Whether a paralyzed woman can feel labor pains depends on her specific spinal cord injury. While paralysis implies a loss of sensation, the experience of labor is not uniform for all women with this condition. The body has various ways of signaling the onset of childbirth. Understanding these processes is important for ensuring a safe pregnancy and delivery for women with spinal cord injuries.
Sensation of Labor with a Spinal Cord Injury
The ability to feel labor contractions is linked to the location and severity of a spinal cord injury (SCI). Nerves carrying pain signals from the uterus travel through specific spinal segments. If an injury is located above where these nerves enter the spinal cord, the sensation of pain may be blocked.
Nerve signals for the first stage of labor are carried through the T10 to L1 spinal segments. Women with injuries at or above the T10 level often do not experience sharp, cramping pains. Instead, they might perceive sensations like abdominal discomfort or pressure.
Conversely, women with lower-level injuries below the T10-T12 vertebrae are more likely to have intact nerve pathways. This means they may feel contractions and labor pains similar to women without an SCI. An incomplete injury may also allow for some sensory feedback, even if it is high.
Alternative Signs of Labor
For women who cannot feel traditional labor pains, the body provides alternative signals. One common indicator is the palpable tightening of the abdomen, which a woman can feel by placing a hand on her stomach. Other signs can include:
- An increase in muscle spasms or spasticity
- Changes in breathing patterns or shortness of breath
- Backache or thigh aches (if sensation is present in these areas)
- A feeling of anxiety or general discomfort
- The breaking of water
- A mucousy discharge or diarrhea
Because these signs can be subtle, it is recommended that women with significant sensory loss undergo more frequent cervical checks after 28 weeks of gestation to monitor for premature labor.
The Risk of Autonomic Dysreflexia
A significant risk for women with an SCI at or above the T6 level is autonomic dysreflexia (AD). This condition is an exaggerated reflex response to a stimulus below the injury level. Uterine contractions are a powerful stimulus that can trigger this life-threatening reaction.
The primary symptom is a rapid spike in blood pressure. For an individual whose normal systolic pressure is 90-110 mm Hg, an increase of 20-40 mm Hg can signify an AD episode. Other signs include:
- A pounding headache
- Flushing or blotchy skin above the injury level
- Profuse sweating above the injury level
- Nasal congestion or blurred vision
- Goosebumps below the injury level
For some women, AD symptoms are their only indication of labor. Because uncontrolled high blood pressure can lead to seizures or cerebral hemorrhage, it is treated as a medical emergency. The symptoms can also be mistaken for preeclampsia, another high blood pressure disorder of pregnancy.
Medical Monitoring and Delivery Options
Close medical supervision is standard for any woman with a spinal cord injury during pregnancy and delivery. A collaborative team, including an obstetrician and an anesthesiologist, is often involved to manage the mother’s needs. Continuous monitoring of the mother’s blood pressure and the baby’s heart rate is standard.
Vaginal delivery is often possible and is the preferred option for most women. In some cases, labor may be faster because the pelvic muscles may be more relaxed. An assisted delivery using forceps or a vacuum extractor may be necessary due to difficulty pushing. A Cesarean section is reserved for specific medical complications.
To manage and prevent autonomic dysreflexia during labor, an epidural is frequently recommended. In this context, the primary purpose of the epidural is to block the nerve signals that trigger the dangerous spike in blood pressure, not just for pain relief. This anesthetic can be administered as soon as labor is confirmed.