Experiences of Women of Short Stature during the Perinatal Period

Abstract

Objective:

To explore the experiences of women of short stature, including women with dwarfism and osteogenesis imperfecta (OI), during the perinatal period.

Design:

Qualitative descriptive.

Setting:

Telephone interviews with women of short stature from across the United States

Participants:

Nine women of short stature, including five with dwarfism and four with OI, between the ages of 18 and 55 years who gave birth within the last 10 years.

Methods:

We used reflexive thematic analysis to analyze interview data.

Results:

Four themes represented the participants’ experiences during maternity care: Clinicians’ Lack of Knowledge, Sources of Information and Emotional Support, Clinical Considerations: Effects of Pregnancy and Disability, and Accessibility Barriers and Adaptations. Participants experienced respiratory difficulties and preterm birth. They expressed concerns regarding the lack of clinician knowledge and experience in administering epidural anesthesia to women of short stature and highlighted the important role of disability organizations in disseminating information about childbirth for women with disabilities.

Conclusion:

Childbearing women of short stature require disability-specific maternity care. Our findings highlight the need for disability education programs for nurse-midwives, nurses, physicians, and other clinicians who provide maternity care to women of short stature.

Precis

Disability education for clinicians is essential for the provision of effective, disability-focused maternity care.

Callouts

1. The experiences of women of short stature during the perinatal period are not well understood.

2. The needs of women of short stature during the perinatal period remain unmet, which puts them at risk for poor perinatal outcomes.

3. Maternity care providers need disability education to better meet the needs of women of short stature during the perinatal period.

Throughout history, society has viewed women with disabilities as asexual and incapable of motherhood (Prilleltensky, 2003). However, in a national study to examine pregnancy occurrences in the United States among women with and without disabilities (N = 27,567), Horner-Johnson et al. (2016) reported that after controlling for sociodemographic factors and age, women with disabilities (10.8%, 95% CIs [9.4–12.3]) had comparable pregnancy rates to women without disabilities (12.3%), [11.7–12.9] Physical disabilities include conditions such as cerebral palsy and spinal cord injuries that are associated with mobility limitations and flexibility (Long-Bellil et al., 2017)

Women with physical disabilities experience unmet maternity care needs, such as the lack of adjustable examination tables and accessible weight scales, that compromise their care (Iezzoni, et al., 2015; Mitra, Smith, et al., 2017). In a survey of 126 women with physical disabilities (Mitra, Akobirshoev, et al., 2017), approximately 52% participants indicated the need for more information about the effect of pregnancy on their disabilities, and 65% needed additional information about childbirth. Women with physical disabilities reported that they experienced negative attitudes from maternity care providers and inaccessible care settings that could affect their maternity care and outcomes (Tarasoff, 2017). Compared to women who were not disabled, women with disabilities were at increased risk for gestational diabetes and cesarean birth (Tarasoff et al., 2020) and adverse birth outcomes, including preterm birth (Clements et al., 2020).

Callout 1

Despite a growing body of research on pregnancy experiences and outcomes among women with physical disabilities (Smeltzer et al., 2017; Mitra et al., 2016), the health of women of short stature during pregnancy has not been investigated thoroughly. Short stature is an adult height of 4 foot 10 inches or less (Mayo Clinic, n.d.) and is a key feature of skeletal dysplasia, a broad range of conditions that affects bones and cartilage and includes osteogenesis imperfecta (OI) and dwarfism (Dhilman et al., 2017). The term “short stature” has been used in the literature to refer to individuals with OI or dwarfism (Lange et al., 2016; Ruiter- Ligeti, 2016; Savarirayan et al., 2018). Although not all women with OI have short stature, all the women in our study were of short stature. Therefore, skeletal dysplasia will be referred to as short stature in this article.

According to the National Organization of Rare Disorders ([NORD], n.d.), OI is a genetic connective tissue disorder characterized by fragile bones and fractures. Approximately 20,000 to 50,000 individuals in the United States have OI. Some common features of OI include bone deformities, spine curvature and short stature (National Organization of Rare Disease, [NORD], n.d). Four types of OI exist. Type Ⅰ is the mildest form. Type Ⅱ is the most severe form and includes adverse pregnancy outcomes. Types Ⅲ and Ⅳ range from moderate to severe forms.

