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 Dublinmidwifery-led units and various midwifery-led initiatives such as ‘early transferhome’ and ‘Domino’ 1 schemes. The increasing use of technology, characterisedas technocratic birth (Davis-Floyd, 1992), and the prevalence of the ‘economicmodel’ of childbirth (Begley, 2002) has led to a diminution of emphasis on theimportance of women’s experiences during pregnancy and childbirth, makingthem almost “invisible” in the process of their own pregnancy and birth (Begleyand Devane, 2003).Across many advanced societies, the movement demanding changes inmaternity services towards more women-centred care, including the key tenet ofchoice, has grown up alongside, and in opposition to, the increasinglyinterventionist provision of maternity care. In the United Kingdom (U.K.), it hasreceived serious parliamentary consideration in the last decade leading to newnational policies and directives (Department of Health, 1993).In Ireland, choice and women-centred care have been described as a minimumrequirement for responsible maternity care by a recent pressure group ofconcerned women, midwives and maternity carers (Choices in ChildbirthInitiative, 2007). Despite this, a national survey of 500 mothers (including thosewith and without disabilities) conducted by the Irish Examiner and LansdowneMarket Research found that 63% of women in this sample were unhappy withaspects of their care during pregnancy or birth (O’Doherty and Regan, 2006). Inparticular, waiting times and travelling distances to attend antenatal clinics werea cause of distress, with 20% of women in Munster forced to travel 31 miles ormore to give birth (O’Doherty, 2006). It is clear that women with disabilities maythus be in an even more challenging situation.1 “Domino” stands for DOMiciliary IN and Out. Women with no risk factors receive antenatalcare in the community from a team of midwives, one of whom visit the woman in her own homein early labour, assists her through labour and escorts her to hospital in time for the birth. Thewoman and her baby may then go home again 6 hours later, if there are no complications, andthey are visited by one of the team midwives daily for 5-7 days in the postnatal period.9
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College DublinA decade ago, Barbara Murray and Audrey O’Carroll commented that the livesof women with disabilities in Irish society remained largely hidden comparedwith able-bodied women (Murray and O’Carroll, 1997:pg. 494). They suggestthe experience of pregnancy and child birth can change this but not necessarilyin a way that fully supports and encourages the expectation that women withdisabilities can undertake mothering successfully, let alone live their lives withresilience, creativity and positivity.According to Segura (1994), society’s construction of motherhood is based onstudies of white, middle class women, not women of colour or less privilegedwomen. Thus it may be hard within Irish culture to accept women withdisabilities as mothers, as they differ from the norm. It may also be particularlydifficult to change the institutional culture of maternity care in Ireland that haslessened women’s involvement for so long, especially when coupled with otherfactors, such as a massive under-investment in wide-ranging midwifery servicesin the community.2.3. Official statistics and definitions of disability in Ireland2.3.1 Historical development of data collectionOfficial statistics on a limited range of what are now termed ‘disabilities’ dateback to 19 th century Ireland in the form of the first modern national Census of1841. Doyle (Doyle, 2003:pg.11) lists the categories that were used up to theCensus of 1911 as follows:-Lunatics and Idiots-Deaf and Dumb-Dumb not Deaf-Blind10
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