Migrant and refugee pregnant women constitute a highly vulnerable group to mental disorders. The rates of mental illness of migrants and refugees are higher than those of host populations, with migrant women being more likely to suffer from prenatal depression. A Policy Paper was developed based on a literature review conducted in Medline, Scopus and Google Scholar. Filtering criteria were: year of publication (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017), study topic relevance, and English language. A total of 63 documents were identified. Most of the documents were scientific papers while a large number of documents were reports of EU committees and networks on migrant issues or annual reports of international bodies. From the analysis of existing evidence, four major topics emerged for the perinatal health of migrant women: 1) Prevalence and risk factors for antenatal mental disorders, 2) Assessment of mental disorders, 3) Healthcare professionals' training on supporting migrant and refugee pregnant women, and 4) Interventions for the mental health of migrant women. Midwives and other members of interdisciplinary teams have to be trained and culturally competent to successfully meet the needs of migrant and refugee pregnant women.

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Background: In recent years, a growing number of studies report on the importance of empathy to women's care. The Midwifery Empathy Scale (M.E.S) was developed in order to study and record the levels of empathy of professional and student midwives. The purpose of our study was to validate this instrument and determine the factor structure and reliability. Methods: The study sample (n = 242) consisted of professional (n = 114) and student midwives (n = 128) of 3 Maternity Hospitals (public and private) of Athens. Results: The exploratory factor analysis on the 25 item of Midwifery Empathy Scale (MES) revealed seven orthogonal factors (KMO Measure of Sample Adequacy = 0.817 and Bartlett's test of sphericity = 1508.169, df = 300, p < 0.0001. The MES showed medium overall internal consistency (Cronbach's alpha value: 0.546, p < 0.0001). The internal consistency characteristics of MES demonstrated good reliability. Our findings attest to the multidimensionality of MES, and the Confirmatory Factor Analysis (CFA) demonstrated that the 7 factor model offers a very good fit to our data. Conclusion: Our data indicate that the Midwifery Empathy Scale (MES) is a reliable and valid tool for assessing the levels of empathy of professional and student midwives for both clinical and research practices.

INTRODUCTION The Birth Satisfaction Scale (BSS) is an important screening instrument that is used with mothers during the postpartum period for the identification of postnatal birth satisfaction. The purpose of this study was to validate and adapt the Greek version of the BSS to test its sensitivity, specificity and predictive values. METHODS Childbearing women (n=310) were recruited from the perinatal care registers of the Maternity Departments of 3 Hospitals of Athens municipality (public Maternity Departments) in 2014. Inclusion criteria included fluency in spoken and written Greek language, within 1-4 postpartum days, and delivery of a healthy infant. Exploratory Factor Analysis (EFA) on the 30-items on the BSS revealed 7 orthogonal factors (KMO measure of sampling adequacy=0.856 and Bartlett's test of sphericity=2999.806, df=435, p<0.0005). A Receiver Operating Characteristic (ROC) analysis was conducted to evaluate global functioning of the scale. Within this context the scoring of the BSS was reversed from the original, to indicate that a lower score was a worse outcome. RESULTS The Greek BSS showed high overall internal consistency (Cronbach's alpha value: 0.876, p<0.0001). The internal consistency characteristics of the Greek BSS showed good reliability: Cronbach's alpha was 0.876 for the total scale (Items 1-30), Standardized alpha 0.859 and Guttman split-half 0.864, Spearman-Brown 0.866. Our findings confirm the multidimensionality of BSS, demonstrating a seven-factor structure that contained subscales, reflecting the postnatal birth satisfaction. Exploratory Factor Analysis (EFA) demonstrated that the 7-factor model offered a very good fit to our data. The area under the minor satisfaction ROC curve is 0.796 (SD=0.025, Asymp. Sig.=0.0005; CI=0.748-0.845), sensitivity=73.8%, and specificity=70%. CONCLUSIONS Our data confirm the validity of the Greek version of the BSS at identifying postnatal birth satisfaction. Hence, the Greek BSS could be used as a useful instrument in both clinical practice and research.

INTRODUCTION Worldwide there is an alarming increase in the caesarean delivery rate which has become a controversial topic. However, the reasons for this tendency are not clear. For example, in Greece alone, rates increased by almost 50% from 1983 to 1996. In order to better understand the causes of this phenomenon, we need to examine closely what groups of women undergo caesarean section (CS). To achieve this, it is essential to use a system that will enable us to monitor and compare caesarean delivery rates. Such a classification system should be easily adopted by obstetricians, midwives, and public health services. METHODS A review search of electronic databases concerning medical care was held from December 2020 to January 2021 in order to find systematic reviews which describe either theoretical or practical CS classification systems. RESULTS The most common classification systems fall into three main categories based on indication, urgency and maternal-based characteristics. According to users the highest rated classification system was women-based classifications in general. In particular the Robson Ten Group Classification System was considered to be the most valid to meet current local and international standards. The Robson classification system is praised for its robustness, simplicity, flexibility, and reproducibility. CONCLUSIONS The right implementation of the Robson Ten Group Classification System can facilitate an in-depth analysis of the main groups that increase CS rates and can be used to both review and monitor delivery practices both in Greece and abroad.