Kinga Gałuszka talks about antenatal classes for foreign women with Marta Piegat-Kaczmarczyk, Inna Padshakh and Hanna Kamińskaby. The interview comes from the publication “Being There is the Most Important Thing Supporting Refugee and Migrant Women in the Perinatal Period – the Experiences of the Polish Migration Forum Foundation”.
It all pretty much started in the delivery room…
M.P.-K.: When I gave birth to my first child and was already at the maternity ward, during the rounds the doctors would ask us all: “How are you feeling? Are you breastfeeding? Is everything OK?”. In the bed next to me was a Vietnamese woman, who nodded at every question. But I could see that she was suffering. She tried expressing her milk with a breast pump – standing up and even on all fours, kneeling. To no avail. She cried. Whenever the doctor came, she nodded to say that everything was fine. One time I stopped him and told him that this lady was having a hard time feeding and that she was not fine at all. I did it without consulting her, but I felt there was no other option. They actually helped her: the baby learned to feed from the breast and all went well. It was only later that I explained to her that I had spoken to the doctors. She was very grateful.
This gave me food for thought. If I, a 29-year-old mother, well adjusted in life, am in total stress and panic at the hospital, what must a Viet- namese woman who can’t communicate with the staff feel? Imagine this: having a baby among people who don’t understand you and you don’t understand them. How stressful! We started exploring the topic at the Foundation and found that there was a gap in the system. This is how we came up with antenatal classes, or birthing schools, for migrant women – the first project of its kind in Poland.
The first classes launched five years later…
M.P.-K.: It took so much planning, researching, checking, analysing various stud- ies. We also travelled to conferences and talked about the project. We felt a bit like a circus. I’m joking, of course, but that’s more or less how we were perceived when we said we were doing classes for foreign women giving birth. “Foreigners? Well, yes, indeed they are here, and they give birth, too” – we heard. In 2014, we brought the project to life. This time
I was giving birth to my second child. While I was lying in the antenatal room, I got a call from Agnieszka Kosowicz saying that we had signed the contract and we were going ahead.
From the beginning you also assumed that the programme would be based on the idea of continued support after the birth.
M.P.-K.: This was due to the specific circumstances of migrant women, with their lives being cut into different stages. So continuity of support in their case is vital. Sometimes the girls would meet a midwife at the antenatal classes who then assisted them during the birth, and after the birth they would come to me for the support group. This was the thing we wanted most – for the meetings to be held in a language they could understand and for them to be uninterrupted. From the moment a pregnant woman comes to us, we cater for her parenting needs and this continues up to the nursery or pre-school stage. During this time, other topics come up: more chil- dren, divorce, all the things that life brings with it.
What was the timetable for these activities in the early years?
M.P.-K.: We run one birthing school per quarter. Immediately after the classes we would start support groups. Then, when the groups wanted to work with us for over six months, we merged them into one larger group.
Who took part in your classes?
M.P.-K.: These were truly beautiful groups. Ukrainian women, Belarusian women, Russian women came – they were all together. There were also Indo- nesian or Tajik women. We did a split between English and Russian, although this did not always work. For several years, classes in these two groups ran in parallel. The girls came with older and older children and then with more children, supporting each other.
Over the period of nearly 10 years since the first birthing school, the migrant reality in Poland has changed a lot, especially of course since 2022, when the war in Ukraine escalated…
M.P.-K.: The type of problems has not changed, only their intensity. There are simply many more women who are in need. Added to this was a group of independent mums – but that was only at the very beginning of the war. In the first few months, women came alone, in advanced pregnancy. They were fleeing the war – without their husbands, and they did not know if they would see them again, if the father would meet the child, if the child would meet the father. It was a distinctive group of very lonely and very terrified girls, to whom it all happened suddenly. Things are different now.
Hania, you are one of the midwives who have been working with the PMF almost since the beginning of the project.
H.K.: I was a volunteer with the Rodzić po Ludzku Foundation. There I met Marta, who was running a training for midwives – she taught us what the cultural differences were and why a Vietnamese woman nods to say yes but thinks the opposite. At the time, I was working at an ordinary district hospital in Piaseczno, where a lot of Vietnamese and Chechen women were giving birth. We were unable to establish a real connection with them. So for me as a midwife that training was groundbreaking and much needed.
I came to the PMF in 2015. Previously, birthing schools were run on the obstetric side by Martyna Grygiel-Kaczmarek, who handed over the job to me as she decided to focus on her work at the hospital.
M.P.-K.: I remember that in 2015 the government froze funding for NGOs, so our financial situation was also tragic. We waited for the money awarded to us in international competitions, which never came. We were only able to do four birthing schools per year, with no possibility of giving postnatal consultations. All our activities were trimmed to the bare minimum.
