these women who face a range of psychosocial challenges are also highlighted. We suggest possible ways to address some of these challenges including how health professionals can actively build on the resilience of asylum seeking and refugee women to improve their perinatal experiences. We conclude by focusing on the implications of these findings; drawing on examples of good practice from the UK, Netherland and Malta to provide recommendations for practice and service development.
    • The Bradford Experience

      McGrath, T.; Haith-Cooper, Melanie (2007)
    • The co-development and feasibility-testing of an innovative digital animation intervention (DAISI) to reduce the risk of maternal sepsis in the postnatal period

      Haith-Cooper, Melanie; Stacey, T.; Bailey, F.; Broadhead-Croft, S. (2020-04)
      Introduction: Sepsis is one of the most common causes of mortality in postnatal women globally and many other women who develop sepsis are left with severe morbidity. Women’s knowledge of postnatal sepsis and how it can be prevented by simple changes to behaviour is lacking. Methods: This paper describes the co-development and feasibility testing of a digital animation intervention called DAISI (digital animation in service improvement). This DAISI is designed to enhance postnatal women’s awareness of sepsis and how to reduce their risk of developing the condition. We co-designed the digital animation over a six-month period underpinned by theory, best evidence and key stakeholders, translated it into Urdu then assessed its use, firstly in a focus group with women from different Black, Asian and Minority Ethnic (BAME) groups and secondly with 15 clinical midwives and 15 women (including BAME women). Following exposure to the intervention, midwives completed a questionnaire developed from the COM-B behaviour change model and women participated in individual and focus group interviews using similar questions. Results: The animation was considered acceptable, culturally sensitive and simple to implement and follow. Discussion: DAISI appears to be an innovative solution for use in maternity care to address difficulties with the postnatal hospital discharge process. We could find no evidence of digital animation being used in this context and recommend a study to test it in practice prior to adopting its use more widely. If effective, the DAISI principle could be used in other maternity contexts and other areas of the NHS to communicate health promotion information.
    • A concept analysis of the term migrant women in the context of pregnancy

      Balaam, M-C.; Haith-Cooper, Melanie; Parízková, A.; Weckend, M.J.; Fleming, V.; Roosalu, T.; Vržina, S.S. (2017)
      Aim - This paper explores the concept of migrant women as used in European healthcare literature in context of pregnancy to provide a clearer understanding of the concept for use in research and service delivery. Methods- Walker and Avant's method of concept analysis. Results - The literature demonstrates ambiguity around the concept; most papers do not provide an explicit or detailed definition of the concept. They include the basic idea that women have moved from an identifiable region/country to the country in which the research is undertaken but fail to acknowledge adequately the heterogeneity of migrant women. The paper provides a definition of the concept as a descriptive theory and argues that research must include a clear definition of the migrant specific demographics of the women. This should include country/region of origin and host, status within the legal system of host country, type of migration experience, and length of residence. Conclusion - There is a need for a more systematic conceptualization of the idea of migrant women within European literature related to pregnancy experiences and outcomes to reflect the heterogeneity of this concept. To this end, the schema suggested in this paper should be adopted in future research.
    • Culture and communication in ethically appropriate care

      Meddings, Fiona S.; Haith-Cooper, Melanie (2008)
      This article considers the difficulties with using Gillon's model for health care ethics in the context of clinical practice. Everyday difficulties can arise when caring for people from different ethnic and cultural backgrounds, especially when they speak little or no English. A case is presented that establishes, owing to language and cultural barriers, that midwives may have difficulty in providing ethically appropriate care to women of Pakistani Muslim origin in the UK. The use of interpreters is discussed; however, there are limitations and counter arguments to their use. Training is identified as needed to prepare service providers and midwives for meeting the needs of a culturally diverse maternity population.
    • Delivery suite assessment unit: auditing innovation in maternity triage

      Nolan, Sheila; Morgan, Jane; Pickles, Jacky; Haith-Cooper, Melanie; MacVane Phipps, Fiona E. (2007)
      A Delivery Suite Assessment Unit (DSAU) has been established at a large Northern teaching hospital. This was as a recommendation of ASQUAM (achieving sustainable quality in maternity) to reduce antenatal admissions to delivery suite and provide a more appropriate environment for women attending for antenatal or labour assessment. The DSAU has also provided an effective teaching environment where skills such as effective telephone triage, diagnosis of labour and care of women with pre-labour spontaneous rupture of membranes (SROM) have been developed by junior staff. The first twelve months' audit results indicate that the establishment of the DSAU has been successful in reducing antenatal admissions to delivery suite by increasing the transfers of clients home, rather than to the antenatal wards. This may reflect the confidence of the highly skilled midwives working in this environment and the confidence women feel about their ability to obtain prompt and accurate advice over the telephone.
    • Destitution in pregnancy: Forced migrant women’s lived experience

