"We were left to our own devices": Midwives' experiences of providing maternity care to Ukrainian women in Poland after the outbreak of the full-scale war in Ukraine.

Background: After the outbreak of the full-scale war in Ukraine, about 2 million people sought protection in Poland. Providing high-quality care for migrants and refugees, especially in times of significant arrivals, can be particularly challenging.

Aim: To learn about the experiences and strategies of midwives providing maternity care to Ukrainian migrant women in Poland after the outbreak of the full-scale war in Ukraine.

Methods: Five focus group interviews with 32 midwives providing maternity care in Poland were conducted. The interviews were thematically analysed.

Results: We identified the barriers experienced by midwives in providing high quality care to migrants to be mainly on the individual and interpersonal levels and levels of management and organization. First, at the individual and interpersonal level, we have identified: fear for life and well-being related to the threat of war in a neighbouring country, depleting resources and post-pandemic fatigue, language barriers, lack of knowledge on caring for women fleeing war. Second, at the management and organizational level we have identified: lack of organizational support, and interpreting services. In the first months after the outbreak of the full-scale war in Ukraine, most strategies to improve the provision of maternity care for women fleeing the war took the form of grassroots initiatives by the staff of individual care units.

Conclusions: The Polish health care services need systemic solutions prepared jointly by state and local authorities and taking into account the voices of midwives to support the provision of high-quality care to migrant population.