Deaf women and pregnancy and perinatal health: Creating systems for communication access
Compared with the general population, deaf and hard of hearing (DHH) women are at increased risk for adverse pregnancy conditions (e.g. eclampsia) and perinatal outcomes (e.g. preterm labour), as found in a retrospective cohort study. As a component of that study, Panko et al. conducted 45 interviews with deaf women who communicate in American Sign Language (ASL); they discovered themes centring around communication and advocacy, including consistent access to qualified interpreters, patient support from healthcare teams, communication quality between patients and clinicians, and self-advocacy strategies. The authors present important arguments addressing imbalanced reliance on social networks, inadequate interpreter presence and training, and incorporation of deaf awareness during healthcare professional education. As deaf physicians (representing maternal and fetal medicine and internal medicine) with personal and professional perspectives on healthcare and perinatal experiences, authors believe that communication access and equity must be woven throughout the fabric of healthcare systems and education institutions.
Typical strategies to engage interpreters depend on individual providers to identify communication needs and activate interpreters, risking marked cognitive overload and subsequent process inconsistencies. To achieve communication equity, healthcare systems must develop and implement processes for identifying and documenting every patient's communication preferences, making such information quickly available to every provider at each patient encounter. For example, labour and delivery units represent the uncertainty of perinatal timing and potential emergencies. They should have contingency plans for prompt access to interpretation and for ensuring that the patient's communication preferences are handed off among nurses and clinicians throughout the patient's stay, including to those caring for the newborns.
While generalist interpreter education programmes are available, specialised ASL/English healthcare interpreting training is sparse. Healthcare institutions should partner with interpreter education programmes to deliver patient centred training to better support DHH patients’ values, while concurrently educating medical, nursing and other professional students across the workforce about interpreters as healthcare team members. Beyond the experiential exposure to deaf culture and communication that the authors describe (e.g. the Deaf Strong Hospital), it is critical that healthcare education programmes integrate DHH people into their recruiting, matriculation and retention strategies as part of diversity and inclusion efforts (Meeks and Moreland, AMA J Ethics, 2021).
As the authors note, the study population underrepresents women of colour. Future studies should incorporate more diverse DHH patient populations to better understand how effective self-advocacy strategies can be nurtured and taught across various communities. Proactive community-based education strategies can include bilingual education and support in ASL and English, such as community discussion forums and ASL-focused classes and online videos reviewing the spectrum of health from prenatal care to potential postpartum complications. Multi-modal strategies, driven by institutional support, can propel equity in and empower DHH women's access to effective communication, health care and advocacy, and thereby improve health literacy, enhance provider–patient relationships and improve perinatal outcomes.
