Deaf and pregnant: Live sign language interpreter or video conference for childbirth?

In a controversial lawsuit, a deaf, pregnant woman wants a live sign language interpreter for the delivery of her child rather than a video interpreting interpreting service the Florida hospital plans to use. This article discusses the issues surrounding the case. Specialties Ob/Gyn Article

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  1. Should the hospital provide this woman with:

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      Live sign language interpreter
    • 8
      Remote video conference sign language interpreter

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Deaf and pregnant: Live sign language interpreter or video conference for childbirth?

Imagine being pregnant, deaf, afraid and soon to be delivering your second child. Your first child experienced problems and remained hospitalized for almost 3 weeks.

In a controversial lawsuit, a pregnant woman, who is deaf, wants a live sign language interpreter for the delivery of her child rather than a video conferencing machine, also called a video relay system or video remote interpreting (VRI) the Florida hospital plans to use.

Video conferencing equipment and videophones can be used for direct communication between deaf and hard of hearing people and with their hearing family and friends who know American Sign Language (ASL). They can also be used by deaf and hard of hearing people who do not know ASL, but who benefit from access to visual communication cues, including speech reading (National Association of the Deaf).

The Department of Justice's revised final regulations implementing the Americans with Disabilities Act (title II and III) state "entities are required to give primary consideration to the choice of aid or service requested by the person who has a communication disability. The state or local government must honor the person's choice, unless it can demonstrate that another equally effective means of communication is available, or that the use of the means chosen would result in a fundamental alteration or in an undue burden" (U.S. Department of Justice).

To the disappointment of the woman, it will most likely be a sign language interpreter on a computer screen - instead of a real person by her bedside - who will serve as the sign language interpreter through the birth of her child.

"In a case that may be a first in the nation, U.S. Magistrate James Hopkins issued a report, finding that the woman did not prove that a video conferencing system violates her rights under the Americans With Disabilities Act" (Palm Beach Post).

The woman shared concerns that a machine won't be able to touch her to get her attention when she is screaming or has her eyes closed while in pain. "The VRIs do not work all the time...It's really serious. What if there was something life-threatening that happened during the delivery?" (Hyman, 2015).

In another interview, she stated "A translator stationed at a remote location, being beamed in via video-conferencing technology - is not sufficient..."When I'm giving birth I can't see everything that's going on with a monitor - I have to change position, close my eyes. There are technical problems. That's not effective communication."(Greenfield, 2015)

The hospital's "portable VRI machine is a laptop computer which can fit in small places where an in-person interpreter might not be able to fit". The woman "explains that an in-person interpreter is preferable because during her first childbirth, her interpreter was able to crouch down and kneel on the floor" (Palm Beach Post).

The woman also said "this is not effective communication for a woman giving birth and ultimately a violation of the American Disabilities Act. No one can sit there in labor and just watch a fixed screen.. "You can't do that. It's much better to have a live interpreter that's mobile and can move around. It's a lot more comfortable. They can lean over. They can get in a different spot." (Hyman, 2015)

According to the letter of the law, an in-room translator is not required. The Americans with Disabilities Act (ADA) says hospitals must provide an effective means of communication, but does not specifically state what constitutes "effective".

What are your thoughts about this case? Is this the spirit of the law?

Any deaf nurses who have used sign language interpreters or video conferencing during childbirth?

Can any L&D nurses shed light? How effective are video conferencing/interpreting relay systems?

Any nurses who are sign language interpreters?

Sharing experiences and insight helps us all to grow in our understanding.

References

Greenfield, B. (2015). Why a Deaf Woman Is Suing the Hospital Where She Plans to Give Birth. Accessed on July 16, 1015

Hyman, A. (2015) Hearing-impaired pregnant woman sues Bethesda Hospital, wants interpreter. Accessed on July 16, 2015

Musgrave, J. (2015) Deaf Boynton woman may not get live interpreter during childbirth. Accessed on July 15

National Association of the Deaf. Video Relay Service. Accessed July 15, 2015 Page not found | National Association of the Deaf.

U.S. Department of Justice, Civil Rights Division, Disability Rights SectionAccessed on July 16, 2015 Revised ADA Requirements: Effective Communication

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Donna Maheady

About Donna Maheady

Pediatrics is my love and passion. I am a Pediatric Nurse Practitioner and have been practicing and teaching nursing for over 35 years. I am the founder of a nonprofit organization for nurses with disabilities, www.ExceptionalNurse.com, author of three books and numerous articles about nurses and nursing students with disabilities as well as other topics. In addition, I am an autism mom/warrior and dog lover!

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It's pretty clear the hospital wants to go with the VRI because it's much cheaper. Whether or not she is legally entitled to an in-person interpreter, I don't know, but I do think it's pretty crappy, ethically, of the hospital not to provide her with one when she very clearly feels that that would much better meet her needs. Childbirth is hard and scary as it is! Why not do what you can to make it a tad bit easier for this woman?

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Specializes in Complex pedi to LTC/SA & now a manager.

It's not always easy to secure a credentialed medical ASL interpreter. Just because she was able to obtain one for her first birth does not create entitlement for subsequent births. Kneeling on a hospital floor is just plain gross. A good support person can secure her attention to look at the screen. Video interpreters are not cheap as the interpreter must be credentialed in medical ASL.

Was her first birth with the in person interpreter in the same facility? What if she goes into early labor and her chosen person is not available? At least with the video service there are credentialed individuals on stand by just like with language lines. Seeing invoicing for interpretation services I wouldn't be so certain this is a cost savings measure as much as an accessibility measure

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Specializes in NICU, PICU, PACU.

Does she not have family with her? We do allow family to interpret but the mom would have to sign a waiver that she doesn't want the tele- interpreter.

