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

[Donna Maheady]

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

[elkpark]

None. JCAHO has recommendations for medical translators that are voluntarily complied with.

(I know; that was my point -- since another poster was pointing out that VRI isn't federally regulated as if this is something ominous and dangerous.)

[JustBeachyNurse, LPN]

Hospitals are obligated to provide medical translators for a variety of needs, whether ASL, a non-American sign language dialect, or foreign language. There is no mandate nor is it reasonable to have an in person translator on site in the preferred gender 24/7. This is not required by the ADA as a reasonable accommodation and it's ridiculous for anyone to demand that all facilities maintain ASL interpreters on site 24/7.

I'm neither arguing the safety nor reliability of VRI, if anything this case proves the risks and limitations of the system.

Do I think her demands to only provide in person female ASL translators only was unrealistic? I do. Same as demanding translators for her family.

Do I think the hospital risk manager was ridiculous in not only delaying access to an in person translator but also limiting access to an in person translator to 4 hours? Absolutely, and especially in light of the VRI system failing multiple times in a short period of time. It's not like the VRI worked to the satisfaction of the patient for three days and then stopped. It was tried, it failed, based on the facts presented the hospital risk manager was wrong.

The one "positive" of this difficult situation is that many who would never know otherwise now know what a VRI is and the limitations and unreliability of the technology. Perhaps someone with the engineering and technological expertise will be inspired to work with the deaf/HoH community to develop a more reliable and suitable technology that can be used in situations (whether emergent, remote location or otherwise) where an ASL translator is needed but there is a delay in one arriving to the facility.

[mamabennett]

As a deaf expectant mother I have to say that this is THE ONLY thing I'm afraid of.

VRI is definitely a viable option for a generic appointment or a ultrasound screening. I have no issues with this. However birthing a child is COMPLETELY different. I would feel extremely limited through labor. Not only will I have wires and tubes stretched and coming from all parts of my body but NOW I have to sit exactly in one position and keep my eyes open during all aspects of labor? That's just not possible I'm sorry.

I want the freedom to birth my child in a position that is comfortable (as comfortable as I can be) for me. Also, cost is an issue but it should not be the primary issue. Every hospital has a budget for disability accommodations and while the VRI may be cheaper, we are discussing patient access here. When I close my eyes or the VRI stops working...I lose my access.

I know babies don't wait but I'm sorry it's in my file that I'm deaf or at least it should be. My due date is also in my file which means that doctors and nurses can call the interpreting agency and say this is when we expect her to have the baby but can we have a few people on call for a week prior...not at the hospital but a few viable options to call if and when mama comes in. Each situation is different and babies sometimes come in prematurely or very quickly but as long as it can be shown that EVERY effort was made in advance to the birth of the child for the deaf mother and father, I think there is some room for flexibility.

Labor can be very long or very short it's not always predictable...again having a few interpreters available to call for switching when necessary is beneficial. Here's how I think it should go down ready?

Deaf Mama is due in approximately 2 weeks. Nurse/Doctor call interpreting agency: "Who do we have who is qualified for this job? We will need approximately 2-3 interpreters on call" Interpreting agency: "we have interpreters A, B and C who are qualified. A is female, B is male and C is female". Doctor/Nurse: "Thank you, please let them know that there will be a birth occurring in about 2 weeks but they may be called at any time between now and two weeks from now". Interpreting agency: "We will do our best to keep at least one of the interpreters available for your call"

Assuming all goes well, VRI is set up for check in and all the paperwork/necessities before going into the delivery room. Then Interpreter A shows up and is ready to go. There will be a switch in about 2 hours for Interpreter B, and again for Interpreter C....

This is an issue about access, not finances, not whether technology is better or not...it's all about access. I want my interpreter in the room. Maybe I don't want my family in the room with me. Maybe my family can't sign...there are all kinds of issues around this and I really hope that when it comes to my time that I am not limited in my options.

[RiskManager]

Speaking as someone who is both bilaterally hard of hearing since birth, wears two hearing aids, and is a risk manager, this is a fascinating thread. I have not encountered this scenario before. I can say that it can be really darn difficult trying to arrange interpreters to meet the needs of the patient. The interpreters are generally not employees of the hospital, so I cannot mandate their availability, gender or on-call status. Generally speaking, the private healthcare payors usually will not pay for interpreters, or if they do (such as many Medicare payors will), mandate the use of video or Language Line interpreters and will rarely, if ever, pay for a live interpreter. So what this means is that the hospital or clinic ends up eating the cost of interpreters, which usually far exceeds the revenue from the encounter.

I will be interested to keep learning from this thread. Not a lot of easy answers, especially with all the conditions imposed by the patient. Putting on my cynical hat as a malpractice claims manager, I wonder how much of this was positioning for a shakedown settlement.

