Pregnancy Care for Deaf and Blind Patients: Accommodation Strategies

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• Deaf Pregnancy Care and Sign Language Access
• Cultural Sensitivity for Deaf Patients
• Hospital Communication for Deaf Patients
• Visual Impairment and Pregnancy Accommodations
• Service Animals in the Delivery Room
• Genetic Counseling and Inherited Disabilities

Deaf Pregnancy Care and Sign Language Access

Dr. Marc Dommergues, MD, emphasizes that accommodating deaf patients in pregnancy begins with recognizing sign language as a primary mode of communication. He states that the fundamental question for healthcare systems is whether to triage these patients to specialized centers or ensure every hospital can provide adequate care. In his hospital, a system is in place where patients can access a translator anywhere in the facility, ensuring seamless communication during prenatal visits, labor, and delivery.

Cultural Sensitivity for Deaf Patients

Understanding the cultural background of deaf individuals is crucial for providing empathetic care. Dr. Marc Dommergues, MD, highlights a poignant historical context, noting that many in the deaf community were victims of the Nazi Holocaust. This history makes them particularly sensitive to discussions about genetics, a common topic in prenatal care. Furthermore, Dr. Dommergues points out that deaf children often lack access to standard reproductive health education, creating knowledge gaps that obstetricians must address with patience and clarity during pregnancy.

Hospital Communication for Deaf Patients

Effective communication strategies are non-negotiable for quality care. Dr. Marc Dommergues, MD, advises against shouting, a common but futile mistake, and recommends practical solutions like using phones to type or dictate messages. He advocates for hospital-wide systems that support text messaging and video conversations. Employing bilingual staff who are themselves deaf can be an invaluable resource, bridging the communication gap and fostering trust between the patient and the medical team throughout the pregnancy journey.

Visual Impairment and Pregnancy Accommodations

Pregnancy care for blind patients requires a tailored approach to environmental and practical needs. Dr. Marc Dommergues, MD, explains that the medical team must first understand the specific type of visual impairment. This assessment directly impacts how the care environment is organized, including considerations for lighting levels in examination and delivery rooms to avoid discomfort or disorientation for the patient.

Service Animals in the Delivery Room

A key logistical challenge is accommodating guide dogs in clinical settings, particularly the labor and delivery ward. Dr. Marc Dommergues, MD, notes that while this requires forethought, solutions are usually straightforward to implement. Hospitals need clear protocols for managing service animals to ensure they can remain with their owners, providing essential support without compromising sterility or safety during the critical moments of childbirth.

Genetic Counseling and Inherited Disabilities

For certain disabilities, pregnancy care must include specialized genetic counseling. Dr. Marc Dommergues, MD, provides the example of blindness resulting from treated bilateral retinoblastoma, an inherited cancer. He stresses that preconception or early prenatal counseling is essential to discuss the risks of passing the condition to the child. These are complex, emotionally charged conversations that require a sensitive and expert approach, perfectly illustrating where disability care and genetics intersect in obstetrics.

Full Transcript

Dr. Anton Titov, MD: Disability is a very wide issue, but it is common. So what should a woman consider and how to manage pregnancy in women with disabilities? Maybe you could group it by different types of disabilities?

Dr. Marc Dommergues, MD: It's a very important question. The world of disability is an incredibly complex world with very different situations.

If you start with deaf people who speak using sign language, is it a disability? Is it a specific culture? Are they different from, let's say, Chinese people coming to France? Interesting question.

Should they be taken care of by doctors who speak the language? This means a kind of triage and going to special places. Or should they be able to go to any place? I have no definite answer to that. It's a philosophical question.

As far as our center is concerned, we and our hospital have developed for years a welcoming system for people who use sign language. They can go to any place in the hospital and have a translator.

In different departments, there is medical staff who speak the language. For example, in our department, there's a midwife who is rather good at speaking with sign language. She is the one who follows the ladies who use sign language.

She taught us a lot about the culture of deaf people. For example, one is not always aware that they were victims of the Nazi Holocaust. This makes them very sensitive to any genetic discussion.

This is something you have to bear in mind. Another issue is that when you're deaf, it's sometimes difficult to get access as a kid to information on reproductive issues, etc.

It's also important that in a hospital, one knows that if people are deaf, the answer is not to shout at them. This is something you see occasionally.

You can just take your phone and type things or dictate things on your phone and have discussions. At the level of the organization or the hospital, the system of text messages or video conversations, etc., is possible to implement.

Also, it's possible to employ people who themselves are deaf and who are bilingual the other way around. This is something we do here.

Dr. Anton Titov, MD: So probably for deaf people who are using sign language, the most important thing is just to recognize that they're speaking a different language and to adapt ourselves.

Dr. Marc Dommergues, MD: Ideally, of course, to have someone who speaks the language and who can follow the pregnancy or have a translator. This is a straightforward thing. It's not that easy to implement everywhere.

Dr. Anton Titov, MD: There are questions about the best approach. Should people be triaged to a specific hospital?

If we consider visual impairment, again, it is probably important that as a team, we understand what type of visual impairment we are dealing with. What will be the impact of the light? How to organize the rooms?

How to manage dogs? I mean a helper dog—how do we manage the dog? How do we manage with this animal in the labor ward, etc.? These are little things you have to find solutions for. Usually, it's rather easy to get those solutions.

There's also the genetic question. For example, just thinking of a patient, blindness may be the consequence of the treatment of bilateral retinoblastoma, which is an inherited disease.

Dr. Marc Dommergues, MD: Then, if you discuss the pregnancy beforehand, the question of the inheritance of the genetic diagnosis will be raised. It is a difficult issue, of course. But this needs to be discussed.

This is an example where disability and genetics meet together.