Denise Lawler

Bio: Denise Lawler is an academic researcher from Trinity College, Dublin. The author has contributed to research in topics: Reflective practice & Grounded theory. The author has an hindex of 4, co-authored 6 publications receiving 79 citations.

(Re)constructing Myself : the process of transition to motherhood for women with a disability

Abstract: Aim This paper presents a substantive theory that explains the transition to motherhood for women with a disability. Background Over the last thirty years, interest in exploring women's experiences of motherhood has increased. Extant theories on transition to motherhood originate, primarily, from the perspective and experiences of non-disabled women with few exploring the phenomenon from the perspective and experiences of women with a disability. Those that do tend to focus on issues of accessibility, profiling the challenges that women with a disability encounter while accessing maternity services, attaining a maternal role and fulfilling the requirements of that role. Little is known about the experiences of women with a disability and their transition to motherhood and even less about the relationship of this process on the self. Design The study was conducted using a Strauss and Corbin approach to grounded theory. Method Individual interviews (n = 22) were conducted over 4 years (2008–2012). Women were interviewed during pregnancy and in the postnatal period. All interviews were recorded, transcribed verbatim, imported into Nvivo 8 and analysed using the constant comparative method. Findings The substantive theory that emerged from the study provides a conceptual framework clinicians can reference when counselling, assisting and facilitating women with a disability during their preparation for and transition to motherhood. Conclusion The substantive theory presented in this paper will increase clinicians' understanding of the process involved in the transition to motherhood for women with a disability.

Access to Maternity Services for Women With a Physical Disability: A Systematic Review of the Literature

Abstract: BACKGROUND: Women with a disability are one of the most disadvantaged groups in society. OBJECTIVE: To identify challenges and facilitators to accessing maternity services experienced by women with a physical disability during pregnancy, childbirth, and early motherhood. DESIGN: Literature review. FINDINGS: Challenges to accessibility included location and models of care, transport difficulties, and moving around the environment. Challenges to accommodation (health professionals’ adaptation to women’s needs) centered on lack of suitable health and parent education information. Challenges to acceptability were caused by poor knowledge and negative staff attitudes. IMPLICATIONS FOR PRACTICE: Improving access to maternity services for women with a disability requires improved access to buildings, provision of sensitive antenatal classes, and development of health professionals’ knowledge and attitudes toward disability and pregnancy.

An evaluation of the appropriateness and effectiveness of structured reflection for midwifery students in Ireland

Abstract: Midwifery students undertaking the undergraduate midwifery education programme in Ireland participate in facilitated reflective sessions that aim to develop their skills of reflecting on and in clinical practice. This paper presents a qualitative evaluation of the appropriateness and effectiveness of the facilitated reflection sessions for pre and post-registration midwifery students in two large Dublin maternity teaching hospitals. The aim was to evaluate structured reflective practice sessions which sought to assist midwifery students to become competent reflective practitioners. Group reflection sessions were conducted weekly in a clinical practice area at the same time each week over one academic year. After the series of structured reflective sessions, midwifery students and facilitating staff were invited to evaluate the reflective process. This evaluation consisted of a self-completion survey to identify the factors that facilitated and impeded student participation in the sessions. Respondents answered a series of questions about the reflective practice sessions and were also invited to enter qualitative data regarding their subjective experiences of the process in free text boxes. The data were then collated into themes by an independent reviewer. The results of the evaluation clearly indicate that midwifery students and facilitators welcomed the opportunity to engage in group reflection sessions as a form of peer support and as a catalyst for learning from clinical practice. Findings suggest that reflective practice can contribute to the development of skilled, self-aware and engaged practitioners.

Mothers with intellectual disabilities: interactions with children and family services in Ireland

Abstract: Accessible summary This article is about women with intellectual disability who have children. The article tells the stories of four women with intellectual disabilities in Ireland who have children. It also explains how hard it was at times for them to work with Child and Family Services. Many mothers with intellectual disabilities want to keep their babies. Women with intellectual disabilities who are mothers should be provided with proper support to help them care for their children. Summary Traditionally, women with intellectual disabilities have faced challenges in accessing effective public health services and social service provision during pregnancy and early motherhood. The authors report on the experiences of four women with intellectual disabilities in their interactions with childcare services in the Republic of Ireland. They discuss the women's feelings of isolation, fears of losing their children and the disempowering effects of inadequate, ubiquitous responses adopted by many professionals and services. This study recommends a person-centred, rights-based approach to meeting the needs of these women.

Maternity experiences of mothers with multiple disadvantages in England: A qualitative study.

