By Mario Cacciottolo
The UK's population is growing. Part of that increase is fuelled by women from other countries having children here.
Many immigrant families are having babies in the UK
And as the Local Government Association (LGA), representing 400 councils in England and Wales, outlines to a House of Lords select committee how migration stretches community services, one midwife tells how the changes affect her.
For midwife Jayne Cozens, going to work these days is also becoming something of a geography lesson.
She has worked in Wisbech, Cambridgeshire, for 12 years, and her caseloads are containing increasing numbers of foreign nationals from across the globe.
Language and culture are becoming more of an issue, as Mrs Cozens' job becomes ever more multi-cultural and multi-lingual.
"It can be a challenge explaining to a 17-year-old English girl what an amniocentesis is, let alone to a teenager from abroad who doesn't speak the language," she says.
Mrs Cozens is a midwife team leader who works for the Queen Elizabeth Hospital King's Lynn NHS Trust in Norfolk.
This acute hospital serves communities in West Norfolk, South Lincolnshire and East Cambridgeshire.
"We see someone who is a foreign national every single day. I've seen a couple from Turkey this morning already, but they spoke English."
Many of Mrs Cozens' charges, however, do not. She often deals with Lithuanian, Latvian, Russian, Polish, Chinese and Portuguese nationals, either at the hospital for antenatal classes or out at their homes for postnatal visits.
The quality of their English can vary. "A lot of the Lithuanians don't speak English, and some of the Polish don't as well. The Chinese won't speak it if they haven't been in the country very long.
"It's fairly easy to get an interpreter for the Eastern block countries, but for Chinese a lady has to come about 60 miles.
"The costs are phenomenal, absolutely huge, and they get their travel expenses paid as well."
Mrs Cozens is frequently unable to have the luxury of an interpreter actually present, so she uses a special translation service which is accessed via the telephone.
"A woman will turn up for her first appointment and look at you like she doesn't understand what you're talking about.
"So you have to call the interpreter on the phone, speak to her, hand the receiver to the woman, get it back and hear the translated reply.
"Everything takes three times as long."
Matters are further complicated when further medical attention is needed, such as blood tests, screenings and scans.
Mrs Cozens explained that she will have to break off from the telephone interpretation, call a translation agency to book a face to face translator appointment, then call back the interpreters, explain this appointment to them and have them relay the information back to the patient.
"It creates a huge amount of work just for one woman," she said.
Mothers often need help from midwives with their new babies
Ascertaining a woman's medical history is also often a challenge, as the patient will sometimes be unaware of just what kind of major surgery she has been subjected to.
"Women from the Eastern bloc have often had medical problems and say they have had an operation.
"You ask them what kind of operation and they show you a scar. You ask what was it for, and they say they don't know.
"They say 'Doctor said I need operation, so I have operation'. This presents a huge, challenging problem for us."
There are cultural issues, too, which midwives must handle in the course of giving their advice to non-UK nationals.
"Chinese families tend to sleep together in the same room and the same bed.
"Children, new baby, mum and dad are all together. It's what they're used to, so you go to a house and there's a couple of mattresses on the floor.
"But our advice in relation to cot death is for women to not sleep with their babies, so if you have the whole family in together then that presents a problem."
Mrs Cozens said that in the course of her work "you do learn a few words" but that this is not enough to clearly explain the full message.
"It's not enough to know a few words and to mime. We need to be able to hold an informed conversation.
"We do intimate things to women so it's important that they fully understand what to expect. And they need to know what to do if there's a problem, what number to ring if they go into labour."
She suggests that English lessons should be made more readily available for people who do not know the language.
"They should be offered in each community. There should be someone in the community who speaks their language and also English who could act as a mediator and encourage them to have English lessons.
"With the best will in the world, we cannot learn fluent Lithuanian."