Midwives' insights revisited

In journal 53/54, we outlined an innovative disability module offered to midwifery students at Anglia Ruskin University. Here, former students Jane Martin and Julie Williams, now practising midwives, describe the practical steps they have taken to ensure that services are accessible to visually impaired mothers-to-be.

During the third year of our midwifery degree at Anglia Ruskin University, we undertook an optional module called Special Parents, Special Needs. For our project, we decided to focus on visual impairment, having cared for a pregnant woman who was blind, and witnessed the inadequacy of her antenatal provision.

During parentcraft classes, the only extra provision that was made for the client was space for her guide dog and the option, at the end of the session, of reiterating the material covered. Fortunately, she was accompanied to the classes by her partner, leaving us to wonder what would have happened if she had attended alone.

Many parentcraft classes are run by a solo midwife, which does not allow for any additional support to be offered. For example, if a visually impaired client required assistance to go to the toilet, the midwife would have to leave the class unattended.

This gap in the provision of basic care prompted us to research further into the needs of visually impaired mothers-to-be. We could not find any specific antenatal resources aimed at visually impaired women, either in the National Health Service or locally, so we decided to devise our own teaching aids. 

Innovative resources

In order to help visually impaired clients imagine the position of their baby, we developed a piece of ‘Braille art’, using different textures to define the position of the baby’s head and bottom. We created a pelvic model and to define its edge, used sand and glue to form a ridge that can be easily felt. The body of the pelvis was sprinkled with sand in order to create a bone-like texture. 

The rationale for the use of this teaching aid with visually impaired clients was to:

•        help them feel the shape of a pelvis

•        help them feel how far down in the pelvis a baby moves during labour

•        help them feel the possible different positions of a baby, such as breech

•        explain terminology such as high head and engagement.

There are no other tactile aids available in our area for visually impaired mothers-to-be so we hope our design will prove useful. We also devised a leaflet, which highlights issues specific to visually impaired mothers-to-be.

A major concern was the recognition of obstetric emergencies, such as bleeding. In order to help make a client aware of the difference between the spontaneous rupture of membranes and an antepartum or postpartum haemorrhage, we came up with the idea of asking her to feel the difference in consistency between liquor and blood, which feels stickier and thicker than liquor. For this purpose, and with her consent, extra blood may be obtained at her 12-week routine antenatal blood test. She can be informed that, should she feel the presence of blood or liquor, she needs to go to hospital immediately.

In view of the available evidence of the many benefits of breastfeeding, we included breastfeeding tips in our leaflet. The experience of coping with a new baby is daunting for any first-time mother, but visually impaired mothers face the added challenge of not being aware of visual clues from their baby. Successful breastfeeding for a visually impaired mother may take a little longer and require a creative approach, but is certainly achievable.

Hand-held notes

We thought about the vital information that is located in the hand-held notes. This infomation is inaccessible to visually impaired women, who should have the same access to their notes as sighted women, and take an active role in decisions about their care, as stated by the Royal College of Midwives Position Paper 11a, Maternity care for women with disabilities, published in May 1996. To ensure that visually impaired clients are able to do so, we decided to transfer the notes onto audiotape, using a hand-held tape recorder. The system we devised consists of three tapes, containing the following information:

Tape 1 – Details from the front page of the hand-held notes, including the client’s hospital number, blood group, Rhesus factor, recent haemoglobin result, obstetric, medical and family history, named midwife and the phone number of the labour ward.

Tape 2 – Details of antenatal check-ups, which are recorded by the midwife at every visit. These include the date, time, blood pressure, urinalysis, fetal movements, fetal heart heard, palpation findings, when blood tests are due and any identified problems.

Tape 3 – Details of scan reports, giving a record of scan results. This may take a little longer to achieve but gives the client a reassuring audio record to keep, in addition to the usual scan picture. Impartial information about available screening tests could also be recorded here, thereby promoting informed choice. This would give the client the opportunity to listen to the tape, digest the information and make her decision.

We also transferred onto audiotape the leaflets that we distribute at antenatal classes.

Hospital accessibility

Braille stickers, or stickers with bold black numbers on a yellow background, are useful to display the labour ward telephone number. These relatively inexpensive stickers make the number more accessible to a visually impaired client and her family. On contacting a number of maternity hospitals, we found that such stickers were not generally used.

Tours of the maternity unit should be encouraged and extra time allowed for visually impaired clients, in order for them to gain familiarity of the layout of a labour ward and room, including the position of the bed, toilet and equipment. Clients should be encouraged to explore the available mobilising area; to listen to a monitoring machine and feel the transducer; to try out the use of Entenox, beanbags, birthing balls, a birthing stool and birth pool.

We were surprised to learn that most hospitals do not have a specialist midwife to assist disabled clients. We think it is a good idea to have a link midwife, who would ensure that up-to-date information regarding voluntary organisations and support groups is readily available. If she was also the named midwife on the hand-held notes, staff would be instantly aware, when the client calls the labour ward, that she has a disability .

Editor’s note

Next: Resources... Pathways to parenthood