“We are in this together” – Polish midwives’ reflections on perinatal care for Ukrainian women after the outbreak of war
Keywords:
pregnancy, trauma, maternity care, war in Ukraine, refugee womenAbstract
Background
February 24, 2022, the beginning of Russia’s invasion of Ukraine, was also the beginning of an exceptional situation and a challenge for the Polish health care system, the health care workers and Polish citizens. This study aims to conduct a qualitative analysis of midwives’ experiences of maternity care for Ukrainian women after the outbreak of war.
Participants and procedure
Eight midwives with experience working with both Ukrainian patients and Ukrainian war refugees (who came to Poland after February 24, 2022) participated in a semistructured interview. The interview data were transcribed and thematically analysed to identify the observations, challenges and medical personnel needs.
Results
The most frequently observed reactions in Ukrainian patients included crying, increased anxiety and irritability, fear, withdrawal, and constant information seeking about the current situation. Breastfeeding problems understood as a consequence of chronic stress were also observed and assisted by the midwives. All respondents pointed out the language barrier and their involvement, showing empathy and attentiveness to the patients’ situation. No hospital introduced additional support for midwives. A high level of emotional burden on midwives was observed.
Conclusions
The midwives were eager to help Ukrainian patients – they emphasized the more frequent need to make themselves available for them. However, the emotional involvement of the midwives is accompanied by the risk of traumatization and burnout, which are associated with exposure to the difficult experiences of patients. Implementation of training in trauma-informed care and supervision could suport midwives in their work and prevent the consequences of long-term stress. Systemic solutions concerning translators’ presence and hospital documents’ translation are also essential.
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References
Adamska-Sala, I., Baranowska, B., Doroszewska, A., Piekarek, M., & Pietrusiewicz, J. (2018). Raport z monitoringu oddziałów położniczych. Opieka okołoporodowa w Polsce w świetle doświadczeń kobiet [Report on the monitoring of maternity wards. Perinatal care in Poland in the light of women’s experiences]. Fundacja Rodzić po Ludzku.
APA (2013). Diagnostic and statistical manual of mental disorders (5th ed.). APA Publishing.
Andersen, L. B., Melvaer, L. B., Videbech, P., Lamont, R. F., & Joergensen, J. S. (2012). Risk factors for developing post-traumatic stress disorder following childbirth: a systematic review. Acta Obstetricia et Gynecologica Scandinavica, 91, 1261–1272. https://doi.org/10.1111/j.1600-0412.2012.01476.x
Arnetz, B., Drutchas, A., Sokol, R., Kruger, M., Mott Center, C., & Jamil, H. (2013). 1991 Gulf War exposures and adverse birth outcomes. U.S. Army Medical Department Journal, 58–65.
Baranowska, B., & Doroszewska, A. (2018). Porozumienie bez przemocy. Jak wykorzystać empatyczną komunikację na sali porodowej? [Agreement without violence. How to use empathic communication in the delivery room?]. Zeszyty Naukowe Ochrony Zdrowia. Zdrowie Publiczne i Zarzadzanie, 16, 241–246.
Berg, M., Lundgren, I., Hermansson, E., & Wahlberg, V. (1996). Women’s experience of the encounter with the midwife during childbirth. Midwifery, 12, 11–15. https://doi.org/10.1016/s0266-6138(96)90033-9
Bielska, E., & Czerkawski, A. (2016). Ryzyko, kryzys, trauma jako przedmiot oddziaływań reprezentantów profesji pomocowych – wybrane konteksty społeczne i psychologiczne [Risk, crisis, trauma as the subject of influence of representatives of the help professions – selected social and psychological contexts]. Studia Edukacyjne, 40, 163–176. https://doi.org/10.14746/se.2016.40.10
Bronowski, P. (2017). Czynniki wpływające na proces zdrowienia w opinii osób chorujących psychicznie, ich rodzin i terapeutów [Factors influencing the recovery process in the opinion of mentally ill people, their families and therapists]. In D. Danielewicz & J. Rola (Eds.), Stare dylematy i nowe wyzwania w psychoterapii [Old dilemmas and new challenges in psychotherapy] (pp. 69–86). Wydawnictwo APS.
