 is now being recorded. So I'd like to introduce everyone to Paulina. Paulina is originally from Poland, came to the UK in 2008. She was a qualified paramedic in Poland and during her training she worked with deaf people and became qualified in Polish sign language. She's a student midwife at the University of Salford. Well she kinda is because she's now on maternity leave as of this week. She was the first student midwife to win a Royal College of Midwife Award and she got the Slimming World Award for Public Health for her Deaf Nest initiative which is what she is speaking to you about today. Paulina was inspired to create the Deaf Nest project because she felt that deaf pregnant women and their partners were not getting the right help and support and the Deaf Nest project provides support and guidance through leaflets, visual aids, quick reference diagrams, flashcards and videos and these are all being made available on her website. So I'm going to just hand over to you Paulina and thank you very much. Thank you Inda for that lovely introduction. Welcome everyone. Today I would like to present you with my presentation Deaf Nest. Improving childbirth and pregnancy experience for deaf parents. And in this presentation I would like to take you on the journey into the deaf parents world and see from their perspective really. Therefore the learning outcomes for this session today are to understand what are the challenges deaf parents face on the journey into the parent world. To recognize that hearing loss is a public health issue. To learn about inequalities people with hearing loss experience when accessing health services. And to introduce you with Deaf Nest project and explain how midwives could contribute in improving maternity care for deaf parents. So for the purpose of this presentation I will use with permission a personal service user accounts from the consultation group for deaf parents that has been organized as a part of Deaf Nest project and has been run in Manchester Deaf Center. And the name of the deaf mother that I used has been changed to ensure confidentiality. So let's walk a mile inside the deaf women's shoes. My name is Amy. I was born deaf and both of my parents are deaf. I attended school for deaf children and I married to deaf partner. Deaf Nest is important part of my social and cultural identity. So on this slide there are a few issues to consider really. First of all I would like to draw attention to the fact that unlike expectant parents with various disabilities, expectant deaf parents like those in any other language minority, commonly hope to have children just like themselves with whom they can share the language, culture and the unique experience. However it is little to recognize that 90% of all deaf children are born to hearing parents. So that's another side of it to consider as well. Deafness and deaf people can be viewed therefore from a social cultural or a medical perspective. The medical perspective defines them as being disabled. However from a social cultural perspective deafness is an important part of the personal, cultural and social identity of a woman and her family and the buddhist sign language is now recognized as a language. So this rise of the social cultural model of deafness defines deaf people with capital D as members of the wider cultural and linguistic minority group and when we spell the word deaf or deafness with a lower case D it's referred to more medical model when we see deaf people as a disabled. Therefore the assumption that deafness and disability are cinemas has been challenged and it's particularly complex in the context of disabled-able binary. Generalization therefore is unhelpful since the empowerment is very individual and manifests itself in emotional, psychological, social and physical dimension of a person life and we should always look at the deaf women as an individual and not make any assumption of how they can perceive their own deafness. I'm pregnant since finding out I'm expecting a baby. I came across so many more barriers. Deaf parents to be do not really have easy access to antenatal information. I can't even book antenatal classes myself. I'm feeling stressed, vulnerable, excluded and low. So it's very important to recognize that even in 21st century there is a group of people very disadvantaged with no access to information and I'm talking about a basic access to information that we are taking for granted every single day. Deaf parents faced considerable obstacles in their journey to parenthood. They are frequently educated below the capacity, employed below the capability and view negatively by the hearing world because they are deaf and that fact that they being viewed, that the deafness being viewed negatively in our society creates them complicated interaction between deaf parents and the hearing professionals with whom they come in contact. Deafness therefore presents additional barriers such as being socially and morally more vulnerable and this is shown in the prison and the most recent research that was undertaken by Sign Health in 2014 and the name of the report is Sikovet where deaf people reported feeling excluded and this franchise by health care system. So they face constant barriers as they try to control their own health and the most recent Saving Mother's Lives report from 2011 has identified the links between social exclusion and vulnerability and adverse pregnancy outcomes. So elaborating this film future it is vital to recognize that any communication barriers may compromise the quality of care we're providing and this is especially relevant when thinking about the importance of obtaining informed consent and ensuring deaf women rights and expectation are met under the Equality Act from 2010. So how do we make sure there is informed consent if there is no access to information and then the interpreter is not always present 20 weeks. This week I have been listing what we need for a baby. I have noticed that recently there seems to be less research and development for products to help profoundly deaf people. There is inadequate response to communication needs of people with hearing loss and evidence shows that the deaf awareness among health care staff remains very low and this is also shown in the survey about access to health care that found that overfair to which stands for 35% of people with hearing loss have experienced difficulty communicating with a GP on nurse. On top of that in connection with deafness and pregnancy there is very little literature available on providing maternity care to deaf parents and I think the last guidebook I have found that provides us information is from 1992 so surely not very evident base anymore and despite those recently available statistics which shows a dramatic increase in hearing loss especially in younger generation deafness and pregnancy are two concepts well we consider together. On top of that there is