In a retrospective cohort study, Ruiter-Ligeti et al. (2016) found that women with OI had significantly greater risk of antepartum hemorrhage and placenta abruption than women without OI, and women with OI were more likely to have neonates with intrauterine growth restriction or small-for-gestational-age than women without OI. Common pregnancy complications include diabetes mellitus, breech presentation, premature birth, fractures (Rao et al., 2021), premature birth and pre-eclampsia (Yimgang et al., 2016). Neonatal outcomes for women with OI include higher rates of low birth weight and neonatal mortality compared to the general population (Rao et al., 2021).

Dwarfism is a genetic or medical condition that results in a short stature of 4 foot 10 inches or less in adults (Mayo Clinic, n.d.). Achondroplasia is the most common type of dwarfism, and it occurs approximately one in 15,000 to one in 35,000 live births (NORD, n.d.). In proportionate dwarfism, individuals have proportionately small limbs and trunks, while those with disproportionate dwarfism lack a proportional trunk/limb ratio. Common features of dwarfism are short limbs and spinal anomalies (Mayo Clinic, n.d.).

In a recent scoping review on complications in dwarfism, Fredwall et al. (2020) found no research studies on pregnancy complications in women with dwarfism, but case reports highlighted anesthesia challenges associated with spinal anomalies, cephalopelvic disproportion that resulted in cesarean birth (Melekoglu et al., 2017), and respiratory complications related to a short trunk and scoliosis (Kawatika et al., 2018). Women of short stature may experience respiratory difficulties as their pregnancies advance because of their short trunks (Kawatika et al., 2018; Savarirayan et al., 2018). Spinal anomalies that result in scoliosis, kyphosis, and a narrow airway may cause challenges to the administration of anesthesia (Lange et al., 2016).

Most researchers who examined pregnancy in women of short stature in the few existing studies focused on individual medical case reports that did not reflect collective experiences (Chamunyonga et al., 2019; Kawakita et al., 2018). Therefore, we conducted this study to explore the experiences of women of short stature during the perinatal period, including women with dwarfism and OL. Our findings could inform strategies to educate and prepare clinicians and improve maternity care for women of short stature.

Methods

Design

Qualitative descriptive studies provide findings that remain close to the data without overstating participants’ experiences (Sandelowski, 2010). Our findings provide straightforward descriptions of maternity care experiences of women of short stature. We adopted the approach to reflexive thematic analysis of Braun and Clarke (2006, 2019). Our goal was to understand maternity care experiences in women of short stature. Our data analysis was influenced by our knowledge of the Perinatal Health Framework for Women with Physical Disabilities (Mitra et al., 2015), which is used to identify barriers and unmet perinatal needs for women with physical disabilities. However, we used inductive coding without a pre-existing coding frame, including a semantic approach, to reflect the explicit narratives of participants (Braun & Clarke, 2006, 2019).

Setting and Participants

We conducted this study with a subset of participants from an earlier, larger qualitative study in which researchers explored unmet needs and barriers to maternity care among 25 women with physical disabilities (Long-Bellil et al., 2017). Participants in the previous study were pregnant women with physical disabilities that affected their mobility and were between 18 and 55 years of age, gave birth within the last 10 years, and spoke English. We recruited primarily through the social media accounts of individuals and disability organizations, email lists, blogs, websites, local community-based organizations, and snowball sampling. Twenty-five women with a variety of different physical disabilities were recruited for the larger qualitative study; this study includes a subset of nine women of short stature, five with dwarfism, and four with OI. The institutional review boards of University of Massachusetts Medical School, Brandeis University, Villanova University, and Massachusetts General Hospital approved the study. We obtained verbal informed consent from the participants. This analysis and the larger qualitative study were conducted as part of a larger mixed-methods study to explore the health needs and barriers to maternity care among women with physical disabilities.

Procedures

For the earlier, larger qualitative study (Mitra et al., 2016) that included the subset of nine women of short stature, investigators developed a semi-structured interview guide based on the literature and a preliminary focus group. The investigators conducted the preliminary in-person focus group with three women in Boston, Massachusetts. The themes from that group helped shape the final interview guide. The three focus group attendees were not participants in the present study. The interview guide included 56 questions and probes that were used to ask women a wide range of questions about their disability, pregnancy, maternity care, accessibility, labor and birth, and postpartum care (e.g., Did you feel the impact of your disability during pregnancy? If so, how? Did your obstetrician/midwife understand the issues related to your disability and how they impacted your pregnancy? Did you have any complications during labor and delivery? If so, how do you think your disability related to those complications? Did you get any special equipment or furniture because of your disability to help you care for your baby? If yes, please describe). Telephone interviews lasted about 2 hours and were conducted by two researchers who were women with a physical disability. We audio-recorded interviews, and a professional transcription service transcribed them.

