Maternity care and occupational therapy support for women with impaired physical mobility during pregnancy, childbirth, and the postpartum period in Estonia
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Midwifery Department, Healthcare Centre, Tallinn Health Care College, Tallinn, Estonia
Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
Occupational Therapy Department, Healthcare Centre, Tallinn Health Care College, Tallinn, Estonia
Publication date: 2023-10-24
Corresponding author
Marika Merits   

Midwifery Department, Healthcare Centre, Tallinn Health Care College, Tallinn, Estonia
Eur J Midwifery 2023;7(Supplement 1):A129
Being a mother is a basic human right and an experience that many women desire regardless of their health status1. All women who decide to become mothers need a support network of family, friends, and a functioning interdisciplinary team2, 3. However, for women with impaired physical mobility (IPM), this experience can be a major social and health challenge in addition to the usual life change. Women with IPM are more likely to miss out on the maternity care services they need, as access to healthcare facilities is difficult. Women with disabilities can only choose between service providers whose facilities are mostly accessible, this limits women's freedom of decision to choose a healthcare professional that suits them4. Several studies have shown that women with disabilities, including women with IPM, do not receive the necessary maternity care from midwives and other healthcare workers, neither during pregnancy nor in the postpartum period5, 6, 4. However, women with IPM may have a higher risk of complications during pregnancy, childbirth, and the postpartum period than women without disabilities7. This is a vulnerable target group that needs more support and counselling from both midwives and occupational therapists. This topic has not been studied in Estonia so far, especially from the context of midwifery and occupational therapy.

The aim of the research:
To analyse the experiences of women with impaired physical mobility during pregnancy, childbirth, and postpartum period in hospital and at home.

Material and Methods:
The research method was qualitative. Semi-structured interviews with women with IPM. Three interviews were carried out among women with IPM aged 37–45 who had given birth in the last ten years. Interviews were recorded and later transcribed verbatim. Qualitative content analysis was used to analyse the transcribed interviews.

Physical environment of health services is a significant problem that requires solutions to support women with IPM in general, as well as during pregnancy and postpartum. For women with IPM, the support network played a major role in starting, growing, and maintaining a family. Interviewees feared negative attitudes from healthcare workers which did not turn out to be true, at the same time negative attitudes were experienced by hospital social and care workers. Women perceived their childbirth experience human centred as they were involved into decisions related to them. Participants perceived a lack of counselling regarding breastfeeding and disability in postpartum. According to women, midwives may need additional training in providing maternity care for women with IPM. During the postpartum period at home, women had a greater need for help in the form of various aids, techniques, and personal assistant. Women IPM emphasized that they would rather need the help of an occupational therapist during the postpartum period, when many problems arise when holding, swaddling, and moving with the baby. There is lack of knowledge among people about the nature of the occupational therapist's profession and service. Women with IPM have a need for specific counselling and information about assistive devices within interventions in occupational therapy to support them during pregnancy and in the postpartum period.

This is the first study in Estonia regarding maternity care and occupational therapy support for women with IPM. The study provides primary information from the perspective of women with IPM and their experiences of pregnancy, childbirth, and the postpartum period. The results of the study highlight the need for an interdisciplinary team to provide sensitive maternity care. Due to the specific nature of disabilities, the target group needs occupational therapy support when using aids. Cooperation between midwives and occupational therapists must also be enhanced to support women more effectively with IPM.

The authors of the study thank the Estonian Union of People with Mobility Disabilities (ELIL) and the study participants.
The study has no conflicts of interest. This study received no specific grant from any funding from the public or commercial sectors.
The study has not received financial support or funding.
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