Teaching student midwives to sign

To undertake their roles effectively, midwives must be able to communicate with women and their partners in their many encounters during pregnancy, labour and after birth.

As part of a research project seeking participants to recount their experiences of disabled parenting, contact was made with relevant local organisations. A number of Deaf parents wanted to tell their stories and their experiences of using maternity services were overwhelmingly negative. So when representatives from the local Action Deafness organisation offered to run free British Sign Language (BSL) and Deaf awareness classes for student midwives, it was hoped that educating future midwives could help improve local maternity services.

These classes were undertaken as a collaborative project by Dr Joanna Downes, the Parenting Project Manager at Action Deafness Leicester and Bernadette Gregory, Senior Lecturer in Midwifery at De Montfort University. A pilot study was undertaken to assess the students' knowledge and skill level, then two groups of student midwives and three midwifery lecturers undertook the sessions. We started with basic signs such as ‘midwife’, ‘my name is’ and ‘tea’, but we were quickly able to sign ‘how many weeks pregnant are you?’, ‘epidural’ and ‘caesarean section’, and discuss breastfeeding support.

This introduction to BSL means that 80 midwifery-specific key signs have been taught to help students communicate with Deaf parents. Students were made aware of their legal obligations to try to contact an appropriately qualified signer for parents, for example, in planned antenatal visits but we hope that students will feel able to communicate until that interpreter arrives, or in some cases does not arrive in time, for example in an emergency birth centre situation, or cope if no one arrives at all. Those involved stated that this was a possibility as statistics suggest that there is a shortage of fully qualified interpreters to sign language users with a ratio of 1:275 (RNID 2010).

Best practice

Teaching strategies included role play and experiential learning, which helped the students better understand what can be seen as poor practice and what constitutes best practice. We discussed the potential for harm of not communicating effectively which students have recognised as being useful in other comparable situations such as when there are language barriers. We discussed the possibility of drug errors, missed appointments and misinformation being given and students were encouraged to think of some solutions to these problems and some of their ideas are relatively simple to accommodate. Although students receive lectures on disability and equality issues, these additional sessions gave them the chance to actually apply this to practical clinical situations.

A number of women and their partners were invited to talk to midwifery students about their experiences; they included those who have been Deaf from birth, others who have become deaf; some who lip speak, some who wear hearing aids or use textphone, and others who use BSL, including those for whom English is not their first language. It is estimated that over 50,000 people use BSL as their preferred language (RNID 2010).

Students became aware that we must ask parents their preferred method of communication, as these are very different methods of communication and that D/deaf parents are not an homogeneous group but people with individual needs. These parents worked with the students in small groups to practise signing and lip speaking and the students evaluated these encounters as their most positive experiences on the course. Some of the stories of negative encounters with health professionals were upsetting to hear.

Amanda Mitchell, one of the student midwives who attended a sign language session, said, “I think the introduction of Deaf awareness classes for student midwives is fundamental in their process of learning and it is important to be aware of the complex needs of all women accessing midwifery services. Midwife means ‘with woman’ and as a future healthcare professional it is my focus to care for all women, regardless of any disability, equally and without prejudice.”

Funding is being secured for the creation of an educational DVD, flash cards, and illustrated booklets and charts for clinical areas. The Royal National Institute for Deaf People (RNID) kindly sent free educational resources to use in the class and in clinical areas. As a result of the success of this project, it is hoped that these classes will continue and become part of a wider initiative involving other health professionals, for example medical students and nurses.

There has been huge media interest in our work with queries as to why this has not already been included in midwifery curricula being the most common question. It is hoped that this collaboration and dissemination of best practice will continue as it appears there is still much to be achieved to help make health professionals and service providers more Deaf aware and make the experience of parenting a more inclusive and positive experience.

A Deaf mother's experience

Marie Sneesby, mother to Erin, now five, knows first hand the huge difference it would make if midwives were able to sign. She and her husband are both Deaf and use BSL as their first language.

Marie said, “When I was seven months pregnant I started to become ill with severe migraines, violent sickness and severe back pain. I was in and out of hospital for two months and during this time I had no interpreter. I was told I could wait hours for an interpreter but I was too uncomfortable to wait and instead had to use my hearing mother to communicate.

“At the time I did not have the energy to challenge the staff about getting an interpreter because I was in so much pain. I can't believe I was told I would have to wait hours for an interpreter and that the staff thought it was OK to use my mother instead. She should have been there to support me and my husband, not to act as my interpreter. It was so important that the staff knew what I wanted to say about my body and that we were able to understand what the staff were telling us.

“Erin was due on 15 August. I had a rota of interpreters starting from 10 August, for two weeks. She wasn't born until 28 August, but because it was a bank holiday, the National Health Service refused to pay for an interpreter. I was then told that I would have to have a caesarean. This was a very upsetting time for me. I had to wait to hear if I would have an interpreter with me for the procedure. Thankfully, I was given access to an interpreter for the next 18 hours.

“I think it would make a huge difference if all midwives knew how to sign, even just for basic communication. If a woman is rushed into hospital and can't get an interpreter straightaway then at least the parents would have some idea as to what is happening. Training midwives to sign would also save the National Health Service money as we wouldn't have to wait so long for an interpreter. It would also hugely improve the experiences of Deaf women going into hospital to give birth.”

References

The Equality Act 2010

Office for Disability Issues (accessed 15th March 2011)

Gallagher, D.W. Sinclair, M. & McConkey, R. (2010) Lived experiences of motherhood Disability, pregnancy and parenthood No.68 p.15

Morris, J. & Wates, M. (2006) Supporting for disabled parents and parents with additional support needs Adult Services Knowledge Review 11 London Social Care Institute for Excellence

Nursing & Midwifery Council (2004) NMC Midwives Rules & Standards London Nursing & Midwifery Council

Nursing & Midwifery Council (2008) NMC Code London Nursing & Midwifery Council

First published, DPPI Journal, Issue 74: Autumn 2011.