Analysis

We used a six-phase reflexive thematic analysis (Braun & Clarke, 2006, 2019) to identify patterns of meaning across the dataset related to the maternity care experiences of our participants. To maintain transparency, the first author (S. N.) coded all transcripts because the other three authors acknowledged their prior work with the dataset. In the first phase of inductive coding, the first author read interview transcripts several times to familiarize herself with the data and to capture the participants’ perspectives and experiences. In the second phase, the first author began to identify meaning from the dataset in consultation with the co-authors. We merged codes with similar meanings and their extracts to develop initial codes. In the third phase, we reviewed and merged the codes into potential themes. The first author generated a table of potential themes with their supporting data. To facilitate reflexivity, all four authors met to review and discuss the findings and determined that the potential themes did not capture the specific maternity care experiences of the participants.

Using a recursive and iterative process (Braun & Clarke, 2006), the first author (S.N.) coded the dataset again to address this gap, and we addressed discrepancies among all authors during the discussion and reflection processes. Theme development continued through a reflexive iterative process in which we reviewed themes against the dataset to identify their relationships and ensure consistency (fourth phase). We merged the initial nine themes into four themes and subthemes and described them in detail to reflect a story (fifth phase). In the final phase, we reviewed and wrote the findings to ensure the coherence of the participants’ stories. We used ATLAS.ti 8 software (Scientific Software Development GmbH, Berlin, Germany) for data analysis; the criteria for trustworthiness in thematic analysis of Nowell et al. (2017) guided our coding. Prolonged engagement with participants during the interview process and constant discussions with co-authors during data analysis helped to ensure credibility. Adherence to logical research and data analysis processes helped to ensure the dependability of our results.

Results

The average age of participants at the time of the interview was 34.7 years. Seven participants had given birth to one child, and two participants had given birth to two children. All participants had cesarean births. Six participants gave birth to term newborns (37–38 weeks gestation), and three gave birth to preterm newborns (30–34 weeks gestation). Two participants had miscarriages with their first pregnancies. The ages of the participants’ children at the time of the interview ranged from 4 months to 9 years. Seven participants lived with their spouses and two were single. Eight participants were white non-Hispanic, and one was Hispanic. One participant had a post-graduate degree, five had four-year college degrees, one had some college education, and two had high school or equivalent education.

We generated four themes from the analysis: Clinicians’ Lack of Knowledge, Sources of Information and Emotional Support, Clinical Considerations: Effects of Pregnancy and Disability, and Accessibility Barriers and Adaptations. The four themes and their subthemes reflected the participants’ maternity care experiences.

Clinicians’ Lack of Knowledge

Under the first theme, Clinicians’ Lack of Knowledge, most participants reported that their health care providers did not have adequate knowledge, skills, or experience related to the care of women of short stature during pregnancy. Consequently, participants advocated for themselves by searching for information and being proactive about getting the right maternity care. Some participants shared information with their providers, and one recounted how she informed her obstetrician about the need to have a cesarean birth: “Honestly, [my obstetrician] didn’t [know]. I was teaching her more because… I have done my research… I told her that I have to have a c-section, this is a requirement because all dwarf people have to have a c-section.” Likewise, during prenatal visits, another participant prompted her physician about the need for additional care: “A lot of the time, I had to bring up things. And I just kind of brought up to my doctor like are there options for like an OT consult?” The lack of knowledge among providers made one participant nervous: “At first I was nervous because [health care providers] don’t know anything about OI.”

Eight participants reported a lack of clinicians who were knowledgeable about maternity care for women of short stature. One participant was “dead set on a specialist” who was knowledgeable about her disability. She found an out-of-state specialized obstetrician and described the related challenges:

I think I had to go see about seven specialists in [state] getting written letters stating that it would benefit me. Also, I had to go to court three times in [state]…So the third time I went to court, I had all of this information. Meanwhile, I was progressing in my pregnancy… Six days, it was actually 6 days before the [fetus’s] scheduled birth that the [state] called me to tell me that they approved of [my out-of-state specialist].

Lack of knowledge about maternity care for women with disabilities among clinicians prompted the participants to meet with anesthesia teams to ensure that they understood the effect of the disability on pain management. Participants reported that anesthesia teams were not knowledgeable about the care of women of short stature:

And I forget how many weeks along in my pregnancy I was when we requested to talk to one of the anesthesiologists. But we went on and still wanted to discuss it with an anesthesiologist and get an opinion. And that was kind of disappointing. He came in and we told him that I have OI…and he said, “Yeah, well, I just kind of read a couple of pages about it in a textbook.” So that’s all he knew about OI.

