Obesity is a problem in our country, and this is also a problem during pregnancy. Vulnerable pregnancies in Finland occur due to mental health issues, social problems, substance abuse, and obesity. We treat refugees on a daily basis, and face cultural and language barriers. We also face challenges related to pregnancies, such as preterm delivery and preeclampsia. I would say our pregnant women are mostly older. We don’t have the issue of teenage pregnancies. In many cities in Finland contraception is free, and our abortion rates are very low.

You may have heard of the baby box; the maternity package in Finland. It’s available to all expecting women visiting the maternity welfare clinic. It’s a huge box. It has baby clothes, diapers, a thermometer, small scissors, books, condoms for the new parents; things you will need in the first months with the baby. The cardboard box itself can be used as the baby’s first bed, as it has a little mattress inside.

One of the problems in Finland is that delivery hospitals are centralised. Women have to travel longer, and this has increased the number of deliveries on the road. The rise in induced labour is another challenge. We induce labour for several reasons, such as diabetes, or when the baby is overdue. The maternity welfare clinics are a great service, but the public health nurses working there don’t have to be midwives, they can be nurses. Nurses don’t recognize conditions in pregnancies as well as midwives, they don’t have the education and training of a midwife.

I got involved in this project through colleagues at the hospital where I work. They asked if someone would be interested, and I said yes. I would say it is good to be aware of experiences in different countries. It is good to bring in some best practices, also from abroad. For the future I hope we’ll develop guidelines for all European midwives to use. During this project I was inspired. It was lovely meeting midwives from abroad. I really hope that we can meet each other once more.

The main problem for vulnerable women that I meet is alcohol, aggression at home and unplanned pregnancies. And also a lack of money, sometimes, but this is gradually coming to an end.

In the program ‘Family 500+’ the government provides 500 zloty (100 euro) per month per child. A new program provides 300 zloty (60 euro) per month per child, starting when the child goes to school.

I wanted to get more knowledge and provide better care; that is why I studied to become a nurse. Nursing is more about prevention. It’s talking to people, getting to know them and help them with different situations. Our knowledge is important for people. We need to share our knowledge and explain it so that they get the help. That’s the biggest thing to do.

I got involved in this project when I was a nursing student. It was a great chance for me to learn about other topics. Especially topics that are not common in the emergency department. During the project we talked a lot about other country’s practices. It helps a lot. Through the project, we have a lot of new ideas on how to help vulnerable people. In our daily work we are so busy with our regular activities that we don’t think about vulnerability. Getting involved in a project like this makes us think from a different perspective, and this is really important.

I learned how different our problems are, and how in every country different issues arise. Also, I never saw cultural differences between the project members. I still like to work with all those women, I think it was great. I miss the activities we did together and I would love to be involved if a new opportunity came up.

Originally I am from Holland, where I also worked as a midwife. The working environment for independent midwives is better in Holland; in Belgium it’s not optimal. Belgium has a very good healthcare system, but there is poor cooperation with most doctors, and the income is less. The range of duties for midwives in Belgium is broad. We provide information on birth control and contraceptives, we support women during menopause, and a lot more. In Belgium midwives also work as coaches to the parents. We guide them up to one year after birth.

In this project I learned that we all have been very creative in looking for solutions to guide vulnerable pregnant women. It’s always good to know that colleagues from abroad experience the same with vulnerable women. They inspired me because they were very creative with their ideas.

The plan was to get a definition for vulnerability in pregnancy, and this expectation was met. But we were eager to go a step further. We wanted to develop a flowchart for implementation as well. I hope this network will develop a flowchart for the implementation in the near future..

Maybe the most valuable element for me was to feel the good intentions of everyone, the drive to guide the vulnerable pregnant women in the best way. Because it’s not always easy. Sometimes you feel distressed or you feel unsafe, for example when you do a home visit and you know that something is going on. Talking about this and hearing the stories of international colleagues was really good. There was a good vibe during this project. I sensed the enormous strength and motivation we sometimes need and that we all have. It was good to hear from each other and yes, it made me proud.

I got involved with this project as a student. My professor, a researcher, invited me to join. It helped me, I learned a lot. I learned that vulnerability can be present in different social and economic situations. It can be dealing with addiction or dealing with a foreign language. Detecting vulnerability can be challenging, as it is different per situation.

In this project, midwives and students were there to study, to improve practices and to talk. It was the first time for me to talk about improving practices with other midwives and students. I learned about elements of community care that are not available in our country.

Vulnerability needs to be discussed more and more. It’s not something that can be resolved in a few talks.

I would like for this network to become wider. If we become a wider network with more people, we will have the power to take actions. That can be helpful for all women, all over the world.