CBOS (2022). Obawy Polaków u progu jesieni [Fears of Poles on the verge of autumn]. CBOS.
Chrzan-Dętkoś, M., Rodríguez-Muñoz, M. F., Krupelnytska, L., Morozova-Larina, O., Vavilova, A., García López, H., Murawska, N., & Nakiš Radoš, S. (2022). Good practices in perinatal mental health for women during wars and migrations: a narrative synthesis from the COST Action Riseup-PPD in the context of the war in Ukraine. Clinica y Salud, 33, 127–135. https://doi.org/10.5093/clysa2022a14
Chrzan-Dętkoś, M., Walczak-Kozłowska, T., & Lipowska, M. (2021a). The need for additional mental health support for women in the postpartum period in times of epidemic crisis. BMC Pregnancy and Childbirth, 21, 1–9. https://doi.org/10.1186/s12884-021-03544-8
Chrzan-Dętkoś, M., Walczak-Kozłowska, T., Pietkiewicz, A., & Żołnowska, J. (2021b). Improvement of the breastfeeding self-efficacy and postpartum mental health after lactation consultations – observational study. Midwifery, 94, 102905. https://doi.org/10.1016/j.midw.2020.102905
Chrzan-Dętkoś, M., & Walczak-Kozłowska, T. (2021a). How do new mothers perceive screening for perinatal depression? Health Psychology Report, 9, 207–216. https://doi.org/10.5114/hpr.2021.102823
Chrzan-Dętkoś, M., & Walczak-Kozłowska, T. (2021b). Badania przesiewowe pod kątem depresji przedi poporodowej. Czy położne są na nie przygotowane? [Screening for pre- and postnatal depression. Are midwives prepared for them?]. Paper presented at the 29th National Conference of Developmental Psychology “Modern ways of development – between fear and hope”.
Collins, C. H., Zimmerman, C., & Howard, L. M. (2011). Refugee, asylum seeker, immigrant women and postnatal depression: Rates and risk factors. Archives of Women’s Mental Health, 14, 3–11. https://doi.org/10.1007/s00737-010-0198-7
Davis, E. P., & Sandman, C. A. (2010). The timing of prenatal exposure to maternal cortisol and psychosocial stress is associated with human infant cognitive development. Child Development, 81, 131–148. https://doi.org/10.1111/j.1467-8624.2009.01385.x
Davis, E. P., Snidman, N., Wadhwa, P. D., Glynn, L. M., Schetter, C. D., & Sandman, C. A. (2004). Prenatal maternal anxiety and depression predict negative behavioral reactivity in infancy. Infancy, 6, 319–331. https://doi.org/10.1207/s15327078in0603_1
Demir-Lira, Ö. E., Voss, J. L., O’Neil, J. T., Briggs-Gowan, M. J., Wakschlag, L. S., & Booth, J. R. (2016). Early-life stress exposure associated with altered prefrontal resting-state fMRI connectivity in young children. Developmental Cognitive Neuroscience, 19, 107–114. https://doi.org/10.1016/j.dcn.2016.02.003
Falah-Hassani, K., Shiri, R., Vigod, S., & Dennis, C. L. (2015). Prevalence of postpartum depression among immigrant women: a systematic review and metaanalysis. Journal of Psychiatric Research, 70, 67–82. https://doi.org/10.1016/j.jpsychires.2015.08.010
Fatušić, Z., Kurjak, A., Grgić, G., & Tulumović, A. (2005). The influence of the war on perinatal and maternal mortality in Bosnia and Herzegovina. Journal of Maternal-Fetal and Neonatal Medicine, 18, 259–263. https://doi.org/10.1080/147670500198501
Fawcett, E. J., Fairbrother, N., Cox, M. L., White, I. R., & Fawcett, J. M. (2019). The prevalence of anxiety disorders during pregnancy and the postpartum period: a multivariate Bayesian meta-analysis. The Journal of Clinical Psychiatry, 80, 18r12527. https://doi.org/10.4088/JCP.18r12527
