Midwives’ experiences of cultural competency training and providing perinatal care for migrant women a mixed methods study: Operational Refugee and Migrant Maternal Approach (ORAMMA) project

Abstract: Background: The number of international migrants continues to increase worldwide. Depending on their country of origin and migration experience, migrants may be at greater risk of maternal and neonatal morbidity and mortality. Having compassionate and culturally competent healthcare providers is essential to optimise perinatal care. The “Operational Refugee and Migrant Maternal Approach” (ORAMMA) project developed cultural competence training for health professionals to aid with providing perinatal care for migrant women. This presents an evaluation of ORAMMA training and explores midwives’ experiences of the training and providing care within the ORAMMA project. Methods: Cultural competence was assessed before and after midwives (n = 35) received ORAMMA compassionate and culturally sensitive maternity care training in three different European countries. Semi-structured interviews (n = 12) explored midwives’ experiences of the training and of caring for migrant women within the ORAMMA project. Results: A significant improvement of the median score pre to post-test was observed for midwives’ knowledge (17 to 20, p < 0.001), skills (5 to 6, p = 0.002) and self-perceived cultural competence (27 to 29, p = 0.010). Exploration of midwives’ experiences of the training revealed themes of “appropriate and applicable”, “made a difference” and “training gaps” and data from ORAMMA project experiences identified three further themes; “supportive care”, “working alongside peer supporters” and “challenges faced”. Conclusions: The training improved midwives’ knowledge and self-perceived cultural competence in three European countries with differing contexts and workforce provision. A positive experience of ORAMMA care model was expressed by midwives, however clearer expectations of peer supporters’ roles and more time within appointments to assess the psychosocial needs of migrant women were desired. Future large-scale research is required to assess the long-term impact of the ORAMMA model and training on practice and clinical perinatal outcomes.

ORAMMA: Evaluating Cultural Competence Training for Midwives in Perinatal Care of Migrant Women

The Operational Refugee and Migrant Maternal Approach (ORAMMA) project aimed to improve perinatal care for migrant women through compassionate and culturally sensitive care training for healthcare providers. The training resulted in significant improvements in midwives' knowledge, skills, and self-perceived cultural competence. Midwives appreciated the support and enhanced communication provided by the ORAMMA care model, although challenges were also faced. The training was generally well received and felt to influence the care provided to recently arrived migrant women. Further investigation into the impact of the ORAMMA approach and training on clinical outcomes is merited.

This research is important as it evaluates the effectiveness of the ORAMMA compassionate and culturally sensitive care training in enhancing midwives' knowledge, skills, and self-perceived competence in providing perinatal care for migrant women. As the number of international migrants continues to increase worldwide, healthcare providers need to be compassionate and culturally competent sensitive to provide appropriate care to migrant women, who may have different maternal and neonatal health needs. The ORAMMA training approach, which includes compassionate and culturally sensitive care training for health providers, integrated multidisciplinary care, and support from maternity peer supporters (MPS), has the potential to improve the quality of care for migrant women. This study provides valuable information on the effectiveness of the ORAMMA training in enhancing midwives' cultural competence, which can inform the development and implementation of similar training programs for other healthcare providers.

Key Takeaways:

1. The ORAMMA compassionate and culturally sensitive care training significantly improved midwives' knowledge, skills, and self-perceived competence in providing perinatal care for migrant women.

2. The training was generally well received by midwives, who felt it would influence the care they would provide to recently arrived migrant women.

3. Midwives appreciated the support and enhanced communication provided by the ORAMMA care model.

4. Further investigation is merited on the complementary role of maternity peer supporters and the impact of the ORAMMA approach and training on clinical outcomes.

5. Adaption of the ORAMMA training package for other health care professionals and exploration of its longer term impact on a wider range of health care providers warrant further investigation.