Oxford Handbook of Midwifery (33 page)

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Authors: Janet Medforth,Sue Battersby,Maggie Evans,Beverley Marsh,Angela Walker

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    • Stereotyping
    • Discrimination
    • Disadvantage
    • Social exclusion.
      Disability, sexuality, and pregnancy
    • That disabled women might have sexual desires, have sex, or reproduce has provoked dispute.
      4
    • Sexual performance for the disabled has been defined as a medical problem.
      4
    • The disabled are capable of being, and entitled to become, parents.
      5
      Women with disabilities are expected to forego mothering in the
      interest of the child, as some fears exist that:
    • The disability will be handed on to the child
    • The child will be psychologically harmed
    • The child will be deprived
    • The child will be burdened.
      Disability and the midwifery services
      Disabled women have reported the following difficulties encountered with maternity services:
    • Lack of physical access
      DEALING WITH DISABILITY DURING PREGNANCY AND BEYOND
      103
  • Lack of accurate information about pregnancy and childbirth, especially in relation to their disability
  • Lack of effective communication
  • Ignorance of maternity professionals about both the medical and practical needs of disabled mothers
  • Inflexibility in maternity services
  • Language and attitudes which reflect prejudice
  • Doubts about a disabled woman’s ability to cope with motherhood
  • Staff who do not respect a disabled woman’s own knowledge of her disability
    6
  • Negative attitudes from health professionals.
    7
    The RCM
    8
    supports the principle that:
    ‘It is important that services reflect the needs of women who have disabilities and ensure that action is taken to overcome the obstacles which confront them. While physical obstructions are of course a frustrating problem, there are other equally daunting barriers resulting from prejudice and ignorance of able bodied professionals.’
    Midwives and disabilities
    Midwives must be aware of their own values and attitudes regarding the
    rights and responsibilities of childbearing.
    Midwives have the potential to strengthen a woman in her ability to give birth and to be a parent in a society that may not be 100% supportive of her decision to do so.
    7
    However, midwives have expressed concerns that:
  • They do not always feel equipped to do this.
  • There is a lack of a coordinated approach by health professionals and health authorities.
  • Little is known about available information and resources.
  • They are unsure about alternative support agencies.
  • They feel that service provision is preventive rather than reactive.
    General recommendations for practice
  • Provide services in settings that are architecturally/physically accessible.
  • Provide services that are psychologically accessible.
  • Provide pre-conceptual care to assist the woman and her family prior to the decision to become pregnant.
  • Provide pregnancy care that is sensitive, based on thorough assessment of physical and psychosocial needs, and well planned.
  • One-to-one care and continuity are important.
  • Plan for the special needs of labour and birth.
  • Assist the mother to organize for the many needs of the postpartum period.
    7
    Sensory impairment
    Recommendations for women with visual impairment
  • One-to-one care and continuity are important.
  • Tactile models are helpful when describing aspects of the childbirth process, e.g. doll and pelvis, knitted uterus, cervical dilation chart which has holes representing the different stages of dilation.
    CHAPTER 5
    Health advice in pregnancy
    104
    • Teach and encourage the woman to palpate her own abdomen, focus in on fetal movements and listen to the fetal heart. This will enable her to know her infant antenatally.
    • Familiarize the woman with the hospital prior to admission. If the woman requests the presence of her guide dog, organize this well in advance.
    • All healthcare workers should introduce themselves verbally by name and function.
    • Give full explanations before all procedures.
    • Encourage immediate skin-to-skin contact following birth, to enable the woman to know her baby.
    • Perform any examination of the baby with the woman present, giving a clear explanation of the procedure.
    • Describe the baby’s characteristics, expressions, movements, and behaviours.
      7
      Recommendations for women with hearing impairment
    • Determine the way in which the woman communicates most comfortably, e.g. writing, hearing aid, lip-reading, finger spelling, sign language, or interpreter.
      •
      Provide one-to-one care or small classes for antenatal education.
    • Make it clear in the records that the woman has a hearing impairment.
    • If the woman is able to lip-read, obtain her attention before speaking, face the woman, do not over-mouth words, do not stand in shadows, and do not dim the room lights.
    • Be patient, repeat and rephrase as required, avoid analgesia that causes drowsiness.
    • Familiarize the woman with the hospital prior to admission. Choose a quiet room.
    • Watch for facial expressions during procedures, the woman may not be able to communicate discomfort or concern.