no accessible information about the antenatal childbirth and postnatal periods for deaf parents containing basic information as the Emma Diaries is not really designed for deaf parents and it's important to realize that most of the deaf people might not even understand English as the British Sun Language is the first language that really depends and that becomes a serious issue because they come to pregnancy and they are completely unprepared. So I'm going to some statistic now and those statistics are mainly from United Kingdom. The action in hearing loss in 2011 estimated that there are 10 million people in the UK recently experiencing some degree of hearing loss and this stands for one in six of the population and by 2031 this number is expected to rise to more than 14 and a half million. Additionally from more international perspective the World Health Organization predicted that by 2030 I'll do onset hearing loss will be in the top 10 diseases burdened in the UK and that stands above diabetes and still deafness in hearing loss is very neglected topic not even perceived as a any public concern and so based on the report on the action of hearing loss from 2011 it pretty much shows that hearing loss is under research then recognized as a public health issue and people with hearing loss have significant unmet clinical and social needs. Moreover there is also failure in the wider society to respond to the communication needs of people with hearing loss and here we have sign health report why do you keep missing me from 2008 that shows that 32% of deaf people find it difficult to explain their health concern and additional 35% leave an appointment not having understood what they have been told to them. Moreover the most recent report produced by sign health from 2014 sake of it shows that 70 a massive 70% of deaf people who hadn't been to the AGP recently had wanted to go but didn't mainly because there was no interpreter and available for them and the NHS Choices website which contains around 900 videos only provides 10 videos out of 900 that are available in sign language that is just over 1% so based on all the statistics and numbers it is really shocking and acceptable to realize that deaf parents are deprived of their fundamental human rights and yet it's true so in response to that really I have created deafness project and deafness project presents a powerful case for change and the project's objective is to meet the challenges that deaf parents face in accessing maternity services and how many women are accessing maternity services where I can't really answer that question because the latest statistic of how many deaf women accessing maternity services has been done 22 years ago and 22 years ago that was 700 deaf women however since 22 years ago the number of hearing people especially the younger population dramatically increased so we can expect increasing that number but there is no research that has been undertaken and no statistic that has been produced so really we don't really know we don't monitor how many deaf parents are there and what are the communication needs and the project also aims to implement the clear guidance to help remove those communication barriers improve their access to information and promote equal participation in the society and the vision is that maternity services where every deaf parent has full access to services an excellent childbirth and pregnancy experience and the information to make informed choices very sadly based on the feedback from the consultation group we perform in Manchester the centre most of the experience of deaf parents has been traumatic ones when they were completely not prepared for childbirth they didn't have a clue what's happening they were relying on the health professional and they were deprived of the basic rights really and you can question informed informed consent and everything that happened really so the project includes components designed to ensure dignity and address the couple's needs in the journey of childbirth so one component of the project was to set up the consultation group in Manchester Deaf Centre to ensure the voice of deaf women and deaf families is heard and this involved communicating and listening to deaf people experience of childbirth and involving them to bring about the change and integral to this is promoting deaf awareness for midwives and other health professional by organizing regular workshops and the conferences and actually the first deafness conference will be held very soon on the 11th of June at the University of Salford and hopefully that will be first but not last event to share and spread the awareness by improving deaf access to information by producing visual aids and leaflets flashcards and videos in British sign language for antenatal interpartum and postnatal education and this will not only contain the basic up-to-date information specific to each stage of pregnancy but hopefully we'll be able to give deaf people the most recent available evidence because if we think deaf people they don't really have basic access to information never mind about the most recent research about cold clamping or you name it really. Finally project 6 to work in collaboration with software engineering and create some innovation and that would be designing a new software to transfer sound of the fetal heartbeat to regional vibration to make that experience a bit more special for them as well. So I truly believe that the implementation of this clear guidance early assessment form effective referral where we can actually measure how many deaf people accessing the maternity services at the moment what are they experience how maternity services are prepared how they're dealing with interpreting services and organizing deafness awareness study days and create support packs for needwifes and other health professionals and with results with ongoing assessment of need improved health and lifestyle choices and greater family involvement. So what's the needwifes role in all of that? First of all there is this perception that we don't really see many deaf women and the deaf women are minority comparing to hearing women we are seeing every day but that doesn't mean they should receive you know less care that the hearing hearing women do. So first of all strongly the midwife should be sensitive to woman's own view of herself as either having a disability or as being a member of particular cultural minority group this being disadvantaged by her deafness. So it's important to know if the lady was profoundly deaf or if she become deaf later on in her life if she what kind of use of communication she's using it will be completely different approach with a British sign language user or someone with knee breathing as I say 90% of children on board to hearing families that creates additional challenge how they perceive themselves if they want to fit more in hearing world because all