Fellmeth, G., Fazel, M., & Plugge, E. (2017). Migration and perinatal mental health in women from lowand middle‐income countries: a systematic review and meta‐analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 124, 742–752. https://doi.org/10.1111/1471-0528.14184
Fellmeth, G., Plugge, E. H., Nosten, S., Oo, M. M., Fazel, M., Charunwatthana, P., Nosten, F., Fitzpatrick, R., & McGready, R. (2018). Living with severe perinatal depression: a qualitative study of the experiences of labour migrant and refugee women on the Thai-Myanmar border. BMC Psychiatry, 18, 229. https://doi.org/10.1186/s12888-018-1815-7
Fuller, A., Messito, M. J., Mendelsohn, A. L., Oyeku, S. O., & Gross, R. S. (2018). Prenatal material hardships and infant regulatory capacity at 10 months old in low-income Hispanic motherinfant pairs. Academic Pediatrics, 18, 897–904. https://doi.org/10.1016/j.acap.2018.04.134
Gawrych, M. (2022). Zdrowie psychiczne pracowników medycznych w czasie pandemii COVID-19 – przegląd literatury [Mental health of medical workers during the COVID-19 pandemic – a review of the literature]. Psychiatria Polska, 56, 289–296. https://doi.org/10.12740/PP/OnlineFirst/127217
Graham, A. M., Rasmussen, J. M., Entringer, S., Ben Ward, E., Rudolph, M. D., Gilmore, J. H., Styner, M., Wadhwa, P. D., Fair, D. A., & Buss, C. (2019). Maternal cortisol concentrations during pregnancy and sex-specific associations with neonatal amygdala connectivity and emerging internalizing behaviors. Biological Psychiatry, 85, 172–181. https://doi.org/10.1016/j.biopsych.2018.06.023
Hahn-Holbrook, J., Cornwell-Hinrichs, T., & Anaya, I. (2018). Economic and health predictors of national postpartum depression prevalence: a systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Frontiers in Psychiatry, 8, 248. https://doi.org/10.3389/fpsyt.2017.00248
Holmes, E. A., O’Connor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arseneault, L., & Bullmore, E. (2020). Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The Lancet Psychiatry, 7, 547–560. https://doi.org/10.1016/S2215-0366(20)30168-1
Huizink, A. C., Robles de Medina, P. G., Mulder, E. J. H., Visser, G. H. A., & Buitelaar, J. K. (2002). Psychological measures of prenatal stress as predictors of infant temperament. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 1078–1085. https://doi.org/10.1097/00004583-200209000-00008
Ilska, M., & Przybyła-Basista, H. (2014). Measurement of women’s prenatal attitudes towards maternity and pregnancy and analysis of their predictors. Health Psychology Report, 2, 176–188. https://doi.org/10.5114/hpr.2014.45300
Jadhav, S. (2000). The cultural construction of Western depression. Jessica Kingsley Publishers.
Jain, A., & Levy, D. (2013). Conflicting cultural perspectives: Meanings and experiences of postnatal depression among women in Indian communities. Health Care for Women International, 34, 966–979. https://doi.org/10.1080/07399332.2013.807258
Jankowiak, B., Krajewska-Kułak, E., Klimaszewska, K., Ostapowicz Van Damme, K., & Kowalewska, B. (2011). Subjection of midwives to psychosocial threats occurring in the workplace. Nursing Problems, 19, 303–306.
Keasley, J., Blickwedel, J., & Quenby, S. (2017). Adverse effects of exposure to armed conflict on pregnancy: a systematic review. BMJ Global Health, 2, e000377. https://doi.org/10.1136/bmjgh-2017-000377
Koss, J., Rudnik, A., & Bidzan, M. (2014). Doświadczanie stresu a uzyskiwane wsparcie społeczne przez kobiety w ciąży wysokiego ryzyka [Experiencing stress and the obtained social support among women with high-risk pregnancies]. Family Forum, 4, 183–201.