    • Wear a transparent mask if one is needed.
    • Provide as much written literature as is available on all aspects of care.
    • Provide early screening for babies at risk of either inherited or acquired deafness.
    • Ensure that application for a baby alarm is made early in the antenatal period.
    • Inform mothers about the RNID book
      Pregnancy and Childbirth
      —
      a guide for deaf mothers
      .
      9
      Women with learning disabilities
      and perinatal mental health disorders
      Recommendations for women with learning disabilities
      Most parents with learning disabilities recognize that they need extra help and support. The support may be practical, emotional, or social, and mostly likely a combination of all three. In order to provide successful support, midwives need to recognize:
    • That these parents are individuals who may have many skills and abilities on which to build
    • Ways in which self-confidence and self-value can be increased
      DEALING WITH DISABILITY DURING PREGNANCY AND BEYOND
      105
  • That external influences will impact on the individuals. When teaching parenting skills, the midwife should:
  • Break a task down into smaller sections, allow time, and be prepared to repeat the same information
  • Avoid using long words or jargon
  • Keep to the facts, avoid using abstract concepts
  • Demonstrate the task alongside the parent, the parent then can watch the task and repeat the actions
  • Allow the parents to complete as much of the task as they know before reminding them what comes next
  • Always repeat the same prompt and the same set of instructions
  • Write down training plans explicitly, showing verbal and physical prompts and at what stage of the task they occur
  • Remember that the written word is not always the most effective or the best way to impart knowledge to parents. A variety of visual or audio tapes, photographs, or drawings may be more accessible, either on their own or accompanied by simple written information.
    When using written information:
  • Avoid abbreviations
  • Use simple words that are not too long
  • Use large print; ask if they prefer capitals
  • Highlight the main points
  • Use lists or bullet points where possible.
    Recommendations for perinatal mental health
    The term ‘perinatal mental health’ is a term used increasingly to relate to the various mental health disorders experienced by women during preg- nancy and the postnatal period. These include a previous history of mental disorder, signs and symptoms demonstrated in the antenatal period, along with the range of disorders that appear in the postnatal period.
    10
    Despite the high prevalence of postnatal depression (10–15%) such disturbances often go undetected.
    11
    Midwives have a crucial role in reducing the effects of perinatal mental health disorders on the mother, her child, and the family.
    12
    Midwives should:
  • Provide continuity of care and carer whenever possible
  • Carry out a modified psychiatric history during the booking interview
    12
  • Be alert to the increased likelihood of a woman relapsing or developing postnatal mental illness if she has a personal or family history of a psychiatric illness and/or a postpartum illness
    13
  • Liaise swiftly and appropriately with the multidisciplinary team.
    If the woman has a previous history of mental disorders, antenatal assessment by a psychiatrist is essential, along with a management plan for after delivery, and access to a perinatal mental health team.
    Post-traumatic stress disorder
    It has been suggested
    14
    that 3% of women may develop post-traumatic stress disorder. Midwives should be aware of:
  • The trauma a woman may experience in childbirth
  • The action that health professionals can take in order to prevent its occurrence
    CHAPTER 5
    Health advice in pregnancy
    106
    • The factors that can contribute to post-traumatic stress disorder, including:
      • Violent birth
      • Fear for the baby
      • Postpartum pain
      • Low energy levels
      • Sexual abuse before and during pregnancy
      • Excessive vomiting in pregnancy
      • Ectopic pregnancy
      • Hospital treatment for miscarriage
      • Macrosomia
      • Episodes of preterm labour although the mother gave birth at term
        15
    • Post-traumatic stress disorder can result from loss of control and a sense of powerlessness in labour, lack of trust, and inadequate information.
      16
      All women should have the opportunity to discuss with their midwife the care they received during childbirth.
      Referral either to a postnatal listening service or to a ‘Births after thoughts’ programme should be available to all mothers, where they can talk to a midwife trained in this area.
      Women with physical disabilities and chronic illness
      Women may present with a wide range of physical disabilities and chronic illness during pregnancy, including multiple sclerosis, spinal cord injuries, cerebral palsy, amputees, and rheumatoid arthritis, to name but a few. The general recommendations for practice identified at the start of this section should be followed, together with the following:
    • Caregivers should respect the woman as the primary source of information about how to proceed with care.
    • Women with disabilities are very aware of their abilities and limitations, and all care should be discussed fully with them and their partners.