In 2022 the project kicked off anew…
H.K.: First, in addition to the standard antenatal classes, we included individ- ual consultations for pregnant women. In the middle of the year, we also started postnatal consultations and that was also a hit. We knew the girls needed them. I am very happy that we are able to do this, because we always wanted it.
Hania, you run English language groups…
H.K.: I work together with psychologist Anfisa Yakovina. Our classes are generally attended by open-minded people, who are also very keen on postnatal consultations. According to my calculations, since April, so over nine months, I have held 56 consultations for women of different nationalities from 15 countries. I am not counting the men who some- times come from some other places. Most girls need a lactation consulta- tion, because breastfeeding is the main problem. Sometimes there are also some nursing issues, and sometimes they just want to make sure they are doing everything right. We often have a postpartum contracep- tive consultation.
In total, we provided over 300 individual consultations in 2023. And each of them, at least the at-home ones, lasts two hours.
What do migrant women fear before giving birth?
H.K.: Apart from focusing on what all other pregnant women think about,
i.e. to get everything ready and to buy the necessary items, they also experience the added stress connected to the registering: registering the children. There is also a lot of anxiety about whether they will find their way around the healthcare system. I always advise them not to call the clinic, but to go there in person or to send their partner there, as it is often difficult to communicate in English over the phone.
They are anxious that they will not understand the doctor; sometimes they write to me to make sure they have understood correctly, or send images from their appointments. Of course, Polish women are also stressed, because every paediatrician is different. I hear stories about young mums feeling terrible after an appointment because the doctor criticised everything they do. This is already a systemic issue. It can also be stressful to deal with a midwife, although it is not so bad because there are midwives who are not afraid to communicate in English.
What do migrant women tell us about their births?
H.K.: They have good memories. However, let’s remember that I only have accounts from Warsaw, where there is a choice of facilities and where, already at the antenatal classes, we advise which hospital to choose depending on the needs of the individual woman.
The ladies are grateful that they had care, that their perineum was not incised or that they were able to give birth in water or in the position of their choice, that they could cuddle the baby before the umbilical cord was cut. We take it for granted.
Sometimes postnatal care has its problems, but I am a midwife myself and I know that one midwife can have up to 20 women who have just given birth under her care. It is not possible to dedicate a lot of time to each of them.
Let’s go back to Vietnamese women for a moment, who sort of started it all. What is your experience with this large and still poorly integrated community in Poland?
M.P.-K.: Vietnamese families do not report to birthing schools. And we know from the Vietnamese women we meet in various places that they lack both knowledge and support. A few years ago, we put together a programme designed for them – there was a need on their part and a willingness on ours. But a barrier arose: the fact that we held the classes at our premises proved too time-consuming for couples, especially when they were supposed to come together, dedicate the whole weekend to it and not work during that time. It is a community that works a lot, and pregnant women often don’t take sick leave.
So when a couple of years ago we went with an interpreter to Wólka Kosowska, the closest place to where they work all day, we found that the ladies were very interested. They were grateful for all the informa- tion we gave them. They asked a lot of very interesting questions, such as how to go straight from hospital back to work with a baby. They were pleased to learn that they could carry the baby in a sling and that the baby did not have to sleep on a pile of jeans in the hall at all. So even if a woman needs to go back to work, at the same time she can fulfil herself as a good, caring mum who is close to her child… Sadly, we have not managed to transfer these activities back to our premises. And a mobile school in the long term is a highly challenging task. But if every other class was dedicated to the Vietnamese com- munity, we would certainly have full attendance.
What is it like working with Russian- and Ukrainian-speaking groups?
I.P.: Those first classes just after the outbreak of war, as mentioned earli- er by Marta, were only for mums who had just come here, experienc- ing a lot of fear, without any support around them. It was very diffi- cult. Most of all, we tried to build a community and, in the beginning, not so much to impart a lot of medical knowledge as to give psycho- logical support. They really needed it a lot. Only later did we get into the subject of childbirth. We explained how the healthcare system in Poland works, so that they would know what they could expect and what they were not necessarily used to.
I know that girls from Ukraine are terrified to learn that an ambulance will not take them to hospital to give birth in Poland…
I.P.: In Poland, we try to stay in the home environment for as long as pos- sible, in comfortable conditions. In Ukraine it is different – women in labour prefer to go to hospital earlier to stay under observation until the birth itself. Polish women wait until the last minute and go on their own.
Inna, from the perspective of your Ukrainian midwifery experience, how do you perceive the standards of perinatal care in Poland and Ukraine?
