Supporting Deaf mothers

Meghan Jackson, a midwifery student at Thames Valley University, UK, discusses her research into Deaf women's experience of maternity services.

As a student midwife, I decided to examine the way that Deaf women experience maternity services and how midwives could better support them. My interest arose following a discussion with a Deaf friend of my family, who had recently given birth in her local hospital and felt she had been very well supported by midwives.

I decided to talk to other Deaf women and gather their experiences. I asked my family friend to email me and I placed an advert on a BBC internet forum aimed at the deaf viewers of See Hear. I received seven emails in total. Names used throughout are pseudonyms. I decided to look at maternity care in three main areas - antenatal, labour and postnatal care.

Continuity of care

All the women I spoke to agreed that antenatal care was the worst part for them, particularly appointments at the hospital clinic.

"How am I supposed to know when it's my turn if they yell my name out from behind me?" Jane, Deaf mother

Most doctor referral letters will contain the information that a woman is Deaf. Therefore, it is relatively easy for these women to be identified and approached in the waiting room when it is time for them to be seen.

Community antenatal visits were felt to be too short to allow for the extra communication needs. Continuity of care may be especially beneficial here.

"[My midwife] always drew a picture of which way my baby was lying. And, my favourite bit, I could put my hand on the [Sonicaid] to feel my baby's heartbeat." Layla, Deaf mother

English as a second language

During the booking appointment, a lot of information needs to be exchanged and this can be a particular challenge. The Disability Discrimination Act (DDA) stipulates that interpreters should be made available for all non-emergency appointments. Where there is no interpreter, it is important that midwives do not assume that a Deaf woman can lip-read. English is often a second language after British Sign Language. For the same reason, it may not always be reasonable to just write everything down. Where things are written, the Royal National Institute for Deaf People (RNID) and the Plain English Campaign recommend short sentences with all medical terms clearly explained. Clear diagrams are also suggested.

The most important thing is to allow the woman and her partner time to fully understand, and to ask questions if they don't understand. Good communication is essential in order to enable a Deaf woman to make an informed choice about her care. "I felt like I was wasting time, like she had somewhere more important to be because it was harder work explaining everything to me." Stephanie, Deaf mother

During labour, a midwife should always take time to fully explain what she is going to do before she does it. This is the case for all women but is particularly important for Deaf women, as explanations and reassurances during a procedure may be difficult.

One woman commented, "It is extremely difficult to understand what is going on down below when you cannot hear what is being said! Because of this it is very difficult to know when to co-operate!" Emma, Deaf mother

With this in mind, it is important to reassure a Deaf woman before beginning any procedure by explaining what is involved. Warn her if a procedure, for example a vaginal examination, may be uncomfortable. It may also be useful to develop some simple signs together that you can use during the delivery in order to communicate. One mother suggests, "It would be helpful to have a midwife at the top end so that he/she can communicate with the mother via the person delivering the baby."

Considerations for pain relief

Pain relief needs to be carefully considered. Certain pain relief options may make a woman feel drowsy and impair her ability to communicate. While this is not a contraindication to those forms of pain relief, the woman and midwife need to be aware of this. In the case of epidurals, the procedure should be fully explained and all questions answered before beginning. The pain of contractions and of the needle being inserted may cause a woman to screw her eyes shut and be unable to see her interpreter. It is important to consider the positioning of a woman, as sitting up and curled over will also mean she is unable to see her interpreter. It should be remembered that a Deaf woman needs her hands to communicate. Therefore, if the use of a cannula (a tube inserted into a vein to administer fluids or medicines) is necessary, the midwife should consider siting it somewhere other than in the hand.

Partners

As 90% of deaf marriages are between two deaf people, it is also important to consider a woman's partner. Many wards have security doors with intercoms that a deaf partner with little speech will be unable to use. The RNID states that, under the Act, hospital departments are expected to provide modifications to the intercom to allow access. This could be, for example, a green light to indicate that the door has been opened. In departments where these are not available, a workable solution should be discussed carefully with the family.

The use of a partner as an interpreter is not appropriate. It can also affect the support that a partner is able to give to a woman in labour.

"Having [Matt] being the interpreter was horrid. He was having to support everyone else but not me. He spent all the time afraid and trying to find the right words for what people were telling us." Jane, Deaf mother

Postnatal care

Postnatally, it was noted: "Seems to me, no woman is happy with the postnatal ward. Lots of information and no time for the midwife." Jane, Deaf mother

However, it is important that Deaf women don't miss out: "[the midwife] gave me leaflets to read. Came back later when she had some time so I could ask all my questions in one go." Jody, Deaf mother

It might be beneficial for a Deaf woman to be in a bed where she can see the midwives' desk or the door. Layla points out, "I'd press the bell and then not know if anyone was coming or if the bell had even worked."

In conclusion, many Deaf women experience inequality during pregnancy and childbirth, which arises mainly from communication difficulties. Many Deaf women want to feel included in the normal provision of care for pregnant women. A midwife can ease these problems by taking time to understand women's concerns and adjusting her practice to incorporate the unique needs of Deaf families.

References

Disability Discrimination Act (DDA). 2005. London: The Stationery Office.

How to write in plain English. 2008. Stockport: Plain English Campaign. Available from www.plainenglish.co.uk/free_guides

Useful organisations

Royal National Institute for Deaf People www.rnid.org.uk

Deaf Parenting UK www.deafparent.org.uk

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