    • Assist the woman to focus on her abilities and not her disabilities.
    • Women with chronic illnesses will require information about the effect of their illness and drug therapy on the pregnancy, birth, postpartum period, and the newborn, as well as the possible effects of the pregnancy upon their condition.
    • A multidisciplinary approach to care must be adopted to include the midwife, the obstetrician, the woman’s disability and/or medical consultant, the physiotherapist and occupational therapist, etc.
    • Help the woman to manage her own care regimes as much as possible.
    • Take extra care to prevent skin breakdown if mobility is restricted.
      7
      DEALING WITH DISABILITY DURING PREGNANCY AND BEYOND
      107
      1. Fraser DM, Cooper MA (2009).
        Myles: Textbook for Midwives
        . Edinburgh: Churchill Livingstone.
      2. World Health Organization (2001). Prevalence of impairments, disabilities, handicaps and quality of life in the general population: a review of recent literature.
        Bulletin of the World Health Organisation
        79
        (11), 1047–1055.
      3. Helman CG (2007).
        Culture, Health and Illness
        , 5th edn. London: Arnold.
      4. Kent J (2000).
        Social Perspectives on Pregnancy and Childbirth for Midwives, Nurses and the Caring Professions
        . Buckingham: Open University Press.
      5. Thomas C (1998). Becoming a mother: Disabled women (can) do it too.
        MIDIRS Midwifery Digest
        8
        (3), 275–8.
      6. Campion MK (1997). Disabled women and maternity services.
        Modern Midwife
        7
        (3), 23–5.
      7. Carty E (1995). Disability, pregnancy and parenting. In: Alexander J, Levy V, Roch S (eds)
        Aspects of Midwifery Practice: A Research Based Aapproach
        . Basingstoke: Macmillan Press, pp. 571–4.
      8. Royal College of Midwives (2000).
        Maternity Care for Women with Disabilities
        . Position Paper number 11a (reviewed 2005). London: RCM.
      9. RNID (2004).
        Pregnancy and Birth
        —
        A Guide for Deaf Women
        . Peterborough: RNID in associa- tion with NCT.
      10. Stewart C, Henshaw C (2002). Midwives and perinatal mental health.
        British Journal of Midwifery
        10
        (2), 117–21.
      11. Cooper PJ, Murray L (1997).
        Postpartum Depression and Child Development
        . London: Guilford Press.
      12. Lewis G (ed.) (2007).
        The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Live; Reviewing Maternal Deaths to Make Motherhood Safer
        —
        2003–2005.
        The 7th Report on Confidential Enquires into Maternal Deaths in the United Kingdom. London: CEMACH.
      13. Bates C, Paeglis C (2004). Motherhood and mental illness.
        Midwives
        7
        (7), 286–7.
      14. Ayers S, Pickering AD (2001). Do women get post-traumatic stress disorder as a result of childbirth?
        Birth
        28
        , 630–63.
      15. Seng JS, Oakley DJ, Sampselle CM, Killion C, Graham-Bermann S, Liberzon I (2001). Post- traumatic stress disorder and pregnancy complications.
        Obstetrics and Gynaecology
        97
        , 17–22.
      16. Laing KG (2001). Post-traumatic stress disorder: myth or reality?
        British Journal of Midwifery
      9
      (7), 447–51.
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      Minor disorders of pregnancy
      ‌
      Chapter 6
      109
      Introduction
      110
      Backache
      111
      Constipation
      112
      Frequency of micturition
      113
      Indigestion and heartburn
      114
      Nausea and vomiting
      115
      Varicose veins and haemorrhoids
      116
      CHAPTER 6
      Minor disorders of pregnancy
      110‌
      Introduction
      Minor disorders of pregnancy are a series of commonly experienced symp- toms related to the effects of pregnancy hormones and the consequences of enlargement of the uterus as the fetus grows during pregnancy.
      The conditions themselves pose no serious risk to the mother, but they are unpleasant and can affect her enjoyment of the pregnancy overall.
      Close questioning of the mother is necessary to ascertain that the symptoms are not masking a more serious problem, and a sympathetic and helpful approach with prompt advice and treatment is needed.
      BACKACHE
      111‌‌
      Backache
      Up to 90% of women may experience backache during their pregnancy making this the most common of the minor disorders of pregnancy. Obesity, a history of back problems, and greater parity increase the likeli- hood of backache occurring.

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