Autistic Spectrum Conditions (ASC)

Pregnancy, antenatal care and autism – a starting point for midwives:

Autistic Spectrum Conditions (ASC) present differently in females to males and are often underdiagnosed in women. We’ve worked with Bristol-based charity Auti.Ms to produce this starting point document for midwives and other health professionals supporting pregnant women with Autistic Spectrum Conditions.

Auti.Ms was established in 2019 to raise awareness of the prevalence and presentation of autism in females so that women and girls can be recognised, understood, and supported effectively. We are very grateful for their collaboration to produce this guidance to help ensure that pregnant women with ASC get the best possible care.

It’s important to understand that every individual with ASC will have different personal needs relating to their care, so it’s vital that effective conversations take place to understand the specific needs of each individual. Reasonable adjustments should be made for these expectant parents to maintain a high quality of care, and this document aims to give you some starting points to consider.

• Consider whether these parents may need extended appointment times to ensure there is sufficient time for information to be communicated and understood. Understand and recognise that there may be a need to take breaks or provide space during the appointment to ensure understanding and manage anxiety.
• Try to conduct appointments with parents with ASC in the quietest available parts of the department the appointment is in, as noise can be a real challenge for people with ASC.
• Consider the impact of bright lighting. Bright lighting can be really difficult for people with ASC to cope with, so a more softly lit room may be beneficial wherever possible.
• Be aware of the significance of touch and the sensory impact it can have. People with ASC can often have a very heightened sense of touch and it can be very difficult and uncomfortable for them. Ensure that you inform them if there is a need to initiate physical contact so that they are aware, have understood, and have consented.
• Make sure that you are consistently clear about what you are going to do as a healthcare professional and why you need to do it. This will aid understanding and help reduce anxiety.
• Every appointment requires the building of trust and consistency. Continuity of carer can contribute hugely to this and should be explored for women with Autistic Spectrum Conditions wherever possible.
• Use simple, clear and concise language. Where possible, avoid words that can have dual meanings or can easily be misinterpreted or phrasing not intended to be taken literally, such as metaphors.
• At the initial appointment, take the time to develop an understanding of how you can provide optimal care by asking questions such as “What do you find difficult?” and “What in particular do you need extra help and support with?”
• Eye contact can be difficult for some people with ASCs – ask the question of the person to ensure that you are tailoring your care to their specific needs.
• Verbal communication can sometimes be difficult and cause increased anxiety.
  • Consider having a note pad available for the parent to write things down if verbal communication becomes too difficult.
  • Encourage parents to write down any questions they may have in advance and bring them to appointments.
  • Consider writing down key topics discussed at appointments for parents to take away and fully process later at their own pace and in their own way.
• Facilitate home visits where possible to ensure that the parents are able to conduct their appointment in a space which is safe and familiar for them.
• Ensure partners/family members, etc, are able to attend appointments alongside the parent to provide additional support, to be able to ask questions on their behalf if they are finding things difficult and to absorb the information given so that they can help reinforce it later.

With special thanks

In proud partnership with Auti.Ms