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 Dublinunable to cope with the functions of their new role (Thomas and Curtis, 1997;McKeever et al, 2003; McFarlene, 2004). Health professionals often interfereand provide unhelpful advice and care which only reinforces the woman’s senseof difference and signals their inadequacy (Thomas, 1997). Frequently,alternative solutions offered or proposed by women that could help them masterthe skills associated with practical baby cares are considered inappropriate byhealth professionals (Thomas, 1997) and they fail to appreciate women’sexpertise in mastering and adapting to their disability.3.5.3. Effect on women of negative staff attitudes and behavioursSuch prejudicial attitudes combined with insensitive and derogatory commentsonly serve to diminish a woman’s self-esteem and self-efficacy and cause her todoubt her own ability to be an effective mother (Welner, 1997). This erodeswomen’s sense of autonomy and empowerment and they become passive andcompliant in their interaction with health professionals (Prilleltensky, 2003),describing how they feel depersonalised and a burden on the health services(Smeltzer et al, 2007).The literature demonstrated clearly the strong emotions such as anger andbitterness, expressed by women with physical disabilities, which emanates fromtheir feelings of isolation and exclusion (Tilley, 1998). These feelings arise inresponse to the assumption that their traditional roles as nurturers, mothers,wives, homemakers, and lovers are not considered appropriate for them;instead society perceives stereotypes and portrays them as dependent andasexual individuals (Tilley, 1998). Moreover, many women may feel disabled,demoralised and ‘at the mercy of a fragmented, medicalised system’ (WHC,2004:pg. 13), which erodes their sense of individualism. In a recent study of 152trusts providing obstetric or midwifery-led maternity services in England, whereover 26,000 women responded to a questionnaire survey, women whodescribed themselves as having a disability responded more negatively toquestions on the quality of care at all stages of pregnancy, birth and thepostnatal period. They were also less positive in their responses regarding65
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinbeing treated with respect and dignity, and on those concerning the receipt ofenough information (Commission for Healthcare Audit and Inspection, 2008).3.5.4. Lack of knowledge of disabilities in health care professionals3.5.4.1. Lack of knowledge in health care professionals resulting inavoidance of women with disabilitiesThe negative attitudes from health care professionals described above maystem from the health professional’s lack of awareness, knowledge and expertisein relation to the disability (House of Commons Health Committee, 2003). Fewhealth professionals seem knowledgeable about the care required by womenwith disabilities and many are unfamiliar with disability related complicationsthat may develop (Westbrook and Chinnery, 1995; Lipson and Rogers, 2000;McGuinness, 2006; Thierry, 2006; Smeltzer et al, 2007). They may lackawareness of, and therefore be insensitive to, the individual needs of women.Quite often it is the woman who educates the health professional about herdisability. This lack of knowledge and awareness leaves many healthprofessionals anxious, uncomfortable and nervous about caring for a womanwith a physical disability during pregnancy, childbirth and early motherhood(Baker et al, 1997), which may encourage them to refer women to anotherphysician. This action impacts on the concept of continuity of care (Grabois etal, 1999; House of Commons Health Committee, 2003), a concept that couldhelp alleviate the many attitudinal challenges experienced by women.Furthermore, the evidence suggests that women with physical disabilities find itextremely difficult to locate a physician with the knowledge to manage thedisability and the pregnancy (Nosek et al, 2001; Veltman et al, 2001; House ofCommons Health Committee, 2003). Many physicians perceive the pregnancyto be high risk, unusual and problematic (Thomas, 2001). For some women,disability does increase the risk of developing secondary complications;however, labelling the pregnancy as high risk results in increased frequency ofantenatal visits, consequently women are ‘compartmentalised and labelled asdeviant from the norm’ (Prilleltensky, 2003:pg. 29). Evidence also suggest that66
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