Statistically, asylum-seekers and refugee women are at higher risk of adverse pregnancy outcomes, including an increased probability of preterm birth and admission to neonatal care units. Access to prenatal healthcare can improve the health of the mother and newborn baby, but the services are for naught if the expectant mothers can’t access them.
Without these regular prenatal checkups, treatable complications, such as gestational diabetes, may go unchecked, putting both mother and infant at risk. But expectant moms who have been forced to leave their home country face compounded hurdles—from finding affordable housing to reliable transportation—so staying on top of these prenatal visits is difficult.
Certified nurse-midwife Anissa Dickerson, CNM, and her team at Boston Medical Center’s Refugee Women’s Health Clinic are working to address this challenge by bringing prenatal care directly to patients who face barriers getting into the clinic.
Bringing mobile prenatal care to refugee women
Boston Medical Center’s Refugee Women’s Health Clinic provides culturally sensitive women’s health services to refugee, asylum-seeking, and recent immigrant communities across the Greater Boston area. When the COVID-19 pandemic started, the center’s co-directors, Dickerson and Wan-Ju Wu, MD, MPH, realized how difficult and anxiety-inducing it was for many patients to come into the clinic, so they began bringing midwife and obstetrics and gynecology (OBGYN) services into the community.
Many patients can’t afford to live close to the city, and it can take hours to travel to and/or from the clinic for care. The mobile clinic program helps women who are refugees or asylum seekers to prepare for labor and birth, literally and figuratively where they are. Midwives and OBGYN clinicians see patients in outer locales, such as Waltham and Woburn, conducting visits in the back of an ambulance donated by Brewster Ambulance.
Having a mobile clinic makes it easier for these patients to receive more consistent care.
“Many of our patients have experienced trauma and having time and trust and continuity of care is so important,” says Dickerson.
The mobile OBGYN clinic's holistic, sensitive approach
In addition to offering prenatal checkups, OBGYN care, vaccinations, and family planning support, the clinicians work through a holistic needs assessment. They support expectant mothers with whatever resources they can, from food to baby clothes, and connect families with additional resources in their local community.
“One of the best things about the initiative to me is the social justice approach,” says Jake Savage, a mobile case manager. “We’re transferring that burden of transportation from the patient to us. That feels like justice is being served. It’s a way of turning the usual approach to care upside down that allows us to be more culturally adaptive and sensitive."
Clinicians found that face-to-face, one-on-one communications help them to truly understand what’s happening in each patient’s life and support them in a wider capacity. Clinic team members aim to approach their work with humility and gentleness.
“Many of us at the clinic have worked overseas, and our patients are accustomed to a different structure of medicine where community health workers play a key role,” says Mary Elise Lynch, MD, a recent BMC residency graduate who worked in the mobile clinic. “Having healthcare that reflects where patients are from is a way to show cultural respect on another level. It’s been a beautiful way to connect with our patients.”
Empowering patients in pregnancy through birth
When they’re in the field, the clinic’s midwife and OBGYN physician are able to spend more time with each patient to support them throughout their pregnancy and beyond. But it's not just about healthcare and the patient's social determinants of health. It's also about empowering pregnant women to make their own healthcare decisions.
“Many patients have previous experiences of being told what to do when it comes to their bodies,” says Savage. “Our job is to present patients with options and let them know we’re there to support them. When we give options to patients, they learn that they can be an active participant in their care. That is justice in action.”
With the opportunity for consistent care with the mobile clinic, midwives, nurses, and doctors are able to work with pregnant patients through their entire prenatal journey to giving birth with the same teams at BMC.
“It’s an immense privilege to care for women in our mobile clinic and then to be there to help them through labor,” says Lynch.
Savage recalls one patient who came to the United States seeking asylum from Ethiopia and was forced to spend much of her pregnancy away from her husband until they were reunited here in Boston.
“During one of our later visits, the husband and wife met us together with their baby,” he says. “It felt like a really special moment to see them happy and healthy.”