      Ellul, R.; McCarthy, R.; Haith-Cooper, Melanie (2020-11-02)
      Forced migrant women are increasingly becoming destitute whilst pregnant. Destitution may exacerbate their poor underlying physical and mental health. There is little published research that examines this, and studies are needed to ensure midwifery care addresses the specific needs of these women. This study aimed to explore vulnerable migrant women's lived experience of being pregnant and destitute. Six in-depth individual interviews with forced migrant women who had been destitute during their pregnancy were conducted over one year. A lack of food and being homeless impacted on women's physical and mental health. Women relied on support from the voluntary sector to fill the gaps in services not provided by their local authorities. Although midwives were generally kind and helpful, there was a limit to how they could support the women. There is a gap in support provided by local authorities working to government policies and destitute migrant pregnant women should not have to wait until 34 weeks gestation before they can apply for support. Home office policy needs to change to ensure pregnant migrant women receive support throughout their pregnancy.
    • Diet and physical activity in pregnancy: a study exploring women's beliefs and behaviours

      Chana, R.; Haith-Cooper, Melanie (2019-05-02)
      Being obese or gaining excessive weight during pregnancy can increase health risks for mother and baby. Adopting a healthy diet and increasing physical activity reduces these risks and has long-term health benefits for women. Despite this, women do not always maintain a healthy lifestyle during pregnancy. Aim To explore the factors that encouraged and prevented a diverse group of women to maintain a healthy lifestyle during pregnancy. Methods A total of 12 women participated in semi-structured qualitative interviews, underpinned by the theory of planned behaviour. Interviews were audio recorded, transcribed verbatim then subject to deductive thematic analysis. Findings Four themes emerged: women's knowledge of a healthy lifestyle, sociocultural influences, physical health and health professional support. These influenced women's intentions and actual behaviours during pregnancy. Conclusions Enhanced health professional advice may motivate women to adopt a healthy lifestyle during pregnancy. This could be through new means such as health technology.
    • Do psychosocial interventions have an impact on maternal perception of perinatal depression?

      Firth, Amanda; Haith-Cooper, Melanie; Egan, Dominic (2016-12)
      Poor perinatal mental health, in particular depression, affects at least 10% of new mothers in the UK. Current best practice recommends the use of talking therapies or medication, however, many women choose not to use medication or are deterred from accessing NHS services for example due to immigration status. Those who can access NHS treatment often face a long waiting list to see a clinician or therapist. Untreated perinatal depression impacts on the health and wellbeing of mothers and babies, consequently it is essential that alternative psychosocial interventions delivered by non-clinicians are considered. A systematic review was conducted on seven quantitative studies examining the effect of psychosocial interventions in reducing maternal symptoms of depression. Interventions focused either on physical activity or peer support, measuring depression scores on a validated screening tool. The review concludes that antenatal group peer support may benefit women in the antenatal period and that postnatal peer telephone support may be helpful for primiparous women but further large scale research is required.
    • The effect of maternal position at birth on perineal trauma: A systematic review.

      Lodge, Fay; Haith-Cooper, Melanie (2016-03)
      Perineal trauma is associated with short- and long-term maternal morbidity. Research has found that maternal position at birth can influence perineal trauma. However, there is a dearth of evidence examining specific maternal positions, including waterbirth, and how these can influence incidence and degree of perineal trauma. Such evidence is important to help reduce trauma rates and improve information for women and midwives. To address this gap in reliable evidence, a systematic review was conducted. Seven studies met the inclusion criteria. Compared to land birth, waterbirth was found to cause an increase in perineal trauma. Kneeling and all-fours positions were most protective of an intact perineum. Allowing for different variables, sitting, squatting and using a birth-stool caused the greatest incidence of trauma. The findings of this review demonstrate that further research is required around perineal guarding in alternative birth positions and how parity affects trauma rates with waterbirth, so that women may be advised appropriately. It also suggests findings that midwives can use when discussing alternative birth positions with women.
    • Ethno-Specific Risk Factors for Adverse Pregnancy Outcomes: Findings from the Born in Bradford Cohort Study

