Women with Disabilities: Barriers and Facilitators to Accessing ...

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WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinoral communication such as lip-reading (O’Hearn, 2006). Many healthprofessionals consider writing and lip-reading as appropriate and effectivemodes of communication; however, the majority of women who are deaf preferhealth professionals to communicate using sign language or a sign languageinterpreter (Iezzoni et al, 2004; O’Hearn, 2006). Despite this preference healthprofessionals in the US rarely engage the services of an interpreter (O’Hearn,2006) mainly because they fail to recognise their responsibility to do so, andmany in the United States complain about the cost and inconvenience incurred(Iezzoni et al, 2004). This can result in women feeling humiliated and frustrated(Clinton, 1995). When sign language interpreters are used, health professionalsdo not request that the person is proficient in the use of medical sign language(Iezzoni et al, 2004) and they have a tendency to communicate with theinterpreter and not the woman, so that the woman feels isolated and excluded(Kelsall, 1992; Iezzoni et al, 2004; Smeltzer, 2007).If present during the birthing process, sign language interpreters may be askedto act as the woman’s support person and to aid in physically supporting thewoman (Ubido et al, 2002); this redirects their hands and so communication islost. In the absence of a sign language interpreter many health professionalsand deaf women rely on family members and/or friends to translate what is saidduring the interaction. This practice is inappropriate and infringes on thewoman’s right to confidentiality. The potential for misinterpretation is enormous.Health professionals regularly misinterpret and misunderstand the facialgestures and expressions that are an integral part of sign language. Theygenerally perceive the gestures and expressions as aggressive andargumentative and this often results in health professionals misinterpreting thesituation and avoiding the woman (Ubido et al, 2002).81
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublin4.6.2.3. Using written informationWhen health professionals attempt to communicate with pen and paper thewriting often poses major problems. It may be illegible and medical terms areoften used, so that words are incomprehensible to the lay person. For womenwho are pre-lingually deaf, sign language is their first language, not English, somany women may not identify with the language and the associated vocabularybeing used. In addition, pre-lingual deaf women may have difficultypronouncing, verbalising and reading English so providing information in writtenformat is inappropriate (Ubido et al, 2002; Iezzoni et al, 2004). Many healthprofessionals are unaware that sign language is the first language of manywomen who are deaf, so interactions are generally initiated and continued onthe assumption that women can lip-read, or pen and paper are used to gatherand relay information. The over-reliance on written communication and theconcessions deaf women have to make are a source of frustration for manywomen (Ubido et al, 2002; Iezzoni et al, 2004). Health professionals do notconsider the possibility that for some people who use sign language, the waythey view and interpret the written word differs markedly from those who are notdeaf. This may mean that deaf women may not fully comprehend any writteninformation provided (Smeltzer et al, 2007) leaving open the potential formisinterpretation (Ubido et al, 2002).4.6.2.4. Using lip-readingChallenges are also encountered by women who use lip-reading as a mode ofcommunication. Health professionals may be unaware that a woman may usethis skill so are not conscious of the need to ensure that their lips are seen at alltimes. Health professionals may talk while reading from notes, turn away, havea beard or wear a mask, making it difficult for women to lip-read (Iezzoni et al,2004). They may not position themselves in proper light so it can be difficult forthe woman to visualise the lips, or words may be unclear and rushed.Distracting background noises, analgesia, exhaustion and fatigue can make itdifficult for women to concentrate on lip-reading or signing.82
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