title: "It's just so bloody hard": recommendations for improving health interventions and maternity support services for disabled women.
abstract: Little is known about the barriers and facilitators to pregnancy, birth and motherhood for disabled women within the New Zealand context. Our study explored this deficit with the aim of improving health care interventions and support for disabled mothers.
  
  
  
  This paper reports on the third phase of a mixed-methods study. The first two phases used semi-structured individual and focus group interviews with disabled women, and health professionals, involved in maternity and postnatal care and has been reported elsewhere. Phase 3 utilised a modified Delphi technique with both groups of participants to seek consensus on the prioritisation of recommendations from the study. This article focuses on the disabled women's recommendations.
  
  
  
  In all, 20 disabled women took part in the Delphi phase of the study (28% of the cohort from Phase 1). In total, 11 key recommendations were identified by the disabled women, with the top seven discussed in detail here.
  
  
  
  Health professionals and health systems could, and arguably should, utilise a matrix of these recommendations to facilitate a review of service responsiveness to disabled women. Implications for Rehabilitation Becoming a mother is a potentially relevant and important rehabilitation issue for women of childbearing age who come into contact with rehabilitation services. Disabled women encounter a range of economic, attitudinal and knowledge barriers in relation to becoming mothers. Centralised sites/sources of information have potential to provide accessible and useful information for disabled women and health professionals.
authors.affiliation: a School of Clinical Sciences , AUT University , Auckland , New Zealand.
authors.forename: Bernadette M
authors.initials: BM
authors.lastname: Guerin
authors.affiliation: b Centre for Midwifery and Women's Health Research, School of Clinical Sciences , Faculty of Health and Environmental Sciences, AUT University , Auckland , New Zealand.
authors.forename: Deborah A
authors.identifier: 0000-0001-6499-4225
authors.initials: DA
authors.lastname: Payne
authors.affiliation: c Department of Nursing, Faculty of Social and Health Sciences , Unitec Institute of Technology , Auckland , New Zealand.
authors.forename: Dianne E
authors.identifier: 0000-0003-0241-8681
authors.initials: DE
authors.lastname: Roy
authors.affiliation: a School of Clinical Sciences , AUT University , Auckland , New Zealand.|d Health Research Council of New Zealand , Auckland , New Zealand.
authors.forename: Kathryn M
authors.identifier: 0000-0003-1240-8882
authors.initials: KM
authors.lastname: McPherson
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003697:Delphi Technique; D006233:Persons with Disabilities / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services / Q000592:standards*; D009035:Mothers / Q000523:psychology; D020380:Needs Assessment; D009520:New Zealand / Q000453:epidemiology; D011181:Postnatal Care / Q000379:methods / Q000706:statistics & numerical data; D058996:Quality Improvement; D012944:Social Support; D016387:Women's Health / Q000592:standards*
keywords: Physical disability; health professional; maternity care; motherhood; qualitative research; sensory disability