      Stacey, T.; Prady, S.L.; Haith-Cooper, Melanie; Downe, S.; Simpson, N.; Pickett, K.E. (2016)
      Objectives Preterm birth (PTB) and small for gestational age (SGA) are major causes of perinatal mortality and morbidity. Previous studies indicated a range of risk factors associated with these poor outcomes, including maternal psychosocial and economic wellbeing. This paper will explore a range of psycho-social and economic factors in an ethnically diverse population. Methods The UK’s Born in Bradford cohort study recruited pregnant women attending a routine antenatal appointment at 26–28 weeks’ gestation at the Bradford Royal Infirmary (2007–2010). This analysis includes 9680 women with singleton live births who completed the baseline questionnaire. Data regarding maternal socio-demographic and mental health were recorded. Outcome data were collected prospectively, and analysed using multivariate regression models. The primary outcomes measured were: PTB (<37 weeks’ gestation) and SGA (<10th customised centile). Results After adjustment for socio-demographic and medical factors, financial strain was associated with a 45 % increase in PTB (OR 1.45: 95 % CI 1.06–1.98). Contrary to expectation, maternal distress in Pakistani women was negatively associated with SGA (OR 0.65: CI 0.48–0.88). Obesity in White British women was protective for PTB (OR 0.67: CI 0.45–0.98). Previously recognized risk factors, such as smoking in pregnancy and hypertension, were confirmed. Conclusions This study confirms known risk factors for PTB and SGA, along with a new variable of interest, financial strain. It also reveals a difference in the risk factors between ethnicities. In order to develop appropriate targeted preventative strategies to improve perinatal outcome in disadvantaged groups, a greater understanding of ethno-specific risk factors is required
    • Evaluating the impact of befriending for pregnant asylum seeking and refugee women

      McCarthy, Rose; Haith-Cooper, Melanie (2013)
      Pregnant asylum-seeking and refugee women are a particularly vulnerable group in society, who may be possibly living alone in poverty in inappropriate accommodation (Dunne, 2007) and experiencing hostile attitudes (Hynes and sale, 2010). They may have poor physical and mental health, placing them at an increased risk of poor pregnancy outcomes (National Institute for Health and Care Excellence (NICE), 2010). Despite this, they are less likely to attend for timely maternity care. This article discusses the evaluation to date of an ongoing befriending project located in Northern england, targeting pregnant asylum-seeking and refugee women and helping to address difficulties that they may face. Volunteer befrienders, who themselves are asylum-seeking and refugee mothers, receive training to provide support and guidance to clients. Preliminary data suggest that befriending has advantages for both client and volunteer: clients appear to develop a trusting relationship with their befriender which facilitates self-confidence and helps overcome social isolation; and the volunteers feel that they are undertaking a worthwhile role and often move onto paid employment. Befriending may be a useful resource for midwives and ultimately improve pregnancy outcomes for asylum-seeking and refugee women.
    • An evaluation of a family health programme for newly arrived asylum seekers living in an initial accommodation centre in Northern England

      Haith-Cooper, Melanie (2014)
      Asylum seekers in the UK often have complex health needs but face barriers when accessing health services. A family health programme was established in an initial accommodation centre (IAC) in northern England, by trained volunteers who are refugees and therefore peers. The main focus of the programme is peers educating asylum seekers about health services in the United Kingdom (UK), including maternity services, and evaluation research was undertaken to explore the effectiveness of this. Two sessions were observed and participants provided a short verbal evaluation. Data were thematically analysed. Around 30 people from 17 countries attended the sessions which were evaluated positively. Three themes emerged related to asylum seekers' perceptions of their learning: access to health care, living as a family, and the UK as a caring country. The findings suggest that peers educating asylum seekers within an IAC appears helpful in overcoming barriers to accessing health care in the UK and could facilitate pregnant women to attend for maternity care.
    • Exercise and physical activity in asylum seekers in Northern England; using the theoretical domains framework to identify barriers and facilitators

      Haith-Cooper, Melanie; Waskett, Catherine; Montague, Jane; Horne, Maria (2018)
      Background: Many asylum seekers have complex mental health needs which can be exacerbated by the challenging circumstances in which they live and difficulties accessing health services. Regular moderate physical activity can improve mental health and would be a useful strategy to achieve this. Evidence suggests there are barriers to engaging black and minority ethnic groups in physical activity, but there is little research around asylum seekers to address the key barriers and facilitators in this group. Methods: A two stage qualitative study used semi-structured interviews underpinned by the Theoretical Domains Framework. The interviews were conducted in voluntary sector groups in four towns/ cities in Northern England. Purposive sampling recruited 36 asylum seekers from 18 different countries. Interviews were audio recorded, transcribed verbatim and subject to framework analysis. Stage two involved a nominal group technique with five key stakeholders including asylum seekers and those that work with them. They followed a four stage process to rank and reach consensus on the key barrier to undertaking physical activity/ exercise that could be addressed locally through a future intervention. Results: A number of barriers and facilitators were identified including a lack of understanding of the term physical activity and recommended levels but knowledge of the health benefits of physical activity/ exercise and the motivation to increase levels having engaged with activities back home. Living as an asylum seeker was considered a barrier due to the stress, poverty and temporary nature of living in an unfamiliar place. The outcome of the nominal group technique was that a lack of knowledge of facilities in the local area was the prevailing barrier that could be addressed. Conclusions: Public health practitioners could develop interventions which capitalise on the motivation and knowledge of asylum seekers to encourage an increase in physical activity which may in turn reduce the breadth and depth of mental health needs of this group.