[JustBeachyNurse, LPN]

As a deaf expectant mother I have to say that this is THE ONLY thing I'm afraid of.

VRI is definitely a viable option for a generic appointment or a ultrasound screening. I have no issues with this. However birthing a child is COMPLETELY different. I would feel extremely limited through labor. Not only will I have wires and tubes stretched and coming from all parts of my body but NOW I have to sit exactly in one position and keep my eyes open during all aspects of labor? That's just not possible I'm sorry.

I want the freedom to birth my child in a position that is comfortable (as comfortable as I can be) for me. Also, cost is an issue but it should not be the primary issue. Every hospital has a budget for disability accommodations and while the VRI may be cheaper, we are discussing patient access here. When I close my eyes or the VRI stops working...I lose my access.

I know babies don't wait but I'm sorry it's in my file that I'm deaf or at least it should be. My due date is also in my file which means that doctors and nurses can call the interpreting agency and say this is when we expect her to have the baby but can we have a few people on call for a week prior...not at the hospital but a few viable options to call if and when mama comes in. Each situation is different and babies sometimes come in prematurely or very quickly but as long as it can be shown that EVERY effort was made in advance to the birth of the child for the deaf mother and father, I think there is some room for flexibility.

Labor can be very long or very short it's not always predictable...again having a few interpreters available to call for switching when necessary is beneficial. Here's how I think it should go down ready?

Deaf Mama is due in approximately 2 weeks. Nurse/Doctor call interpreting agency: "Who do we have who is qualified for this job? We will need approximately 2-3 interpreters on call" Interpreting agency: "we have interpreters A, B and C who are qualified. A is female, B is male and C is female". Doctor/Nurse: "Thank you, please let them know that there will be a birth occurring in about 2 weeks but they may be called at any time between now and two weeks from now". Interpreting agency: "We will do our best to keep at least one of the interpreters available for your call"

Assuming all goes well, VRI is set up for check in and all the paperwork/necessities before going into the delivery room. Then Interpreter A shows up and is ready to go. There will be a switch in about 2 hours for Interpreter B, and again for Interpreter C....

This is an issue about access, not finances, not whether technology is better or not...it's all about access. I want my interpreter in the room. Maybe I don't want my family in the room with me. Maybe my family can't sign...there are all kinds of issues around this and I really hope that when it comes to my time that I am not limited in my options.

Your description sounds very reasonable.not necessarily low cost but most definitely reasonable and realistic. How would you feel if only a make interpreter was available when you went into labor? They can get a qualified interpreter, hospital is willing to do what they can to ensure one is on call but cannot realistically guarantee gender. One of the complaints in this case was that an interpreter was male.

That said my state just approved ASL as a world language as the coursework includes the cultural education. And my local college now offers classes and the exam to become a certified ASL interpreter.

[Donna Maheady]

Good to hear your state approved ASL. I always encourage my nursing students to take ASL.

[JustBeachyNurse, LPN]

I'm trying to get the director of curriculum to coordinate with the local college to offer it at the HS for an option for students like my son who already knows some basic signs but would struggle with a typical foreign language.

Having more non-hearing impairs people understand the culture and language could reduce the potential for misunderstanding and perhaps bridge the gap in scenarios such as this.

I still think the original case was not just about the refusal of an interpreter based on her refusal to even use a male ASL interpreter when offered. Whereas the poster above appears to just trying to ensure that communication during labor goes both ways. When I delivered I didn't care who was letting me know what was going on (I'm not hearing impaired but when they took my eyeglasses on the way to the OR it's hard to focus when multiple people are speaking at the same time) if they were male, female, a drag queen in full regalia (though that would have been an awesome story) I wanted to know my child was safe and well and that I was going to be OK. I definitely have more of an understanding of the limitations of in person interpreters and VRI. Hopefully I can rearrange my own schedule to take the ASL program to expand my knowledge.

[Cbbeatty]

While I am not deaf, I have spent many years around my local deaf community, as well as in school to better understand Deaf culture. I think everyone should read mercymoms post as I feel it is relatable to the deaf also in my community. I heard a story about a man stuck in the hospital with a glitchy Virtual Relay Interpreter who has no clue what was going on. He asked multiple times for an in person interpreter, and the hospital said none were available. When he phoned a local interpreter and a friend in the area, the interpreter reported she had received no calls to come in. This group is repeatedly advocating for their needs and consistently being told they cant have the access they need in the medical field. 

I also have learned that VRI is cheaper and often easier for hospitals, and that it is the nurses and doctors that choose when to turn it off. It is charged by the minute, so typically it is not on as long as the deaf need or want it to be. 

I personally think VRI solves the problem of a FAST fix. This is a great option to insert while the live interpreter is on their way, but overall it is not something that can be a standard choice of access for the deaf.