Leinweber, J., Creedy, D. K., Rowe, H., & Gamble, J. (2017). A socioecological model of post-traumatic stress among Australian midwives. Midwifery, 45, 7–13. https://doi.org/10.1016/j.midw.2016.12.001
Monk, C., Georgieff, M. K., & Osterholm, E. A. (2013). Research review: Maternal prenatal distress and poor nutrition – mutually influencing risk factors affecting infant neurocognitive development. Journal of Child Psychology and Psychiatry, 54, 115–130. https://doi.org/10.1111/jcpp.12000
Prot-Klinger, K. (2021). Reakcja na katastrofę – perspektywa psychoanalityczna [Reaction to a disaster – a psychoanalytic perspective]. In S. Kluczyńska & C. Czabała (Eds.), Interwencja kryzysowa. Wybrane zagadnienia [Crisis intervention. Selected issues] (pp. 33–54). Wydawnictwo APS.
Punamäki, R. L., Diab, S. Y., Isosävi, S., Kuittinen, S., & Qouta, S. R. (2018). Maternal pre- and postnatal mental health and infant development in war conditions: The Gaza Infant Study. Psychological Trauma, 10, 144–153. https://doi.org/10.1037/tra0000275
Punamäki, R. L., Isosävi, S., Qouta, S. R., Kuittinen, S., & Diab, S. Y. (2017). War trauma and maternalfetal attachment predicting maternal mental health, infant development, and dyadic interaction in Palestinian families. Attachment & Human Development, 19, 463–486. https://doi.org/10.1080/14616734.2017.1330833
Ryding, E. L., Wijma, B., & Wijma, K. (1997). Posttraumatic stress reactions after emergency cesarean section. Acta Obstetricia et Gynecologica Scandinavica, 76, 856–861. https://doi.org/10.3109/00016349709024365
Roumieh, M., Bashour, H., Kharouf, M., & Chaikha, S. (2019). Prevalence and risk factors for postpartum depression among women seen at primary health care centres in Damascus. BMC Pregnancy and Childbirth, 19, 519. https://doi.org/10.1186/s12884-019-2685-9
Signorello, L. B., Mulvihill, J. J., Green, D. M., Munro, H. M., Stovall, M., Weathers, R. E., Mertens, A. C., Whitton, J. A., Robison, L. L., & Boice, J. D. (2010). Stillbirth and neonatal death in relation to radiation exposure before conception: a retrospective cohort study. Lancet, 376, 624–630. https://doi.org/10.1016/S0140-6736(10)60752-0
Shorey, S., Chee, C., Ng, E. D., Chan, Y. H., Tam, W., & Chong, Y. S. (2018). Prevalence and incidence of postpartum depression among healthy mothers: a systematic review and meta-analysis. Journal of Psychiatric Research, 104, 235–248. https://doi.org/10.1016/j.jpsychires.2018.08.001
Straż Graniczna (2023). Statystyki SG – Komenda Główna Straży Granicznej [Border Guards statistics]. Retrieved from https://www.strazgraniczna.pl/pl/granica/statystyki-sg/2206,Statystyki-SG.html
Templeton, L., Velleman, R., Persaud, A., & Milner, P. (2003). The experiences of postnatal depression in women from black and minority ethnic communities in Wiltshire, UK. Ethnicity & Health, 8, 207–221. https://doi.org/10.1080/1355785032000136425
United Nations Population Fund (2022). UNFPA expects unintended pregnancies in Ukraine to go up due to war. Retrieved from https://www.devex.com/news/unfpa-expects-unintended-pregnancies-inukraine-to-go-up-due-to-war-102950
Utari-Witt, H., & Walter, A. (2021). W drodze na obcą ziemię. Psychoanalityczne refleksje na temat migracji [On the way to a foreign land. Psychoanalytic reflections on migration]. Warszawskie Centrum Innowacji Edukacyjno-Społecznych i Szkoleń.
Weisenberg, M., & Caspi, Z. (1989). Cultural and educational influences on pain of childbirth. Journal of Pain and Symptom Management, 4, 13–19. https://doi.org/10.1016/0885-3924(89)90059-6
World Health Organization (2018). International classification of diseases (11th revision). Retrieved from https://icd.who.int/en
World Health Organization (2022). Ukraine: Immediate steps needed to prevent a measles outbreak due to the ongoing war and low vaccination rates, warns WHO. Retrieved from https://www.who.int/europe/news/item/27-04-2022-ukraine--immediate-steps-needed-to-prevent-a-measles-outbreak-due-to-the-ongoing-war-and-low-vaccination-rates--warns-who