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A New Communication Tool to be Used with Hearing-Impaired Parturients to Evaluate and Consent for Obstetric Anesthesia
Abstract Number: 37
Abstract Type: Case Report/Case Series
Introduction: An increasing number of hearing-impaired parturients have presented at our institution recently, requiring a deaf interpreter for the preoperative anesthesia evaluation and obtaining informed consent for labor analgesia. At times this has presented challenges, especially for the parturient arriving after hours or on weekends, as the only official deaf interpreter is not always in-house. An additional challenge includes the variety of sign languages, even within the United States, making it even more difficult to communicate with American Sign Language, as that may not be the variety the patient understands.
Case Example: A deaf primigravida presented to the labor and delivery unit for a scheduled cesarean section for breech presentation. She understood American Sign Language, however had difficulty understanding written English and could not communicate well by writing, while her boyfriend understood a different variety of sign language and therefore could not assist with communication. The patient's Spanish-speaking mother was available by phone so could not interpret. The deaf interpreter was unavailable due to illness; however, we could communicate enough to understand the patient had a history of a congenital heart condition requiring open heart surgery as a child, but we were unable to obtain detailed information, making a safe anesthetic plan quite difficult to formulate. We spent a large amount of time writing in simple terms in order to obtain information pertinent to providing optimal anesthesia care.
Discussion: Communication with hearing-impaired parturients presents a number of obstacles, especially those patients with a history of significant medical/surgical conditions. We have developed a tool that will be useful for gathering pertinent medical information from hearing-impaired patients in a timely fashion, allowing women to receive labor analgesia/anesthesia quickly. This document will also be effective for obtaining informed consent for the anesthesia procedures. The document consists of a section for the patient to fill out upon arrival to labor and delivery, which includes the preoperative evaluation and is written in simplistic terms for easy understanding. An additional section describes epidural and spinal analgesia/anesthesia options, risks, and benefits, including a place for the patient to sign acknowledging her understanding of the procedures. Also included is a section for the patient to write any questions she may have. We anticipate this tool to be quite useful, especially after hours when it is more difficult to quickly obtain deaf interpretation services.