Abstract: Background Disadvantaged mothers and their babies are at increased risk of poor perinatal outcomes and have less positive experiences of maternity care. Aim To explore the maternity care experiences of mothers with multiple disadvantages. Methods A qualitative descriptive study based on semi-structured interviews with 40 mothers with multiple disadvantages, using thematic analysis. Findings Four themes emerged: ‘A confusing and frightening time’, ‘Longing to be respected as an individual’, ‘The importance of choice and control’, and ‘Needing trust to feel safe’. Mothers brought feelings of powerlessness and low self-esteem to their encounters with maternity professionals, which could be significantly worsened by disrespectful care. They needed support to navigate the complex maternity system. Positive experiences were much more likely where the mother had received continuity of care from a specialist midwife or small team. Discussion and conclusion Mothers with multiple disadvantages value being treated as an individual, making informed choices, and feeling safe, but they may lack the confidence to ask questions or challenge disrespectful treatment. Training and supervision should enable maternity professionals to understand how confusing maternity care can be to very disadvantaged mothers. It should emphasise the need to provide accessible and empowering information and guidance to enable all mothers to make choices and understand the system. Leaders of maternity services need to do more to challenge negative staff attitudes and ensure that that all mothers are treated at all times with kindness, respect and dignity. Specialist midwives can deliver a high quality service to mothers experiencing multiple disadvantages.

Factors affecting access to primary health care services for persons with disabilities in rural areas: a “best-fit” framework synthesis

Abstract: Access to primary health care (PHC) is a fundamental human right and central in the performance of health care systems, however persons with disabilities (PWDs) generally experience greater barriers in accessing PHC than the general population. These problems are further exacerbated for those with disabilities in rural areas. Understanding PHC access for PWDs is particularly important as such knowledge can inform policies, clinical practice and future research in rural settings. We conducted a synthesis of published literature to explore the factors affecting access to PHC for PWDs in rural areas globally. Using an adapted keyword search string we searched five databases (CINAHL, EMBASE, Global Health, Medline and Web of Science), key journals and the reference lists of included articles. We imported the articles into NVivo and conducted deductive (framework) analysis by charting the data into a rural PHC access framework. We subsequently conducted inductive (thematic) analysis. We identified 36 studies that met our inclusion criteria. A majority (n = 26) of the studies were conducted in low-and middle-income countries. We found that PWDs were unable to access PHC due to obstacles including the interplay of four major factors; availability, acceptability, geography and affordability. In particular, limited availability of health care facilities and services and perceived low quality of care meant that those in need of health care services frequently had to travel for care. The barrier of geographic distance was worsened by transportation problems. We also observed that where health services were available most people could not afford the cost. Our synthesis noted that modifying the access framework to incorporate relationships among the barriers might help better conceptualize PHC access challenges and opportunities in rural settings. We also made recommendations for policy development, practice consideration and future research that could lead to more equitable access to health care. Importantly, there is the need for health policies that aim address rural health problems to consider all the dimensions and their interactions. In terms of practice, the review also highlights the need to provide in-service training to health care providers on how to enhance their communication skills with PWDs. Future research should focus on exploring access in geographical contexts with different health care systems, the perspectives of health care providers and how PWDs respond to access problems in rural settings.

Access and quality of maternity care for disabled women during pregnancy, birth and the postnatal period in England: data from a national survey

Abstract: Objectives More disabled women are becoming mothers, and yet, their care is rarely the focus of quantitative research. This study aimed to investigate access and quality of maternity care for women with differing disabilities. Design Secondary analysis was conducted on data from a 2015 national survey of women9s experience of maternity care. Descriptive and adjusted analyses were undertaken for five disability groups: physical disability, sensory impairment, mental health disability, learning disability and multiple disability, and comparisons were made with the responses of non-disabled women. Setting Survey data were collected on women9s experience of primary and secondary care in all trusts providing maternity care in England. Participants Women who had given birth three months previously, among whom were groups self-identifying with different types of disability. Exclusions were limited to women whose baby had died and those who were younger than 16 years at the time of the recent birth. Results Overall, 20,094 women completed and returned the survey; 1958 women (9.5%) self-identified as having a disability. The findings indicate some gaps in maternity care provision for these women relating to interpersonal aspects of care: communication, feeling listened to and supported, involvement in decision making, having a trusted and respected relationship with clinical staff. Women from all disability groups wanted more postnatal contacts and help with infant feeding. Conclusion While access to care was generally satisfactory for disabled women, women9s emotional well-being and support during pregnancy and beyond is an area that is in need of improvement. Specific areas identified included disseminating information effectively, ensuring appropriate communication and understanding, and supporting women9s sense of control to build trusting relationships with healthcare providers.