France : Easing the plight of highly vulnerable mothers

Easing the plight of highly vulnerable mothers is the goal of Anne de Truchis, a pediatrician in the perinatal care unit at Le Vésinet Hospital, and her staff. 


Family physicians, gynecologists, midwives and psychiatrists provide comprehensive care to pregnant women, then to mothers and babies after delivery.


“The women we work with – about 250 a year – are very vulnerable. Sixty percent of them are migrants and almost all of them have experienced a traumatic event,” says de Truchis. “In 10% of cases, they give birth to premature babies and 20% of the time, the infants suffer from neonatal abstinence syndrome (from addiction to alcohol, tobacco or other toxins). One day, during a departmental meeting, a staff member pointed out the gap between the advice given in the maternity ward and the reality facing the mothers when they leave the hospital.”


Some of these women receive follow-up care from France’s “SAMU Social,” an emergency medical service for the homeless, which means a life of vagrancy, moving from one homeless shelter to another with their infant, while others live in substandard or overcrowded housing. Hospital-level baby care is impossible in these settings: How can a bottle be prepared without a convenient source of clean water? How can a mother avoid sleeping with her baby when there’s not enough room? How can she bathe her baby in a common shower? How can a variety of foods be introduced when there’s nowhere to heat them up?


The mothers are perfectly aware of these problems, which makes them feel guilty. “Regardless of their habits, culture or skills, even if they’re nutritionally deficient, isolated, depressed or sick, they quickly adopt common baby care practices – either because they provide psychological support, the mothers don’t have any choice or it’s a way to show their desire to become part of society,” says de Truchis.


In response, the pediatric team developed a booklet that mainly uses images since some of its target audience is illiterate; the booklet provides tips for taking care of infants. The booklet “can serve as a happy medium between ‘ideal’ baby care practices and the difficult realities of daily life,” explains de Truchis. It aims to “reduce anxiety when mothers leave the hospital, limit the emotional impact of returning home and capitalize on the mother’s ability to adapt.” Other hospitals, social service agencies and community organizations working with marginalized women may eventually find the booklet useful as well.