Some participants described their concerns related to receiving epidural/spinal anesthesia given their spinal curvature anomalies. One participant who had a compressed spine expressed the fear of possible complications associated with spinal anesthesia:

I was given the anesthesia in my spinal cord, which they said, that was another thing, that it could be very dangerous for a little person because it could cause paralysis because we have a compressed spinal cord…So with that, you’re putting a needle into the spinal cord, and it could cause a problem, so it was scary.

CALLOUT 2

Sources of Information and Emotional Support

In the second theme, Sources of Information and Emotional Support, limited disability-specific pregnancy information from health care providers made it necessary for the participants to seek information and emotional support from their peers. Participants used different avenues to obtain pregnancy-related information, including disability organizations, peers, and social media. Social media platforms were a way to obtain information and emotional support for the participants.

For the subtheme, Sources of Information, participants described how the lack of relevant maternity care information necessitated the need for them to find information for themselves. Most participants reported that the websites and conferences of disability organizations were their primary sources for pregnancy-related information for women of short stature: “The main source of [pregnancy] information that I found was at OI conferences.” Another participant described how she acquired information related to her pregnancy:

There’s Little People of America, it’s an organization with…over 5,000 dwarves in the group…they have a convention every year…at the convention, they’ll have workshops, meetings about pregnancy, and things like that. And the doctors will tell you all of the information you want, and other people that had babies will give you more information. And just from that organization, I learned everything I need to know.

Likewise, a participant who found pregnancy information from the OI website stated that the information helped her understand “…what can happen to the body [during] pregnancy.”

Four participants described finding information from social media groups of women with disabilities. One participant joined several social media groups and noted the following:

And then there [are] also several Facebook groups that I am in of other women that have OI and have gotten pregnant, and [I] got a lot of advice…I really found out most of that [information] through the Facebook groups and the women that had already experienced pregnancy.

A participant who owned a blog explained, “We own the [blog site], and we like to give as much information as we can to people with dwarfism and to people that will have a child with dwarfism.”

In the subtheme, Emotional Support, seven participants described how they made the effort to seek and receive support from peers with similar disabilities through social media groups. Finding emotional support among their peers gave them hope and helped them embrace their pregnancies. Peer groups provided an avenue for sharing experiences and receiving support throughout pregnancy and the postpartum period. One participant summed up her peer support experience: “One of the best things that I found is that I actually have a really strong support network of other moms with dwarfism.” Another participant who was not sure about the possibility of becoming pregnant found encouragement from her social media peers:

I found Facebook groups and the other women with OI that had successful pregnancies, and some of them were smaller than me. And that kind of gave me the confidence and helped me make the decision to [become pregnant] myself.

Likewise, another participant explained, “It helps to be part of the community, you know? We are very involved with our community, within the dwarfism community, so we share a lot of friends, and we hear a lot of war stories.”

Clinical Considerations: Effects of Pregnancy and Disability

Under the third theme, Clinical Considerations: Effects of Pregnancy and Disability, participants described how their pregnancies affected their disability and vice versa. They expressed concerns about the effects of their specific disability and sought information on weight monitoring, physical discomfort, and respiratory difficulties during pregnancy. These concerns included the need for weight monitoring to avoid increased strain on their bodies during pregnancy. One participant stated, “You have to manage your weight really well too because the heavier you are, and the joints are small, so [the weight has] more impact on your joints.” Another participant recalled the following:

That was some advice that I had been given during the consultations from the [disability] conferences with the [doctor] is that it would not be in my best interest to gain a ton of weight because of just the extra pressure on bones and things like that.

Likewise, another participant emphasized, “I put on roughly 30 pounds with both pregnancies…30 pounds was a third of my weight anyway.”

Participants expressed concern about the early onset of physical discomfort related to the disability: “I became uncomfortable… but [the fetus] took up a good portion of my torso pretty early in the pregnancy.” Another participant stated, “And at this point, at 24 and 25 [weeks], I felt like I was -- I don’t know what 9 months pregnant feels like, but that’s what it felt like.” As the pregnancy advanced, four participants described experiencing shortness of breath:

My lungs did start to collapse there towards the end… I was having a harder time breathing, and [the health care providers] started to look further into that, and they said that [the fetus] was starting to collapse the bottom of my lung. So for many reasons, it was time to get him out.

