Experiences of disabled women during pregnancy, childbirth and early parenting services: implications for occupational therapy

The aim of this study was to understand the experiences of women with physical and sensory disability during their interaction with maternity services. The study was funded by a national charity whose previous research identified that disabled women had more negative experiences than non-disabled women (Birthrights, 2013). This paper specifically discusses implications for occupational therapy. Two-phase, inter-professional mixed methods research was used involving online surveys in phase 1 and narrative interviews in phase 2. Recruitment was through disability and parenting networks and social media. Survey data were analysed descriptively and open questions were themed. Phase 2 telephone interviews were audio recorded, transcribed verbatim and analysed thematically. Although overall satisfaction with care was scored highly in phase 1, negative experiences were described. Key challenges included a lack of continuity of carer; women feeling that they were not being listened to; feeling they were treated less favourably because of disability; and 56% feeling that maternity care providers did not have appropriate attitudes to disability. Interview themes echoed these, when women described implications of not being listened to, including that their judgement about their own bodies was ignored or undermined. The research revealed that occupational therapists did little to support women during this time. While some occupational therapy input was described, this focused on equipment provision. Minimal support with the occupations of parenting was described. The results suggest a clear need for interprofessional working and the need for occupational therapists to liaise between midwifery staff and disabled women

Digitising the acute service based home assessment

Cost improvements and delayed discharges or ‘bedblocking’ are historical, ongoing and topical issues (Gaughan et al 2016). Crucial for many inpatients in the discharge pathway are access and home visits (Marks 1994, Parker et al 2002). Many patients require Occupational Therapy home assessments prior to hospital discharge (Sheppard et al 2010). They are labour and resource intensive (Sampson et al 2014). Clinical practice also suggested that although necessary, arranging and conducting visits can delay discharges. It was hypothesized greatly reducing Occupational Therapists physically visiting homes could significantly reduce the costs to conduct the visits and speed up discharges. A NHS Trust, University collaborative delivered a secure videoconferencing and note taking prototype. Immediate service deployment was inappropriate; consequently an emulation of adapted practice in realistic home assessment settings plus clinician and public consultation regarding the service development is reported. A registered volunteer or relative being the home visitor with a smart phone or tablet and the hospital based Occupational Therapist operating a personal computer. A simple to use videolink allowed the therapist to instruct the visitor and make notes. Therapists evolved draft practice protocols progressively learning from scenarios that were increasingly better home assessment simulations. They also provided feedback for system improvements and obtained information to analyse cost and time savings. Findings: Patients’ discharge could be quicker through an approach offering easier patient involvement in the home assessment. For stroke and wheelchair services there was an estimate of £81,000 savings per year without accounting for reduced bed blocking