Katherine Letley#ThisBillHarmsMyPatient
This has been designed for healthcare professionals and written as if the Illegal Migration Bill has passed and come into effect to demonstrate its potential impact on pregnant women.
Rita presents to A&E with abdominal pains on her own, at 10am. On her admission, Rita is found to be pregnant so she is taken swiftly up to the Central Delivery Suite where you meet her as her midwife.
You introduce yourself to Rita who does not maintain eye contact and looks worried. You explain that you believe her to be approximately 32 weeks pregnant and arrange for an urgent ultrasound scan to confirm her dates. She is not on the hospital records and does not have an NHS number so this takes you some time.
Rita is dehydrated and appears malnourished. You provide Rita with some pain relief, food and water. You identify that Rita has a urinary tract infection so you arrange for some antibiotics.
Rita speaks good English, and you do your best to take a comprehensive history from her. She is very shocked to find out she is pregnant. She is withdrawn and not willing to share much information with you. You manage to learn a few details – she is 19 years old and was born in Nigeria. She tells you she was brought to the UK on an arrangement by her aunt to provide childcare for a wealthy family. She has worked for the family for 2 years, she lives with them providing cleaning, cooking and childcare services. She is very anxious about telling them she is pregnant. She says she will have nowhere to go, and she knows the family will make her leave on discovery of the pregnancy.
Rita is anxious to leave as she says there are important jobs she must do in the home. She leaves in a hurry and before you manage to learn much more about her. You arrange for follow up care with the community midwife for the next week who will visit Rita at the home address to assess what is going on and help Rita tell the family that she is pregnant.
A few days later a letter arrives at the address with the information for an urgent ultrasound. The letter is addressed to Rita but is opened by her boss, the woman whose children she cares for. The woman is very angry and tells Rita she must leave, that she will not have her caring for her family or in her home any longer. Rita tells her she has nowhere to go. The woman calls the police and upon discovering Rita is in the UK without a legal working visa, she is sent to a detention centre in another county. She is in the back of a car for hours and is not sure where she has been taken.
Rita stays in the detention centre for five weeks. She sleeps on a thin mattress and receives very limited medical attention. The food provided is very basic and makes her nauseous. The space is overcrowded and Rita becomes weak, lonely and increasingly worried about the health of her baby.
Katherine Letley is a midwife and maternity consultant for City of Sanctuary UK.
