When “one instruction at a time” still was not heard

Written By Kieran Simkin

I am an autistic father of three. During the unexpected home birth of my third child, I learned how quickly a communication adjustment can become a safety issue rather than a preference.

We had been preparing to drive to the hospital when it became clear there was no longer time. I called 999. I explained that I am autistic, that too much spoken information overwhelms me, and that I needed one instruction at a time.

I knew what I was asking for. When several questions or directions arrive together, I can lose the sequence. I may be trying to answer the first question while the second and third are already replacing it. In an emergency, that overload does not make me faster. It makes it harder to use the information I am being given.

The communication did not adapt. Questions and instructions kept coming together. I became more flustered and less able to focus on what was happening in front of me.

At one point I was told to fetch towels. I was not told what they were for. I assumed they would be used to clean and wrap the baby after the birth. I did not understand that I was expected to use one to help catch them. When the baby arrived, they slipped through my hands and fell to the floor. (The baby was checked by a health professional and did not sustain any injury)

That is painful to write. I am not sharing it to blame an individual call handler or to claim that one sentence would have made every part of the birth safe. I am sharing it because the most important practical information was absent while other language continued to arrive faster than I could process it.

“One instruction at a time” was not vague. It did not require specialist equipment, a diagnosis document or a long planning meeting.

It was a direct description of what I needed in that moment.

Autistic communication needs are often treated as relevant only when a person appears visibly distressed or cannot speak. I was speaking. I had identified the problem and proposed the adjustment. The fact that I could make the phone call did not mean the standard communication

style was accessible to me.

NHS England’s Accessible Information Standard https://www.england.nhs.uk/accessible-information-standard/) includes autistic people and family members involved in care. It says services should identify, record, share and meet communication needs. Its implementation guidance also says that people should define their own needs rather than having professionals assume them.

An emergency will never be tidy. Staff may have incomplete information and multiple risks to manage. Accessible communication still has practical forms:

- acknowledge the request;

- give one concrete action;

- explain its purpose where that changes how the action is carried out;

- wait for confirmation before adding the next instruction;

- use plain, direct language; and

- check whether the person can still process what is being said.

This experience sits within three births in which I sometimes felt that fathers and birth partners were expected to provide support without being treated as participants. I am not claiming the whole story belongs to me. I can only describe what I saw, heard, did and remember, while protecting the identities and distinct experiences of my partner, children and professionals.

I later wrote a song called Birth Stories (https://kieransimkin.co.uk/birth-stories/) because the memories remained difficult to explain in ordinary conversation. The song is relevant context, but the point is larger than the release: an autistic person who clearly asks for one instruction at a time should receive one instruction at a time.

Accessible communication is not about making an emergency comfortable.

It is about making vital information usable.