Women with paralysis can often become pregnant and carry a pregnancy to term. While unique considerations and potential challenges exist, many successfully conceive and deliver babies. This journey requires careful medical management and a multidisciplinary approach to ensure the well-being of both mother and baby.
Understanding Fertility
A spinal cord injury (SCI) generally does not compromise a woman’s fertility. Reproductive organs and hormonal cycles typically remain functional. Ovulation and menstruation usually continue normally, though some women may experience a temporary disruption in their menstrual cycle for three to six months following the injury.
Certain factors can influence fertility, such as specific medications or secondary health complications like severe urinary tract infections (UTIs) or pressure sores that might affect pelvic health. These can often be managed. If a woman with SCI experiences fertility issues, assessment and treatment approaches are generally similar to those for the general population, including ovulation-inducing medications or assisted reproductive technologies. Studies indicate women with SCI have a comparable chance of becoming pregnant through fertility treatments as women without disabilities.
Potential Pregnancy Considerations
Pregnancy for women with spinal cord injuries involves specific medical and physiological considerations. Autonomic Dysreflexia (AD) is a concern, especially for those with injuries at or above the T6 level. This condition causes a sudden, dangerous rise in blood pressure, often triggered by stimuli below the injury level, such as a full bladder or bowel. AD symptoms, including pounding headaches and nausea, can be mistaken for typical pregnancy discomforts, requiring careful monitoring and prompt management.
The risk of urinary tract infections (UTIs) increases during pregnancy for all women, but is higher for those with SCI due to neurogenic bladder and catheterization. UTIs can lead to serious complications like preterm labor, making vigilant management and frequent urine cultures necessary. Bowel management also becomes more complex due to hormonal changes and iron supplements, which can alter bowel routines.
Pressure injuries are another concern, as weight gain and altered body positioning during pregnancy can increase their risk. Regular skin checks, pressure-relieving techniques, and repositioning help prevent skin breakdown. Spasticity levels may also change, potentially worsening due to pregnancy hormones and weight. Medications for spasticity require careful review, as some are not recommended during pregnancy, and alternatives may be necessary.
Mobility and transfers can become more challenging as the belly grows and weight increases. This may require adjustments in transfer techniques, the use of sliding boards, or assistance from others. A thorough medication review is needed to ensure all prescriptions are safe for pregnancy, with adjustments made as needed. Fetal monitoring is also recommended to detect fetal distress, particularly if AD occurs.
Managing Labor and Delivery
Labor and delivery for women with spinal cord injuries have unique aspects, especially regarding sensation. Women with injuries at or above T10 may not perceive labor pain or feel uterine contractions. In such cases, other signs of labor, such as increased spasticity, sweating, or the onset of Autonomic Dysreflexia (AD), become key indicators. Some women may learn to monitor contractions by feeling their uterus or using a contraction monitor at home.
Vaginal delivery is often possible for women with SCI, regardless of injury level, and is generally preferred. Cesarean sections are performed when medically indicated, similar to the general population, rather than solely due to the SCI. Pain management options are available, with epidural or combined spinal-epidural anesthesia often recommended, especially for those at risk of AD. An epidural can help prevent or manage AD during labor.
A specialized medical team, including obstetricians, physiatrists, and nurses experienced in SCI care, is helpful during delivery. This team can manage potential complications such as spasms, AD, and pressure area care. The birthing process may involve assisted delivery methods like vacuum or forceps if needed to expedite delivery or manage AD symptoms.
Postpartum Recovery
Postpartum recovery for women with spinal cord injuries requires continued attention to specific health concerns. Vigilance for urinary tract infections (UTIs) is necessary, as the risk persists after delivery. Pressure injury prevention also remains a focus, with meticulous skin care and frequent repositioning recommended, especially during inpatient stays.
Fatigue can be pronounced, as caring for a newborn adds new physical demands to existing challenges. Adapting to these new routines while managing physical limitations can be taxing. Support systems, including family, caregivers, and rehabilitation services, play a role in assisting with newborn care and the mother’s recovery.
Breastfeeding is often possible for women with SCI, though some may experience difficulties such as decreased milk production due to altered nipple sensation, which is involved in the milk ejection reflex. Strategies like mental imagery or oxytocin nasal spray have shown to aid in the let-down response. Postpartum care focuses on optimizing the mother’s health and facilitating her adjustment to motherhood.