In our previous article, we heard how a birth companion provided vital support for Mary when she needed it most. We met with Amma Birth Companions to learn more about the work they do.

By Jack Howse | Illustration by giacinta frisillo | Photo by Stuart Wallace Picture

“When you’re pregnant, sometimes you’re tired, you’re hungry, you want something warm.” Vongayi Mufara says, catching a quiet moment in between entertaining her two-year-old. “But at the same time, you’re dreading standing up and going to make a hot drink. So if someone else walks in and says ‘Do you want a cup of tea?’ it just comforts you.” Vongayi first came into contact with Amma when navigating this country’s healthcare and asylum system as a single mum-to-be. She was carrying twins.

According to Amanda Purdie, head of development at Amma: “It exists to support people who are facing pregnancy or parenting alone and for people who face any kind of barriers to care. We mostly support people in the asylum process, who are quite new to Glasgow and maybe lack a support system.”

The charity advocates for both a holistic approach and medical rights for its service users. It is made up of a core team alongside over 50 volunteers who support expectant mothers during pregnancy – from the third trimester through to postnatal care.

For someone who is new to the country and has experienced birth in a different cultural context, attending all the appointments as a pregnant person can be overwhelming, especially if coupled with financial and language barriers.

While seeking asylum, Vongayi was surviving on the Home Office allowance of around £5 a day. She remembers finding out through a third sector organisation that she could claim expenses from the NHS for travel when attending appointments. “No one from the hospital told me I could claim this,” she recalled.

Many of those who access the service have pre-existing experiences that can affect them: “We make sure we’re trauma informed in everything we do.” said Amanda when discussing the intensive six-week training program for volunteers. “We'll look at things like FGM [female genital mutilation], as well as what it's like to actually go through the asylum process.”

Another main tenet of the training is learning about informed consent – meaning that pregnant people should only give the go-ahead on any procedure once being told all the benefits, risks and alternatives.

After a difficult pregnancy, Vongayi lost one of her twin sons, an experience that Amma supported her through. She became a birthing companion in 2021 before becoming vice-chair. Vongayi is a proponent of informed consent, something she thinks is not offered enough:

“If I come in as an asylum seeker, it doesn't mean that my body has collapsed or is fading. I can still have the same birthing choices as anyone else. If I want to have a water or home birth, I should be given those choices. But what I've realised is a lot of these women who come into this country are placed on the red pathway [the highest risk category for pregnancy]. Then we are frequently booked for induction which brings with it higher risks of emergency caesarean sections.”

In 2021, draft guidelines for induction were published by the National Institute for Health and Care Excellence (NICE). It advised that a person from Black, Asian or minority ethnic backgrounds should be induced at 39 weeks; a week before what is usually considered full-term. The guidelines were retracted after outcry, but Amma still sees a similar trend: “We do see very high rates of induction at a point in pregnancy that seems quite early. People being induced at 38 or 39 weeks.”

Research has shown that in the UK, when it comes to maternal mortality rates, women from Black ethnic backgrounds are at four times higher risk, and women from Asian ethnic backgrounds two times higher than white women. Another report by UK charity Birthrights highlighted systemic racism in the healthcare system with testimonies from both patients and healthcare professionals.

Yet there does seem to be some promising signs that charities like Amma are being listened to by public health bodies. Amma regularly meets with senior management in Greater Glasgow & Clyde maternity services. Amma is also publishing a report based on the experiences of pregnant people they have supported over the past two years. A major change they are calling for is more interpreter provisions in the maternal services.

“Issues with NHS interpreting provision were recorded for 74 percent of clients,” says Sarah Zadik, head of services and co-founder of Amma. “There were instances where the NHS didn't have interpreters who spoke certain languages or dialects. This led to one person who had significant health issues, not understanding her health situation for several months. This can also severely impact the possibility of informed consent.” It is hoped that the report will create lasting change in Scotland’s hospitals.

As mentioned, Amma seeks to centre holistic birthing practices, whilst also championing medical rights for their service users. In the following article, we look at how a project in India is training local women in villages with medical intervention knowledge alongside their traditional and cultural birthing practices.