Navigating institutional constraints: A phenomenological study of specialist midwives’ relationships with women seeking sanctuary

The Centre for Maternal and Child Health Research at the School of Health and Medical Sciences, City St George's, University of London welcome Katherine Waterfall to discuss the lived experiences of specialist midwives developing relationships with women seeking sanctuary, as part of the SHMS research seminar series.

Abstract

Background

Women seeking sanctuary as refugees and asylum seekers face significant barriers accessing maternity services in the UK. Whilst existing research largely focuses on women’s experiences, this study explores the lived experiences of specialist midwives navigating their relationships with women seeking sanctuary within complex institutional and socio-political contexts.

Aim

To explore the lived experiences of specialist midwives developing relationships with women seeking sanctuary.

Methods

A hermeneutic phenomenological approach was used to explore the experiences of six specialist midwives working with women seeking sanctuary in England. In-depth interviews were analysed interpretively, drawing on Foucault’s theories of disciplinary power and governmentality, alongside the concept of positive deviance.

Findings

Five themes were identified: (1) bridging between services, (2) specialist knowledge, (3) adapting care, (4) building trust, and (5) navigating hostility. Midwives described relational practices that often defied institutional norms, positioning themselves as advocates and change makers.

Conclusion

Specialist midwives' were able to work within institutional constraints to achieve positive relationships with women. The ability to develop meaningful relationships with women seeking sanctuary was facilitated by protected roles which afforded time, autonomy, continuity and flexibility. These findings highlight the value of positively deviant practices in sustaining compassionate, relational maternity care. The study calls for investment in specialist midwifery roles to better support women seeking sanctuary and advance equitable maternity care.

About the Speaker

Katherine Waterfall is a PhD student at City, St George’s University, and a midwife by background. She currently works as a midwifery lecturer at the University of East Anglia and serves in an advocacy role with City of Sanctuary UK, where she works to raise awareness of the challenges faced by asylum-seeking and refugee women accessing maternity services in the NHS. Katherine is also a Trustee of Happy Baby Community. She is passionate about improving access to maternity care and empowering midwives to provide compassionate, person-centred support within an increasingly hostile political landscape.