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Specializes in Pediatrics, developmental disabilities.

Good question...I honestly don't know.

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Specializes in Pediatrics, developmental disabilities.

You raise some great questions and perspectives...thank you!

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Specializes in Pediatrics, developmental disabilities.

I'm not sure of the cost of either one. It probably varies depending on location and availability of ASL interpreters.

I would also add/ask why the hospital wants all of this negative publicity?

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Specializes in Complex pedi to LTC/SA & now a manager.

The yahoo article states that rather than wait for the judges ruling they will provide a live interpreter in this case....so she's getting what she asked for I was able to access the article the mother does not drive. Her first pregnancy she went to a different facility that used a live interpreter (she still runs the risk of one not being available if she has an urgent delivery scenario) and her daughter had a two week NICU stay. Since mom doesn't drive she had to find rides to visit her daughter in the NICU, hence why she wanted to use the facility (it's 20 minutes closer) she's suing for access to a live interpreter.

This isn't a simple case as the mother has additional limitations unrelated to being deaf. Not being a licensed driver with transportation limitations. There is no mention of a spouse/father or family to support her in any of the articles (only pregnant mom & her older daughter in the photos) so her family support (or lack thereof) may exacerbate the situation.

I know she keeps mentioning video response isn't helpful for position changes or if her eyes are closed but there is no guarantee that if there are urgencies that the interpreter can kneel next to her, sign into mom's hand or move next to the mom. Granted the potential is there for a human interpreter rather than a video screen to move around. Overall it's a challenging situation, not unlike someone who speaks no English nor a common foreign language such as Russian, Polish or Slavic. I had a patient who spoke a Slavic language and we had a hard time securing an interpreter that I got permission to call my grandmother who was fluent in Polish or my mom who speaks functional Polish just to get the basics across and offer some reassurance. (My ASL is very basic and my Polish pronunciation is limited). Even in ASL there are "short hand" and idioms used that can be misinterpreted by a lay interpreter.

I know in one facility we were discouraged from using the language line if a staff interpreter was available (before mandates were in place to use qualified, credentialed interpreters rather than a facility qualification) because the cost was hundreds of dollars an hour (more for less common languages like Polish and less for more common languages like Spanish or French). Fortunately my current employer would rather get it right the first time and pay for a language line rather than risk an improvised translation.

I suppose the real winner here would be the one who developed stable, high definition real time technology for video translation services since video/audio/technology quality seems to be a big complaint of the deaf community advocacy groups. (A smart entrepreneur would involve the advocacy groups and potential patients in the technology development).

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In some areas it isn't easy to find a medical ASL interpreter. In our state you have to go through one facility to book them; they supply interpreters to anyone who needs them. I used to work in an office and we had a horrible time trying to get an ASL interpreter to last minute appointments. Legally we had to supply someone but it was next to impossible to get one when we needed it.

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Specializes in Early Intervention, Nsg. Education.

Here's my perspective...

I lost my hearing in 2006 due to aminoglycoside ototoxicity. Unlike the majority of Late Deafened Adults, I chose to return to school and earn Certification in Deaf Studies. I am fluent in ASL and am an active member of my local Deaf community. I use Video Relay Service to make all of my phone calls and am usually happy with the quality and availability of VRS operators. I've also used video interpreters and live interpreters in medical settings. When I'm in a stressful situation and my DH or teenage kids are not around to interpret for me, I am lost without a live interpreter. There are just too many places to look, and if more than one person is speaking , moving, gesturing, even showing reactive facial expressions, I have no clue what's going on.

There's another HUGE issue here: many members of the Deaf community have very low to low health literacy. I work with Deaf adults in Adult Basic Education, mainly teaching English literacy and numeracy, but I do as much as I can to work in as much health literacy as possible. I've talked to certified Medical Terps in great depth, and heard lots of horror stories. For example, a Terp I know professionally accompanied a 40-something yr old Deaf man to a post-op appt. The man had no idea what surgery he had, or why he had it. He was unable to read the pre-op consent forms and post-op discharge instructions...but he was capable of signing his name. Apparently, that was enough.

I had 3 C-sections, so I can't answer this myself: if a woman is in labor, how well would she be able to watch TV and follow the story line? How about skyping to a friend and actually process what they're talking about? Touch is VERY important in Deaf culture. Knowing basic signs is definitely not enough. ASL is NOT like French, Spanish, Russian, etc; people who speak those languages are able to listen to an interpreter, live or over a phone, with their eyes closed. Deaf patients can't do that. Info can only be processed visually and through touch. The Deaf patient's responses are likely to be non-manual signs or gestures/classifiers rather than true signs. (How often do laboring women speak in full, articulate sentences while in labor?)

Certified Medical ASL Interpreters are pricey, but definitely worth it. Hospitals are required to provide all necessary ADA accommodations, not just the cheap ones.

Mercury's Mom, RN

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Specializes in Pediatrics, developmental disabilities.

Thank you so much for sharing so much of yourself and the "lived experience". I learned so much from your post!

What can we do as nurses do learn more about deaf culture?

Does this speak to the need for more deaf nurses?

Are you working as a nurse as well?

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Specializes in Clinical Research, Outpt Women's Health.

It is a very difficult issue.

When i worked in the medical office we had patients who would demand a live interpreter for their visits. The insurance might pay $70 for the visit and the interpreter would cost close to $400.00. Obviously this is not realistic as it cost the practice hundreds of dollars to see this patient.

Ideally I think it would be best for a live interpreter to be present, but who pays? Why do we just assume it is the "cost of doing business" for the care providers?

When we did not provide the service the deaf community would scream and yell at us and treat us horribly. As though we weren't doing it to be hateful. it is a very frustrating situation.

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