why do we need to assist first those customers who have mobility difficulties., senior citizen or pregnant women?
Answers
Women with disabilities often find prenatal classes uninformative and not helpful because the class instructors are not knowledgeable about their disabilities and possible effects on pregnancy, labor and delivery. Therefore, nurses and others providing prenatal care need to make special efforts to identify the questions and concerns of women with disabilities about prenatal care, labor and delivery, and the post-partum period, including strategies or modifications that may be needed to enable them to care for their infants. Efforts to anticipate challenges that may occur during labor and delivery should be undertaken to minimize women’s concerns and risk for negative outcomes. In addition, attention should be given early in pregnancy to identify modifications and to acquire specific childcare equipment that may be helpful to women with disabilities to care for their infants.
Labor & Delivery Issues. With appropriate planning and management, most women with disabilities have labor and delivery experiences similar to those of other pregnant women. Most women with disabilities prefer to have a vaginal delivery. More women with disabilities than women without disabilities have Cesarean sections, although disability by itself is not an indication for Cesarean section. It is important to realize that even women with neurological disorders, such as multiple sclerosis or spinal cord injury, that affect sensation often experience spasm, abdominal pressure and pain or discomfort associated with contractions.
In some cases, obstetrical care providers refer women with disabilities to the anesthesia team during the last month or so of pregnancy to ensure that any issues that might affect anesthesia, labor and delivery are considered prior to the onset of labor. For example, women with spinal cord injuries or musculoskeletal disabilities (e.g., spina bifida, osteogenesis imperfecta, cerebral palsy) often have specific issues that may require special planning prior to receiving epidural anesthesia for delivery.
Postpartum. Many women with disability find themselves on postpartum nursing units in inaccessible rooms, making their recovery and self-care difficult. Depending on the type of delivery they had (vaginal delivery vs. Cesarean section) and the nature of their disability, they may have difficulty managing an episiotomy incision following a vaginal delivery.
Many women with disabilities plan to breastfeed their babies although some women need modifications in breastfeeding positions and strategies to hold their baby for breastfeeding. Nurses who are knowledgeable and sensitive to the needs of women with disabilities and their preferences for breastfeeding can be very helpful in assisting women in breastfeeding. Referral to lactation consultants may also be helpful to any woman wanting to breastfeed, including women with disabilities.
Childcare. Most women with disabilities, including those with severe disabilities, are very resourceful and find ways to do an excellent job in taking care of their infants. Some modifications may be needed, such as a side-opening crib that open like a door and can be opened by a mother from her wheelchair. Because of concern that they might be considered incompetent mothers if they ask too many questions, some women with disabilities are reluctant to ask their health care providers questions about childcare issues.
Discussion Guide
1) Identify/discuss the role of the nurse at each of the phases identified above.
2) Identify the accommodations that might be needed for women with the following types of disabilities:
a) Physical disability that limits mobility and affects sensation
b) Deafness or hearing loss acquired as an adult
c) Blindness or vision loss
d) Communication impairment
e) Intellectual or developmental disability