Based on information gathered from disability organizations and social media groups, the participants became knowledgeable about the need for cesarean birth: “As a little person you don’t have a choice. It’s c-section.”

Accessibility Barriers and Adaptations

In the fourth theme, Accessibility Barriers and Adaptations, nearly all participants reported access barriers in health care facilities and equipment in the prenatal, labor and birth, and postpartum periods. Participants used whatever necessary adaptations they could in the prenatal and labor and birth settings and were able to customize their home environments during the postpartum period to meet their own unique needs.

In the subtheme Barriers in the Prenatal Period, participants discussed barriers they encountered during prenatal visits. Some described the lack of accessible examination tables in physician offices to accommodate people of short stature. Participants found solutions to adapt to their inaccessible surroundings to access care: “[My doctor’s] office is not [accessible] -- it’s not set up for a little person.” Participants described how they used stepstools to get on inaccessible examination tables:

[Getting on an examination table is] a pain in the butt, pregnant or not. And it was hard, and towards the end, the nurses would help me or… I’d get a stool and put a stool next to a chair, put a chair next to the table, and just kind of stair-step my way up there.

Another subtheme, Barriers in Hospitals, represented accessibility limitations associated with standard hospital equipment; participants reported inaccessible hospital beds, bathrooms, and infant bassinettes. During postpartum hospital stays, participants reported that stepstools were essential for accessibility in hospital rooms: “it is different in your hospital room as a person with dwarfism because everything is taller…I had to remember to remind [the staff], I need a step-stool right next to my bed to reach out.” Likewise, another participant stated the following:

So you have to scooch to the edge of your bed, scooch, scooch, you know, do your butt scooch, and then you stand on a chair. Now you have all these wonderful wires attached to you, and you turn yourself around on the chair, and you step down onto a stool. It’s still a pretty far step.

Participants also reported that hospital bassinets were too high: “The biggest accessibility challenge we just had...[was]…those plastic bassinets are so high and not easily accessible.”

In another subtheme, Barriers in the Postpartum Period, participants discussed how they made adaptations to accommodate for their disability during the postpartum period and made various adaptations to meet their needs as mothers in their home settings. For example, one participant described carrying the infant: “She weighed less than a gallon of milk, but I couldn’t carry her very long, not because she was too heavy, but because I wasn’t used to carrying anything.” Similarly, another recalled, “I can carry her into the stroller. I can carry her for a minute but not…for a long period of time…Because my arms are short.” In response, some participants described innovative ways they used strollers to help carry their infant around the house:

But most little people, what they do is they keep a stroller in their house…And when they need to move from room to room, or move the child, or the child stays in the stroller because they can’t carry her.

When participants carried their newborns, they were careful to take precautions to ensure the newborn’s safety. Some described “landing stations” around the house upon which to lay their infants when they got tired:

To have sort of a landing station for the [infant] in every room. So…I mean…depending [on] how much she weighs, I think she’s 10 pounds now…both of [my babies] were [5 pounds 13 ounces] when they were born…I can carry her for…certain periods of time. But I also…have spots in every room that I can sort of…lay her down if I need to.

Almost all participants reported barriers to finding adaptive infant equipment, but they described the innovative ways they made adaptations with help from their spouses or family members: “So a lot of it was trial and error the first time. And again, we had the fortune of being able to afford.” Standard infant cribs were inaccessible and required innovative modifications as one participant recounted:

My dad and grandpa modified the crib for me…and the way they did it is that the front of the crib has two doors that swing open like fridge doors. They put piano hinges down on either side and then some latches in the middle, which has been amazing for me.

The participants also reported challenges in finding accessible changing tables: “I’ve never had any luck, or very much luck, with changing tables for [my child]. They’re often hung way too high for me” and described how they made modifications to changing tables: “We had a changing table, and we had a crib already set up. So the changing table had been actually cut down so it was at height for both [my husband and me].”

Discussion

The purpose of our study was to explore the experiences of women with short stature during the perinatal period. The nine participants, women with dwarfism and OI, offered insights into their interactions with clinicians, the need for maternity care information and accessible health care facilities, and the effect of their specific disability on pregnancy. Consistent with findings from Yimgang and Shapiro (2016), some participants reported respiratory difficulties and preterm birth. We confirmed the unique needs of women of short stature. Our participants articulated the need to monitor their weight due to skeletal and respiratory complications associated with their disability during pregnancy (Savarariyan et al., 2018). There is a need for information and guidelines on gestational weight gain for women of short stature. The Institute of Medicine (Rasmussen & Yaktine, 2009) published guidelines on recommended gestational weight gain during pregnancy; however, these guidelines lack specific information for women of short stature.

