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On International Day of the Midwife, City St George’s, University of London celebrated the work of its midwifery staff and researchers.

This year’s theme is ‘Midwives: critical in every crisis’, and at City St George’s, our staff and students in the Department of Nursing and Midwifery are leading vital projects. These range from exploring how midwives provide care in critical situations, such as prisons and refugee communities, to how trauma affects maternity staff themselves.

Understanding the impact of birth trauma

A published in Midwifery by researchers at City St George’s and Queen Mary University of London highlights a significant but under-explored issue: the psychological toll of traumatic births on maternity professionals. The study, which involved Professor Susan Ayers, Alice McInnes, Nazihah Uddin and Rebecca Webb, validated the City Birth Trauma Scale (City BiTS) for maternity staff, a tool originally developed to assess PTSD in mothers but now adapted to support healthcare professionals exposed to traumatic birth experiences.

Among the 396 maternity staff surveyed, over 55% reported witnessing severe injury, and 41% had experienced a maternal or infant death during their work. Nearly one-third (30.7%) met the diagnostic criteria for PTSD.

The scale shows promise in identifying PTSD symptoms, potentially offering a structured way to recognise staff who need support.

“Our findings underscore the impact that traumatic birth experiences can have on the professionals who care for women and babies. By adapting the City BiTS for maternity staff, we hope to provide a practical tool that can help organisations support their workforce more effectively,” said Professor Ayers.

Why are pregnant women in prison?

Maria Garcia de Frutos, a midwifery lecturer at City St George’s, has also been exploring the impact of prison on pregnant women. In a report titled “”, Maria and colleagues investigated the circumstances and policies that lead to the imprisonment of pregnant women in England and Wales.

Prompted by the tragic 2019 case of a woman giving birth alone in a cell at HMP Bronzefield, where the baby died, the research examined 22 cases of pregnant women in custody. The findings are as follows:

• Most women were incarcerated for non-violent offences, including shoplifting and breaching probation.
• Many entered prison during the final trimester of pregnancy, with some reaching 35 or 36 weeks gestation.
• Vulnerabilities were prevalent, including mental illness, homelessness, addiction, and domestic abuse.
• Prison care was inconsistent, with many women reporting delayed or inadequate access to maternity support.

The report calls for a complete overhaul of sentencing practices, with the starting position that no pregnant woman should be in custody and that no court decision should endanger the life of an unborn baby. It highlights that imprisonment for pregnant women is not necessary, rather it is a choice made by the legal system of each country, and the report instead recommends alternatives such as community sentences, women’s centres, or residential support facilities, which are less punitive and more supportive of both mother and child.

It argues that imprisoning pregnant women should be a last resort, only used when absolutely necessary—and even then, only with clear justification in open court.

Relationship between midwives and refugee women

Katherine Waterfall, a Midwifery Lecturer at the University of East Anglia, is also exploring the intricacies of the relationship between refugee women and midwives working in the NHS as part of a PhD at City St George’s.

While the research is ongoing, in a recent literature review Katherine found that the relationship between a midwife and a refugee woman can vary from trusted friendship to interactions characterised by explicit discrimination. In addition, midwives are subject to external and institutional pressures which affect their ability to foster positive relationships. The review also recommended that future investment should be directed towards models of care which prioritise the midwife-mother relationship for refugee women.

Critical care

As the world celebrates International Day of the Midwife, these research initiatives illustrate how City St George’s is placing midwifery and maternal health at the forefront of justice reform and workforce wellbeing.

The University is also passionate about training a dedicated and caring community of midwives, and it offers courses for those starting their career (BMid Midwifery) or for those wanting to develop leadership skills to improve the quality, accessibility, and safety of maternity care globally (MSc Global Maternal Health).