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 Dublinservices during pregnancy, childbirth and early motherhood are described inmore detail under the remaining 3 headings.3.3. Barriers to accessibility of services for women withphysical disabilities3.3.1. Location of services and models of careThe Maternity and Infant Care Scheme provides a programme of care to allwomen in Ireland during pregnancy, childbirth and early motherhood, andensures that care administered through the public system is delivered with nofinancial cost incurred by women. Accessibility of health care is determined,however, by the location of services. Services that can be accessed by publictransport, are located in the local vicinity and flexible in the provision of care aremore accessible for women with disabilities.In the western world, most women now give birth in hospital. Although thereasons for the move from home to maternity hospital in Ireland are multifaceted,they are undoubtedly influenced by Department of Health and Childrenpolicy to centralise services (Kennedy, 2002), thus providing units of a minimumcritical size. This ensures that specialist staff receive sufficient experience tomaintain skills in diagnosis and treatment of rare complications but inevitablymeans that some women will live at a distance from the nearest maternity unit.In Ireland there are 19 maternity hospitals and 2 midwifery-led units that areresponsible for the provision of publicly-funded health care to women duringpregnancy, childbirth and early motherhood. In addition, independent midwivescan be contracted by any woman planning to have a home birth. The hospitalsare geographically spread throughout the country and are generally located indensely populated urban areas. This regionalisation of maternity and perinatalcentres, is designed to enable a range of specialist staff to be employed andavailable, and offers sufficient experience in identification and treatment of morerare conditions or complications. However, O'Doherty and Regan (2006) argue53
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinthat the policy reduces the availability of alternative models of care and theproximity of services to women as some women are required to travel up to 80kms to the nearest maternity unit (Sheeran, 2007). The organisation andmodels of care are not uniform or standard among these hospitals. In additionto the 2 midwifery-led units, 4 out of the 19 hospitals offer community basedservices, for example, Domino and Community Midwives schemes. Theseschemes afford a woman who is classified as having a ‘low risk’ pregnancy theopportunity to access care in the community or in her own home. Depending onthe model of care on offer the woman may also give birth at home. Somehospitals provide an alternative model called the ‘early transfer home’service/scheme where mothers and babies are discharged from the hospital 6hours after the birth and a team of midwives provide midwifery care for thesubsequent 5 days in the woman’s own home. To be eligible for this schemethe mother and baby must have had an uncomplicated birth and immediatepostnatal period.3.3.2. TransportDriving independently may not be an option for some women with a physical (orsensory) impairment so they are reliant on public transport, taxis or otherindividuals when travelling to and from health care facilities (Anderson andKitchin, 2000; Lawthers et al, 2003; Prilleltensky, 2003; Scheer et al, 2003).Depending on the woman’s geographic location and the availability of suitablyadapted public transport, access to health care facilities and participation inother community activities may be severely curtailed. In the United States, it isestimated that 1 in 4 women with disabilities have no access to appropriatetransportation (Nosek, 1992; Goodman, 1994). Inadequate transport to andfrom the health care facilities can pose significant challenges for women tryingto get to appointments and to access reproductive care. Even when publictransport is available Smeltzer et al (2007) report how, in the United States, it isexpensive, undependable and inadequately equipped to accommodate orsecure women with a wheelchair (Smeltzer et al, 2007). Long waiting times forsuitably adapted transport to arrive is the norm and can be problematic when54
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University of DublinTrinity College
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