Researchers reported that clinicians lack knowledge about maternity care for women with disabilities (Smeltzer, Mitra et al., 2018; Tarasoff, 2017). Almost all of our participants reported clinician’s lack of knowledge about the needs of women of short stature during the perinatal period and the difficulty in identifying clinicians who were knowledgeable about disability. Our findings support the work of Long-Bellil et al. (2017) and Smeltzer et al. (2017) who reported that participants expressed concerns about clinicians’ lack of knowledge and experience in administering epidural anesthesia to women of short stature. Women of short stature may experience complications associated with epidural anesthesia because of spinal anomalies (Lange et al., 2016). Nurse and other anesthetists can benefit from targeted education and the development of practice guidelines that address anesthesia for women of short stature.

In our study, participants highlighted the important role of disability organizations in disseminating information about pregnancy and birth for women with disabilities. Most participants reported that they found useful information through disability organizations and peers that helped them plan and communicate their needs with clinicians, particularly regarding cesarean birth.

Consistent with our study, some researchers reported that maternity care providers acknowledged their lack of formal education and experience in providing maternity care to women with physical disabilities (Mitra, Akobirshoev, et al., 2017; Smeltzer, Mitra, et al., 2018). These findings indicate the need to better educate midwives, nurses, and other maternity care providers to meet the maternity care needs of women of short stature. One learning opportunity could entail collaboration between women of short stature and maternity care providers, which could increase maternity care providers’ awareness of needs during the perinatal period for women of short stature. Another potentially useful educational resource could be the creation of disability-specific online modules for maternity care providers.

Our findings support the need for maternity care guidelines that include women of short stature. Savarirayan, et al. (2018) developed guidelines regarding maternity care of women with skeletal dysplasia to help promote the provision of optimal care; however, they did not include the perspectives of women of short stature in the development of these guidelines. Consumer or patient involvement in the development of clinical guidelines helps to improve the focus on patient-centered care and health outcomes (Armstrong et al., 2018; Guidelines International Network, 2020).

Our findings support the work of previous researchers who reported that women with physical disabilities continue to face disparities in maternity care related to multiple accessibility barriers, e.g., inaccessible hospital equipment (Iezzoni et al., 2015; Mitra, Smith, et al., 2017; Tarasoff, 2017). The burden of accessibility often fell on the participants, who used stepstools and other mechanisms to access examination tables, hospital beds, and bathrooms. These strategies likely put them at risk for falls and injuries. Our findings highlight the persistent lack of adaptive child equipment for women with physical disabilities. Powell et al. (2019) reported that women with physical disabilities received inadequate information about maternity care, support, and accessible child equipment, which necessitated the need for the women to make modifications in their home environments, including child equipment. Leaders in health care institutions should consider modification or replacement of standard hospital equipment to accommodate women of short stature.

Callout 3

Limitations

A limitation of this study is the small sample size of nine women of short stature. We included women with dwarfism and OI but not women of average stature with OI. Our participants were predominately non-Hispanic White women, so findings may not reflect experiences of women from minority racial/ethnic groups. We identified participants through social media and disability organizations; therefore, it is possible that participants were more actively involved in disability organizations and may have different experiences than women without connections to the disability community. Despite these limitations, our results provide valuable insight into the maternity care experiences of women of short stature.

Implications for Practice

Our findings underscore the need for enhanced content on disability in health care curricula. One approach could be the integration of patients with disabilities in simulation laboratories (Smeltzer, Ross, et al., 2018). Midwives, nurses, and other maternity care providers require continuing education programs that address the needs of women with disabilities during the perinatal period. Including women of short stature in the development of practice guidelines could help provide disability-relevant content for maternity care providers. Collaboration between maternity care providers and disability organizations could help identify resources to support women with disabilities during the perinatal period. Weight management programs during the perinatal period could help to reduce respiratory and skeletal problems in women of short stature.

Recommendations for Future Research

Further disability-specific research is needed with larger samples on the needs and outcomes of women of short stature during the perinatal period, including the prevalence of pregnancy among women of short stature and pregnancy outcomes. Results of these studies can advance the development of practice guidelines for women of short stature during the perinatal period.

Conclusion

Our findings highlight the maternity care experiences of women of short stature and demonstrate the need for disability-specific maternity care. To accomplish this, there is a need to have disability-education programs for midwives, nurses, physicians, and other clinicians who may provide maternity care for women of short stature.