Knowledge, Attitudes, and Competency about Providing Perinatal Care to Women With Disabilities

Purpose: Women who are disabled (n=8 million) account for approximately 11% of the childbearing population in the U.S. today. Although there are no available population based studies that report incidence and prevalence of pregnancy and birth in this population, smaller studies find that many women who are disabled desire biological children and plan to become mothers. The majority of women with disabilities report a physical disability (51%) followed by mental disabilities (30%) and sensory disabilities (19%). The purpose of this study is to describe the knowledge, attitudes, and perceived competencies about providing perinatal care to women with disabilities by nurse practitioners and certified nurse midwives.

Methods: A 37 item online, anonymous survey developed for the purpose of this study was distributed via SurveyMonkey to the membership of a leading U.S. based Nurse Practitioner organization after IRB review and approval. Eligibility criteria included licensure as an advanced practice nurse/nurse-midwife and current clinical practice in this role. Of the 185 surveys returned, 150 were eligible for inclusion in the final analysis. This represented almost 7% of eligible participants to whom the recruitment email was sent. Surveys with incomplete data were excluded from the final analysis. SPSS version 22 was used to analyze the data. Descriptive statistics were used to analyze demographics and participants’ education and practice histories. Chi-square tests were then conducted to investigate the association between knowledge, attitude, and perceived competency to provide perinatal care to women with disabilities.

Results: Although only 30% of respondents reported receiving didactic information, and 20% of respondents reported receiving clinical experience on providing care to women with disabilities during their academic coursework, a majority of respondents reported positive knowledge, attitude and competency in providing care to this population.There was a significant relationship between professional experience (years of practice and education) and knowledge, attitude, and perceived competency in providing care to women with disabilities. NPs/CNMs who were in practice over 10 years reported greater perceived competency providing care to pregnant women with intellectual (χ² =5.18, n=150, p<.05) or developmental disabilities (χ² =4.14, n=150, p<.05). In addition, NPs/CNMs who received either didactic (χ² =8.81, n=150, p<.001) or clinical (χ² =5.81, n=150, p<.05) education in this area were more likely to feel that they received sufficient education to attain competency in providing care to disabled women than those who reported receiving none of this content

Conclusion: Advanced practice nurses can help bridge the gaps in care and help ensure positive experiences with the healthcare system. Raising awareness about the unique needs of women with disabilities is one step toward ensuring a more positive experience within the healthcare system. Nurse practitioners reported providing perinatal care to women with physical, sensory, intellectual and developmental disabilities. However knowledge about providing care to women with disabilities came through clinical experience, by working with colleagues who share their own experience and knowledge and experiences learning from disabled patients. We recommend the development of formal didactic and clinical education to prepare NPs to care for this population of women.