On the margins: improving outcomes for vulnerable women

By Juliette Astrup on 05 October 2018 Women's Rights FGM - Female Genital Mutilation RCM Annual Conference

Three inspirational midwives, who have devoted their professional lives to supporting the most vulnerable women in society, gave the RCM conference an insight into one of the most challenging – but rewarding – roles in midwifery.

Memuna Sowe, midwife at Croydon Health Services NHS Trust’s Rainbow Health Centre and 2018 winner of the BJM Midwife of the Year, is a specialist midwife with a caseload of vulnerable and marginalised women including homeless women, trafficked women, women with drug and alcohol misuse issues and asylum seekers.

She told delegates: ‘To me, an asylum seeker is a 16-year-old lady who has come to this country seeking a better life, but has been trafficked and ended up pregnant as a result.

‘To me, a homeless woman is Emma, who got pregnant sleeping with men to pay for her habit. As a midwife it’s not my job to judge Emma – it’s my job to provide care for her.’

She added: ‘You have these definitions, but the true definition is when you meet these women and hear their stories.’

She told delegates about the need to ensure ‘compassionate care and make sure these women feel welcomed’, and the need to consider the barriers they had overcome to present to services. 

‘Make sure you’re giving individualised care, and make sure you here her story,’ she said.

Faye Macrory, a former specialist midwife who worked with vulnerable women in Manchester, devoted her career to caring for women on the margins of society, including those with problematic drug or alcohol use, mental health problems, or those facing domestic violence.

Faye reflected on how midwives must support themselves and the implications on their practice of ‘bearing witness’ to horror and trauma.

‘Hearing and being constantly exposed to stories of trauma and abuse, how do we keep ourselves safe so we can do the job we love?’ she asked.

She touched on the need to manage not just the workload and its emotional toll, but processing traumatic material, building up resilience, and self-care.

And she reflected on the need to tackle prejudice, adding: ‘While we need researched-based evidence to do our jobs, we don’t need research-based evidence to treat people with respect and dignity and be kind.’

Community midwife manager with NHS Greater Glasgow and Clyde’s Special Needs in Pregnancy Team Hilary Alba works with complex asylum seekers, trafficked women and survivors of FGM.

She told of the ‘humbling experience’ of working with women trafficked so many times they had no idea what country they were in, or FGM survivors who weren’t aware of what FGM was, or women who had lost their children overboard on a refugee boat.

She called it an ‘absolute privilege’, but added: ‘It’s not for the faint hearted what we do – but it’s probably one of the most rewarding jobs you could do as a midwife.’

The trio then took audience questions, including around maintaining personal and professional boundaries, training, and caseloads.