Migrant mothers receiving the support they need

WHO

“We doulas build a bridge between the migrant women and the midwives. The midwives and doulas have different roles and by working together we create a calm environment, we make the women feel relaxed and safe,” says Rima Hanna, who has been a doula for over a year. Rima is originally from Syria but has been living in Sweden for more than 20 years. During her time as a doula, she estimates that she has helped about 70 women.

“I meet the women several times before they give birth,” she explains. “I am present during birth and I meet them afterwards. We mostly meet at their place, where we can address any questions they might have and go through different exercises that are beneficial before, during and after birth. Afterwards, we also talk about breastfeeding and how the experience of giving birth has been for them.”

Research indicates that refugee and migrant women in the WHO European Region have poorer pregnancy outcomes than non-migrant women. Rima is part of a Swedish project called Doula och kulturtolk that seeks to change this by improving migrant women’s experiences of care.

Run by a nongovernmental organization, the project has received government funding through the Health and Medical Administration in Stockholm. Midwives train the doulas on various topics including Swedish health care, women’s rights in the health-care system, how to support women during birth, breastfeeding, contraception and female genital mutilation.

Doulas making the difference

Speaking to the collaboration of midwives and doulas, Maria, a midwife who is part of this initiative, says: “It’s a wonderful project. Migrant women who are either new to Sweden or who have difficulties communicating well in Swedish can choose to be supported by a doula. The doulas speak the mothers’ native language, are familiar with their culture, and are educated in supporting expectant mothers during pregnancy and labour and after they have given birth.”

Maria recalls a birthing experience in which the presence of the doula made all the difference. “The birthing mother was from northern Africa and didn’t speak Swedish. She was a survivor of female genital mutilation and she had no partner, so she was particularly vulnerable. When I attended the birth, the doula and the woman already had a bond, as they had established a relationship beforehand. That was wonderful, because the labour then progressed very well – it’s crucial to feel secure when giving birth.”

The project involves about 40 community-based doulas who can work in 26 different languages. The partnerships between midwives and doulas bring a unique element to the birthing experience of migrant women.

Rima describes how she sees her role: “I feel like a big sister or a mother to them. Sometimes the woman doesn’t want to let my hand go and won’t let me leave the room. I remember I was called to a delivery once where the birthing woman spoke some Swedish but was too tired to communicate and too scared to follow any instructions. I succeeded in soothing her and calming her and we soon started doing exercises together which resulted in a successful delivery.”

“What makes me most proud is knowing that I am helping a person who is in a moment of need,” she continues. “Many women are scared, as I myself have been when giving¬ birth, so I understand what they are going through. I know how important the right support is, especially if it comes from someone who speaks and understands your language. I have always been a person who wants to help and support people, and that wish has intensified during my work as a doula.”

Focusing on the health of refugees and migrants is an important part of International Migrants Day. Achieving universal health coverage is a vital part of WHO’s work, but this cannot be realized if migrants and refugees are left behind. The doulas play an important role in ensuring that women from a variety of backgrounds are able to access health services whenever and wherever they need them.