A “better service” promoting “better experiences”: Midwives' experiences working in a caseload service for women of refugee backgrounds

Background: Women of refugee backgrounds living in high-income countries experience health inequities. One contributing factor is maternity services that are unresponsive to their particular needs. In 2016, after a service evaluation identified significant issues, an Australian tertiary hospital redesigned a service for women of refugee backgrounds by incorporating continuity of midwifery carer with 24/7 phone access to midwives and interpreters. Midwives provided group antenatal care at a community venue with an onsite social worker, interpreters, and postnatal care at home. There is a dearth of literature describing midwives’ experiences of working in such services. 

Aim: To explore and describe midwives’ experiences and perceptions of working at a dedicated Refugee Caseload Midwifery Group Practice service (RMGP). 

Methods: One focus group and five one-on-one online interviews were conducted between 12 and 30 July 2021 with eight midwives working, or previously working, at the service. Reflexive thematic analysis interpreted midwives’ work perspectives and experiences.

Findings: Themes included 1) Accessible and responsive care, 2) Understanding and valuing women's needs, and 3) Strong partnerships. Our findings suggest that the RMGP service promoted equity-oriented care by contextually tailoring care to meet women's cultural and logistical needs. The service components were responsive to women's needs, promoting easier access to care. However, midwives lacked adequate support to provide trauma-informed care. 

Conclusion: The RMGP service promotes accessible care and is an excellent example of a service that provides equity-oriented care for women of refugee backgrounds. Effective training in trauma-informed care will enhance midwives’ provision of quality care.