the families hearing possibly friends are hearing or are they more attached to deaf community itself. Another thing it's important to understand that it is in fact external restraints which excludes the individual from full participation in society therefore it's absolutely vital for the midwife to consider any external factors and work towards improving the standard of care provided to deaf couples on the journey to parenthood and this is achieved by an early assessment of the women needs which is in aspiration and so really understanding disability or empowerment is the key to providing positive pregnancy care experiences alongside a supportive attitudes. Moreover a careful thought should be given to working in a partnership with other professionals and voluntary organizations now we should be more aware what kind of organizations are out there and while you start looking actually realize there are quite a few that we could use and they could actually support and obtain equipment or even provide interpreters so and that join up care for the anti-natal in an apartment post-natal periods by an integrated movies team it's particularly important in order to provide midwifery care of the styler to the individual needs but also it's very important in decreasing risk so this perspective in relation to deafness leads us to use of professional interpretation services as highlighted in the latest CMA report midwives must ensure the presence of a british sign language interpreter to allow to allow the woman to fully access to information available to them and actually speaking with one lady on the consultation group when we ask her what would be the most important thing midwife should do when working with with the family she replies should make sure the interpreter is on the way that's the one thing that that she will find very useful because if we think about the presence of interpreter it's really crucial to interpreter and findings communicate any concerns a couple may have and most of all to ensure informed choice and confidentiality and we should be never using family numbers to interpreter for the for us so what we're doing there if the interpreter is not present in all labour it's very unexpected it may happen every any day of the week and time of the day and that creates additional challenge and I think interpreters service are not really didn't find the proper way to address that issue yet so midwife needs to be not innovative in enhancing their communication skills and midwives can learn sign language and I'm not talking about becoming fully qualified interpreter but the basic signs while waiting for the interpreter might be a lifesaver finally there need to be more awareness among midwives about caring for their women and not feeling awkward and knowing what to do that that's why the one of the component of the deafness project is to create deafness packs that will be available in trust and will provide a very simple quick reference guide of what to do once the family arrives in maternity unit and it will give you some ways of communicating values of flashcards and other resources so really the challenge is not only to see which women as individual but also be aware of the impact empowerment may have on her life this concerns the importance of taking a positive approach to the pregnancy where emotional support is important as practical one and in fact the midwives need to integrate the model of care with the vision represent by the six this care compassion competence communication college and commitment so for more information and about deafness and more recent statistics and deafness in pregnancy I put a few website there you can go and access and download some documents for free and in conclusion I hope this presentation has given an account of some of the factors that influence the physical emotional social well-being of deaf child-bearing women and from outset I aim to demonstrate the principles of midwifery kind providing women center and holistic care are used to women's individual needs and as I said before unfortunately there is very little territory available and providing maternity care to deaf women and their families and the lack of that literature suggests that deafness and pregnancy are too conceptually considered together and the deaf word in providing in relation to pregnancy is until now and there is no one to promote and protect its values and views accept deaf people themselves additionally deaf women and hearing impaired mothers are very small minority among the many thousands of hearing mothers that we do I see every day despite that however the month is no less urgent because it's not widespread after all each mother is an individual and need less methodical accordingly and there are some references and if you would like a full a reference list and please let me know I'm more than happy to share and thank you thank you very much Paulina can you okay yes yes good good good right so do we have any questions from the floor and yes I agree with everything that everybody else has been saying that was a fantastic presentation such an interesting power point set of power point slide Karen to now Karen to do you want to take do you want to ask your question oops she's staining her hand back down again I'm just wondering if the Karen too wanted to actually ask her question or type it I'd like to be an accent yes I agree Gina saying that you know this is really good and you're amazing doing all of this as well as working hard as a student and I would agree I would add being pregnant as well when is your baby due Paulina now second of June almost there my goodness have you personally met up with a lot of deaf people um I don't know that you protect I don't know what to use really um deaf people as you as a student midwife and as a student midwife actually had two ladies in my caseload that were hard of hearing and they had to come here and cut the influence so they could they were relying on leap reading but that presented additional challenges because if you think about the child birth you tend to close your eyes you tend to kind of be on your own zone especially on the transition stage so really really hard and to communicate with those ladies um yeah but other than student midwife I finished British someone which course before I started the degree so I was meeting within the deaf community and it's very interesting to see them as a cultural minority really rather than being disabled as most people will will you know will see them I'm quite sure they would be pleased to meet up with you someone has asked the question compared to women who have language other than English in the UK how do the needs of deaf women differ so is that if they are not speaking if this not English is not the first language and they're speaking different language yes what's the difference between someone with a different language as the first language and deaf women