1 Midwife based in Belladère At Doctors Without Borders

Objectives and responsibilities:

Provides obstetric care to pregnant women and their babies, follow up before, during and after delivery, in accordance with obstetric and reproductive health protocols MSF , universal hygiene and standards of care for newborns, and under the supervision of a specialist doctor, in order to ensure their health conditions and avoid postpartum complications.

Migrant women and adolescents, returned from the Dominican Republic or internally displaced, suffer a combination of vulnerabilities: sexual violence along the way, unwanted pregnancies, lack of prenatal follow-up, risky deliveries, no access to contraception. MSF is setting up a mobile and fixed system dedicated to the sexual and reproductive health of adult and minor migrants, with integrated management of physical and sexual violence.

Under the supervision of the Medical Manager, you are the technical referent for the sexual and reproductive health of migrants. You provide CPN/CPON consultations, family planning, care for GBV and medical abortions according to MSF protocol. You work closely with doctor, psychologist and social worker.

1. Maternal health adult and minor migrants

• CPN adapted to the migratory context: Iron/folic acid supplementation if anemia, hypertension control.
  • Minors: Special attention 10-19 years old. Essential consent. Hidden GBV screening behind early pregnancy.
  • Mobility: Simplified MSF health record given to each patient. Short treatments. Single dose when possible. Link with other MSF projects if departure.
• Childbirths: referrals to Belladere hospital for treatment of eutocic births. Screening and stabilization of obstetric emergencies: hemorrhage, eclampsia, dystocia. Decision and organization reference to hospital.
  • Postpartum: CPON J1-J7-J42. Postpartum depression screening. Breastfeeding support in a street/precarious context.
• Essential neonatal care: Management of low birth weight. Reference to nutrition center at Belladère hospital if possible. Ability to provide medical nutrition if mobile patient.

1. Physical and sexual violence

• 24/7 GBV clinical care according to MSF protocol:
  • <72h: PEP HIV, emergency contraception <120h, hepatitis B/tetanus vaccination, STI treatment, pregnancy prophylaxis, injury/injury care.

  • 72h: Medical care, STIs, vaccination, psycho-social support.

  • Minors: Examination only if child consent + trusted adult presence chooses the patient. No forced gynecological examination. Forensic documentation if patient/representative wishes.
• Reception and confidentiality: Dedicated closed room. No interruption. No information shared without written consent. No mandatory denunciation. File under code.
• Multidisciplinary circuit: Immediate activation after patient agreement:
  • Doctor: if serious injuries, need PEP.
  • Psychologist: PFA, trauma monitoring.
  • Social worker: Secure accommodation, dignity kit, clothing, legal support if desired.
• Physical violence: Treatment of assault and battery, minor fractures, burns. MSF descriptive medical certificate. Link with doctor for sutures/painkillers.

1. Adapted migrant family planning.

• Adapted counseling: Preferred long-term methods: IUD, implant, injectable 3 months. Mobile patient = no pill if risk of loss.
• Post-event offer: Postpartum FP, post-abortion, systematic post-GBV.
• Minors: Free access from menarche according to MSF protocol. No parental permission required. Total confidentiality. Age-appropriate counseling.
• Rumor management: Fighting disinformation: key information in the patient’s language.

1. Medical abortion management.

• Comprehensive abortion care according to MSF protocol:
  • Medical abortion <12 weeks: Mifepristone + Misoprostol. Non-directive counseling, informed consent, pain management, follow-up.
  • Post-abortion care: Management of incomplete abortion, hemorrhage, infection. AMIU if trained or doctor reference.
• Absolute confidentiality: Separate, coded, locked registry. No mention in general file.
• Post-abortion contraception: Systematically offered before discharge. Patient choice.

1. Collaboration & data.

• Multidisciplinary staff: Weekly meetings for complex cases with doctor, psychologist, TS. Collegial decisions. Shared secret respect.
• Data: Filling MSF registers: CPN, childbirth, PF, GBV, abortion. Migrant coding. Trend analysis with MedRef.

Selection profile:

Education : Recognized Midwifery Diploma MSPP + Up-to-date License.

Experience 3 years experience including maternity, delivery room, CPN, PF. Obstetric emergency experience. GBV skills: Training or experience in rape clinical management. If not trained: commitment to be trained by MSF. Abortion care: Experience or unreserved adherence to MSF protocols. Desired: Migration experience, working with minors, mental health. Knowledge of sexual and reproductive rights.

Languages : Creole and perfect command of French essential, Spanish is an asset.

Mobility : Mobile device, staggered hours, VBG/delivery on-call duties.