Improving communication in pregnancy: a neurodivergent-responsive approach.

Abstract

Communication, informed consent, and patient cooperation in obstetrics often occur under significant time pressure, particularly on labor and delivery units where delays can directly affect maternal and fetal outcomes. Standard communication approaches assume uniform information processing, which may not apply to patients with neurodivergence, including autism spectrum disorder, attention-deficit/hyperactivity disorder, and related sensory processing differences. These differences are common, frequently unrecognized in pregnant women, and can become clinically consequential during key transitions in care. This Clinical Opinion presents a neurodivergent responsive framework for obstetric practice that emphasizes early identification of communication and sensory processing differences during prenatal care and translation of these needs into actionable intrapartum strategies. The approach is grounded in qualitative evidence and established communication principles, recognizing the current absence of robust outcome-based data. Practical adaptations include the use of plain and concrete language, stepwise information delivery, written reinforcement, teach-back, advance warning before physical contact, and structured involvement of support persons. A central component is the development of a brief communication care plan, distinct from a birth preference document, designed to ensure that communication needs are visible and actionable across care transitions. These adaptations are applied across prenatal counseling, admission, intrapartum decision-making, and postpartum discharge, where failures in communication may lead to delayed consent, reduced tolerance of monitoring or procedures, and misunderstanding of discharge instructions. Because these strategies align with established patient safety principles and benefit a broad range of patients, their implementation represents an extension of standard obstetric care. This framework offers a pragmatic approach to improving communication, consent, and patient experience in contemporary obstetric practice.