well I can relate I can relate to that because I'm Polish yeah I was thinking that yeah and I did say Polish ladies as well that they they cannot speak English and it is different because if you think about the deaf deaf people they have completely different needs communication needs they are not aware of the noises around them as I said that they are closing their eyes and they are kind of really really hard to reach you have to really consider your body language use of touch as well not necessarily a good idea more all the time where with someone who doesn't speak the English but it still has language it's easier it's easier to communicate it's easier to obtain the translation services over the phone you can use a google on your computer it's not so easy with with with your sign language and interpreters it's not enough interpreters in the country and normally what happens is for appointments you have to book in advance but for the labor there is you know you cannot book in advance because you don't know when it happens so it's more deafness presents much more challenges and also because it's seen from both perspective being disabled or belonging to a cultural group you have to be very sensitive of how women and their families perceive themselves you have to be very sensitive when you know the babies are given hearing tests because for them it might be not necessary a bad thing if the baby is deaf so there's many many issues associated with deafness I would say and more than more than someone who has speech and can speak their own language that's a good few points there's another question there is my language different in different countries oh yes yes it's different it's it's even different across the UK apparently if you go to Liverpool you'll have different signs I'd know about that but yeah it's very different but I was reading something very interesting recently that apparently if three deaf people meet from different countries so let's say they will be English Polish and Spanish they are more likely to get some conversation and understand between three of them in British sign language that they would within the languages they were speaking so I guess it's all about body language and you can kind of know read some of it but it'd be for the sign that different sorry I turned myself off to the top do we have any other questions for Paulina any experiences you wish to share Chris says he's seen something about language generally which described about how for people who are deaf from birth the sign language evolved like a spoken language Ruth is asking if there are enough British sign language interpreters so can you repeat that question Ruth is asking are there enough British sign language interpreters now that's the problem never seems to be enough interpreters and in terms of maternity services there is no right system in place to ensure there will be an interpreter available for when the baby is born when the lady is labored just because you know you don't know when the baby will come and there is short notice when they try to find an interpreter so it may happen that all of them are booked and you just have to wait until one available until one is available therefore I really think that if we have some deaf awareness basic deaf awareness and if we have these basic ways of communication and basic signs for health that will make massive difference you know for your for you as a midwife being more confident to to provide that care but also for the lady and the families because as them to see them through the comments and if someone is profoundly deaf and it belongs to that deaf community they more likely to have deaf partner as well so you are more likely to have to work with with deaf women and the partner yeah Clara Montt wants to know if you think that all student with wives should be taught British sign language I think definitely a basic British sign language including basic health signs and deaf awareness should be part of midwifery curriculum and over three years I think we easily find the time to do that and I think you know student-midwives would would like to do that and yeah so definitely yes I think you're quite right it's the students who are usually most enthusiastic about something like that isn't it yeah exactly in your deaf nest website resources do you have things there that people can download that would maybe help them if they were looking after a woman who was there during labour yes so deafness deafness them website is still under construction and we are kind of in process of preparing different resources and all the resources that will be produced by deafness project will be available on the website both to go and see on youtube or to download as a pdf file and so yes so there will be more resources coming and as I said recently working on a conference which is really time-consuming and it's only for a week deadline now so but yeah but there will be more coming both for midwives and for deaf parents and hopefully we'll create a deafness pack as I said that will be available across UK and in each trust so when that family arrives all you do which is open the pack and then you can use this information and hopefully feel less anxious that sounds fantastic are you going to manage to do this conference before you have this baby yes well yeah I've been asked this question a lot of time and the only thing that can stop me not coming on the conference is if I'm in the second stage of labour so hopefully hopefully that will not happen and I'll be able to attend it's going to be a great day and I really don't miss it very can you read the chat room at all yes yes there's a very interesting comment made by Kerry Anne at the bottom yes yes I think I think it's an important issue as well because you have to think like if they're using sign language or even if it isn't reading then it's a proper light how you position yourself as well it's important how you position the light it's important you have to consider you know a few things there I think you've introduced some great ideas here and we all wish you the very best with your imminent birth and we hope you have a lovely natural birth and all the rest of it as you would expect and thank you very much then Paulina for coming and speaking up today and you all know now to go and look for this and your website is on the wiki so we'll all be able to go and have a look I noticed that someone's already had a look and says it looks great so thank you Paulina very much indeed thank you very much Linda and thank you very much to our participants lovely experience really to that presentation well well done thank you sorry one coughing and splutton all over the place here I shall just run through the final few slides for everybody oh I need to remember to turn off the board which I will now do my computer's running a wee bit slow so please bear with me I might have to change computers in a minute