Background: Perinatal depression disproportionately affects asylum seeking and refugee (AS&R) women, but they are less likely to receive support than other women. There is no published research which considers the assessment and support for symptoms of perinatal depression provided by midwives for AS&R women navigating England’s maternity services. Aim: To investigate how midwifery practice can be developed to support asylum seeking and refugee women with symptoms of perinatal depression. Methods: A post-colonial feminist inquiry consisting of a scoping survey (study one) and a qualitative research study (study two) using remote interviews with AS&R women and midwives. Qualitative data was analysed using reflexive thematic analysis. Findings: Study one demonstrated that midwives who care for AS&R women work within diverse roles and service structures across England. Study two identified that midwives lack the resources and support structures required to effectively recognise and support symptoms of perinatal depression in AS&R women. These factors were sometimes invisible to AS&R women, but still negatively affected their ability to effectively discuss perinatal depression with a midwife and access help for any symptoms. The lack of appropriate resources was harmful to both AS&R women and midwives. Conclusion: AS&R women and midwives who care for them navigate an inequitable maternity system in England. Midwives do not have the appropriate resources to provide a level of care which is equitable to women in the general maternity population. This leaves AS&R women’s perinatal mental health needs unrecognised and unmet, acting as a barrier to receiving effective support. / Mary Seacole research development scholarship

Yes / This article examines the effects of role redesign on the work and professional boundaries of midwives employed in the National Health Service. It outlines midwives' views and experiences of attempts to change their skills and professional boundaries and, using the concept of closure, considers the implications for the midwifery profession. The findings show that role redesign is changing midwives' work and that the traditional emotional, social and caring skills associated with a midwife are being undermined by the growth in technical work. Importantly, midwives attempts to use closure have met with limited success and aspects of their work which they enjoy are being delegated to maternity support workers, while midwives' roles expand to include work traditionally performed by doctors. Midwives' concerns about the implications of work redesign for maternity care and their professional boundaries reflect the uncertainty surrounding the profession about the future role and skills of a midwife.

No / NHS maternity services in England must increase productivity if the NHS is to make efficiency savings by 2014. At the same time, it is expected to maintain or improve patient outcomes such as safety and quality. Given staff costs are 60% of the budget; it is likely that either the number or composition of the workforce will need to be changed to meet these targets. In this article, the authors argue that very little is known about the impact of altering the skill mix on either productivity or patient outcomes. Furthermore, it is unclear whether output and outcomes are themselves trade-offs between increased workload, increased number of deliveries and the increased complexity of demand.

No / The NHS needs to make real term cost savings whilst maintaining and, where possible, enhancing the quality of essential services. The performance of maternity services is seen as a touchstone of whether the NHS is delivering quality health services in general. Recent events in relation to increased infant and maternal mortalities demonstrate the necessity of the benefits of continued improved patient safety. The pressing issues which maternity services face are financial, quality and safety.

No / Postnatal care is an area for serious concern, with readmission of women and infants following discharge having increased significantly over the past decade. A reduction in average postnatal stays together with care delivered by many members of a fragmented multidisciplinary team disallowing full timely assessments of health needs, are reasons cited for this. There is a disjuncture between process, policy and health outcomes in maternity and neonatal outcomes. While there is evidence indicating what needs to be done to reduce mortality and morbidity and improve outcomes, more is required in relation to how this is done; central to this is innovation. Currently, the NHS does not have sufficient useful data on the extent to which frontline workers are delivering needed interventions, or their short and long-term impacts. Unscheduled maternity and neonatal admissions are supposedly a key indicator of the quality of maternity care. An understanding of why these incidents occur could generate significant cost reductions at a time of severe austerity and enhance the quality of care and safety for women and their infants.

Yes / 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.

Yes / 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.

No

No

Yes / Evidence for early intervention and prevention-based approaches for im-proving social and emotional health in young children is robust. However, rates of participation in programmes are low. We explored the dynamics which affect levels of community readiness to address the issues of social and emotional health for preg-nant women, young children (0-4 years) and their mothers.Setting:A deprived inner‐city housing estate in the north of England. The estate falls within the catchment area of a project that has been awarded long-term funding to address social and emotional health during pregnancy and early childhood.Methods:We interviewed key respondents using the Community Readiness Model. This approach applies a mixed methodology, incorporating readiness scores and qualitative data. A mean community readiness score was calculated enabling the placement of the community in one of nine possible stages of readiness. Interview transcripts were analysed using a qualitative framework approach to generate con-textual information to augment the numerical scores.Results:An overall score consistent with vague awareness was achieved, indicating a low level of community readiness for social and emotional health interventions. This score suggests that there will be a low likelihood of participation in programmes that address these issues.Conclusion:Gauging community readiness offers a way of predicting how willing and prepared a community is to address an issue. Modifying implementation plans so that they first address community readiness may improve participation rates. / Better Start Bradford