I was a community nurse for 14 years, before I specialized in midwifery. I have worked as a nurse-midwife in Portugal’s biggest maternity hospital for 12 years. I am a nurse specialized in maternal health and midwifery.

Being a nurse was and still is not a very good job in Portugal. We are considered to be the doctor’s aid.

In Portugal, girls as young as 13 or 14 years are allowed to have an abortion. There are no restrictions. Sometimes it gives them a special status among their friends, if they have had an abortion. No one tells them that having an abortion can damage someone for the rest of their life. In private hospitals there is another kind of vulnerable women, who don’t know they are vulnerable. They are submitted to a lot of interventions which are not needed. During this pandemic the main problem has been domestic violence. Some private clients are victims of domestic violence with mental problems.

In this project we had several meetings. That was very useful to build the relationship and make the networking stronger. The discussions worked as an eye opener for me. Situations that I would consider vulnerable, wouldn’t be considered vulnerable in for example the Netherlands. I should tell people who want to join the network in the future, that they will be surprised. You will learn a lot with the shared information.

Vulnerability exists in different forms. It can be domestic violence, abuse, or being a refugee. I think in our country being in a difficult social and economic situation is the big problem. In the last two years the problems of refugees have increased.

We see a lot of vulnerable pregnant women with several problems: teenage pregnancies, social isolation and loneliness, excessive smoking. Every woman with her own problems needs a different type of care. The most important thing is to gain their trust; because if you don’t have their trust you only do the regular checkups and you might miss the vulnerability. It’s important to ask a vulnerable woman what she needs. I think home visits are really important. Because when you see the situation at home you see much more than the women coming to the clinic.

I knew Hanneke Torij, the initator of the project, before the project started. They approached me and asked me to join as I am a practicing midwife. That’s how I got involved. The most interesting thing about this project is that I felt I am not alone in this situation and we learn a lot from other people. It was so nice to hear from other colleagues how they provide care to these women, but also the problems you encounter as a care provider, your limitations or the search for good help. In the project I saw we have the same intrinsic motivation regarding the problems we handle.

Sometimes we think we are doing the best in our fields, but it’s really good to know how others are dealing with similar situations. Through this network, we can develop a curriculum for the universities in future.

In the Netherlands, midwives usually work in independent practices, where in other countries midwives usually work in hospitals. Most pregnant women first go to an independent midwife, and will only go to hospital if there are complications. The independent practices are nice, because they are in your own community.

I really liked the live meetings of the project because that was really good way to exchange information and to hear how midwifery care is organized in different countries.

Discussing the definition of vulnerable pregnancy was a really nice starting point of the project. Because there is no international definition of vulnerable pregnant women and it’s good to have a project definition of vulnerability. It led to really nice discussions. Because who is vulnerable and what is vulnerability?

The expectation was to exchange knowledge and best practices, and we really achieved that goal. The cooperation of the different project members was really, really great. This has exceeded our expectations. We didn’t know all the participants when we started, we all live in different time zones, and we thought it would be difficult to communicate with everyone. But everyone was very dedicated to the project and the communication went really well. Everyone was very enthusiastic, and everyone spent many hours in the project and the cooperation.

I would like to continue the cooperation with all the different countries and all the different members of the network. And it would be great to expand the network.

During discussions and conversations internationally, two things kept coming up. The first is that midwives need training and support to be able to provide adequate care to vulnerable pregnant women and their families. This also needs to be embedded in midwifery curricula. The second is that many professionals throughout Europe struggle with the same theme. That is why we started this network: To cooperate and to exchange knowledge and best practices so that we can learn from each other. With the aim to supporting (future) mothers and families in the best possible way, and, at the same time, empower midwives, students, teachers, and researchers throughout Europe.

Students ask other questions than professionals, because they see things from another perspective and often for the first time. Midwives bring their knowledge and experience from daily practice and based on their experiences from practice. Teachers, who have ideas and experience concerning the embedding of this theme within the curricula, bring their knowledge and perspectives related to education. And researchers, who develop knowledge and tools, and struggle with how to involve vulnerable families into their research, how to measure the effects of interventions, and how to generalize research results, bring the scientific perspective into the network.

During this project, we succeeded in bringing these students, teachers, midwives, and researchers together. We worked in, and discussed about, these issues, we exchanged best practices, and we initiated the IMREF network.

Something that works well in Lisbon, Portugal, isn’t necessarily a best practice in Turku, Finland. But at the same time, we can learn from each other’s practices and use elements of best practices in a different context.

If you involve professionals from all over Europe, when a midwife from Turku talks to a teacher from Milan, or a midwifery student from Lisbon meets a researcher from Antwerp, then you are really challenged and inspired to look at this theme from another perspective. This is very inspiring and opens doors to new solutions in improving the quality of midwifery care.