I.P.: In Ukraine, it is the norm for the doctor who looked after the pregnancy to be present at the birth. In Poland it is completely different: not only is there little chance of the same gynaecologist attending the birth, but in Poland in general a doctor is rarely present at the birth. Especial- ly if everything runs smoothly and the mother and the baby feel well. Everything depends on the midwives, who are very professional.
I hear from girls that they expect the doctor looking after their preg- nancy to prescribe some medication or supplements. Meanwhile, if everything is OK and test results are good, the doctor in Poland does not prescribe anything, whereas in Ukraine you always leave the doc- tor’s office with a prescription. This makes them feel that the doctor over here is not paying enough attention to them.
And any positive surprises?
I.P.: In Ukraine if a woman has made arrangements with a doctor at the hospital, she will receive care and be treated well. But you have to pay
a lot for everything. So they are surprised that in Poland you can get the same care for free – from a midwife, who just works at the ward and is on call. All the standards in place here, like Hania said, are a pleasant surprise. This is nice, and it was especially important for the women who came to give birth here at the beginning of the war and were in a very difficult situation.
The war has been going on for so long now, so your groups must have changed too?
I.P.: Now women come to classes with their partners. They are much calmer. They ask specific questions about hospitals where they can give birth, as well as types of delivery. They are more aware. They have lived here for some time now and have become accustomed to the system.
The programme of your birthing school is divided into several modules. The first deals with formal-legal issues, the second with the psychological wellbeing of women in the postpartum period and the supportive role of the partner during this period, the next with purely obstetric issues and finally with issues related to taking care of the newborn. From the perspective of your experience so far, are there any areas you would like to add to the programme?
M.P.-K.:The answer to this question is complex, as we assume a great deal of flexibility each time, as each group is different. When the ladies showed up just after 24 February 2022, we knew that with them we had to work mainly on their resources, on community building. Whereas we certainly couldn’t start the subject of the relation- ship with the partner after the birth. We knew it was a very painful topic.
With each group, we explore their expectations. And although the framework programme of the classes is always the same, we try to manoeuvre with perinatal, psychological, educational and migra- tion topics. Multidisciplinarity is key in this work.
There are some topics that we would not have thought of and could not have planned for, such as what to do when registering a child if the father is not the husband of the child’s mother and he is not here, or what should the mother do if she gives the father’s name, which could result in his deportation?
Let us pause finally on the subject of mental wellbeing. During the antenatal classes you devote a lot of time to this subject, you do it in a very specific way – talking directly about, among other things, postnatal depression. You say: there is such a disease and it can also be part of the experience.
M.P.-K.: We observe that many of the girls we know from the schools or sup- port groups reach out for psychological and psychiatric help, which we familiarise them with a little bit during the antenatal classes. They often say that they would never have gone to a psychologist before because they thought that a psychologist, and even more so a psychiatrist, was a last resort.
Meanwhile, all studies show that women with migration experience have a much higher risk of postnatal depression. This is linked to high levels of anxiety and uncertainty about the future and often also to previous traumatic experiences.
I believe, from the point of view of a psychologist working with childhood trauma, that the most important thing about antena- tal classes is something that is not visible. Working with women in the perinatal period is the key element in protecting children from possible later harm and trauma. Because if the parents or the woman herself, if she is an independent mum, gets support, understanding and acceptance of her different and difficult emotions during this very sensitive time, she will be a safer person for her child. These first patterns of attachment are of key importance for our whole lives.
Hanna Kamińska – midwife, been working with the Polish Migration Forum Foundation since 2015. As part of the “I Am a Mom in Poland” project and at her own birthing school, she educates and supports young parents of different nationalities living in Poland. She gained experience at St. Anne’s Hospital in Piasecz- no and St. Sophia’s Hospital in Warsaw. Advocate of home births.
Inna Padshakh – midwife and doula, been working with the Polish Migration Forum Foundation as an educator in the women’s programme since 2022. She supports migrant women in the perinatal period in the scope of issues related to being a parent in Poland, preparing for childbirth in Polish hospitals and the healthcare system in Poland. She cares for pregnant women and women with young children in long-term accommodation and crisis centres.
Marta Piegat-Kaczmarczyk – intercultural psy- chologist, certified TSR therapist. She runs therapy for children and adolescents with refugee, trauma, violence or discrimination experiences. She supports migrant and refugee women in perinatal crises, con- ducts intercultural birthing schools, support groups and workshops for parents as well as postgraduate classes at the University of Warsaw.
>> See the whole publication “Being There is the Most Important Thing Supporting Refugee and Migrant Women in the Perinatal Period – the Experiences of the Polish Migration Forum Foundation”
