 |
Resources |
|
|
|
Guidance for midwives and nurses Jackie Rotheram, disabled mother, midwife and founder of the first specialist midwifery service for disabled women, based in Liverpool Women’s Hospital, UK, calls for changes in attitudes towards woman-led service provision in nursing and midwifery. Zita Killick, Senior Lecturer in Midwifery at Anglia Ruskin University, UK, reviews the guidance launched at the Royal College of Nursing (RCN) Midwifery Society Congress in April 2007. Pregnancy and motherhood are major life events for all women, not least for disabled women. Disabled women are often seen as a minority within a minority. Nevertheless, they want to be treated like every other woman but not at the expense of their impairment being ignored or over-reacted to. The lack of relevant literature suggests that disability and pregnancy are two concepts rarely considered together. Is it assumed then that disabled women do not want to become parents or are unable to fulfil the responsibilities of parenting? Disabled women would argue that health care professionals are not experienced enough in catering for individual needs, nor are they prepared to accept the challenge. Issues around disability are complex and vast. All nurses and midwives who encounter disabled women contribute to their childbearing and parenting experience. For this to be a positive experience, midwives, nurses and other carers need to be empowered and enabled to deliver care that is woman-led to meet individual needs, at the same time as being evidence-based. Health professionals can only hope to make a difference to the experience of disabled women by taking time, being innovative in practice and being prepared to learn from disabled women themselves, giving them back control, independence and choice. The biggest barrier cited by disabled people today is that of negative attitudes and behaviours, a lack of relevant and up-to-date information and a lack of disability awareness from healthcare providers. To redress the balance, Pregnancy and disability: RCN guidance for midwives and nurses aims to give guidance to all those involved in the maternity experience, to seek ways to remove barriers of access to goods and services, to improve communication, and to explore ways to make reasonable adjustments that are both creative and flexible to meet the needs of disabled parents. Embracing diversity is key to change. To see a person's strengths will help focus on the positive. This will 'make a difference' for both carer and user alike. I hope this publication will motivate the reader to provide equity in service provision for all disabled parents, seeing them as women first and disabled second. Jackie Rotheram The Royal College of Nursing and Jackie Rotheram must be congratulated for producing this much needed guidance paper, which has been supported by many knowledgeable, interested individuals and groups across the UK. The aim is to enable professionals "to provide evidence-based and client-led care to meet a disabled individual's needs during pregnancy, birth and beyond" (page 4), with the contents list clearly indicating the variety of useful information contained within the 29 pages so the reader may easily find the appropriate section. The social model of disability underpins the information and advice, with a useful section on disability definition and relevant legislation. Midwifery and nursing responsibilities, as well as NHS trust corporate responsibilities, are clearly summarised and it is to be hoped that all healthcare providers obtain a copy of this paper without delay - and fulfil their responsibilities, particularly with regard to the recently implemented Disability Equality Duty. Practical advice for service provision includes aspects of disability awareness and etiquette, with examples of acceptable terminology and an emphasis on appropriate attitudes and communication skills. Consideration of women's individual concerns about their pregnancies and the needs of their partners are explored. Case studies of four broad categories of disability - covering physical, sensory, learning and mental illness - give excellent illustrations of the type and variety of care needs with practice points providing detailed advice for adaptation according to each individual's needs. Brief sections for specialist healthcare workers such as community public health nurses, learning disability team workers and occupational health nurses emphasise the careful thought given to ways of increasing multi-professional team working. Consideration is also given to social services support for adults or children at risk, with a reminder that disability does not mean automatic referral. It is pleasing to read that offering antenatal care in the home is recommended, but I would have liked to have seen inclusion of choice of place of birth, as well as choice of delivery in section 4.3, "The impact of pregnancy on disabled parents", as hospital care for births seems to be indicated here as the norm. However, the possibility of choice of home birth is included in section 4.5, "Effective care - general practice points", but could have been further emphasised in one of the case studies. The three appendices provide further information including examples of good practice; contact details of support, advocacy and information organisations and other resources. With the emphasis clearly placed on respect for the 'diversity and individuality of people with disabilities' (page 24) and the need for partnership among all professionals, agencies and disabled people, this guidance paper should be studied by all personnel who may have contact with childbearing women. Midwives and nurses could then recommend it to their local general practitioners and obstetricians. As the guidance paper includes advice for birth and postnatal care, perhaps the title could have been broadened to 'Pregnancy, childbirth and disability', as citing 'pregnancy' alone might deter professionals from accessing this paper when seeking advice on birth and postnatal care, but this is only a minor quibble. I will certainly be recommending this publication as an excellent resource to my colleagues and students in education and in clinical practice, in midwifery, nursing and in social work. Zita Killick Pregnancy and disability: RCN guidance for midwives and nurses by Jackie Rotheram. 2007, London, Royal College of Nursing ISBN 978 1 904114 46 6 Available from www.rcn.org.uk |
