Paraplegia, which is paralysis resulting from a spinal cord injury (SCI), does not prevent a person from having children. The ability to conceive, carry, and deliver a baby is possible for individuals with paraplegia, but it requires specialized medical planning and management. Pregnancy in a mother with an SCI is considered high-risk due to potential complications, necessitating a multidisciplinary healthcare team. With careful prenatal care and awareness of the unique challenges, individuals with paraplegia can successfully become parents.
Impact of Spinal Cord Injury on Fertility
The effect of a spinal cord injury on fertility differs significantly between men and women. For women with paraplegia, the long-term capacity to conceive is not compromised. While the initial trauma may cause a temporary cessation of the menstrual cycle (amenorrhea), this resolves within three to six months following the injury. Once the menstrual cycle and ovulation return to normal, a woman with paraplegia is as fertile as she was before the injury and can conceive naturally.
The situation is more complex for men with paraplegia, as the SCI often disrupts the neurological pathways necessary for ejaculation. Although sperm production itself is usually unaffected, the ability to release semen is impaired. Furthermore, the quality of retrieved sperm is frequently diminished, showing low motility and viability.
Because of the inability to ejaculate, assisted reproductive technologies (ART) are commonly required. The least invasive method is penile vibratory stimulation (PVS), which uses a medical vibrator to induce reflexive ejaculation and works best for injuries around the mid-back (T10-L1). If PVS is unsuccessful, electroejaculation (EEJ) can be used, which involves electrical stimulation of the seminal vesicles and vas deferens under anesthesia to retrieve sperm. Retrieved sperm can then be used for intrauterine insemination (IUI) or, if quality is poor, for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).
Managing Pregnancy with Paraplegia
Maintaining a pregnancy with paraplegia requires careful monitoring by a high-risk obstetrical team to address specific medical risks exacerbated by gestation.
Autonomic Dysreflexia (AD)
The most serious potential complication is Autonomic Dysreflexia (AD), a life-threatening over-reaction of the sympathetic nervous system occurring in injuries at or above the T6 level. The growing uterus, particularly in the third trimester, can act as a trigger by causing pressure or discomfort below the level of injury, leading to an uncontrolled spike in blood pressure. Symptoms of AD include a sudden, severe headache, profuse sweating, flushing of the skin above the injury level, and a dangerous increase in blood pressure. Management involves immediate identification and removal of the trigger, such as a full bladder, a bowel impaction, or a tight piece of clothing. Fast-acting antihypertensive medication may also be required. The pregnant individual must be educated to recognize these signs, as they can be mistaken for preeclampsia, which is a different condition.
Pressure Injuries and UTIs
The physical changes of pregnancy increase the risk of other common issues for individuals with paraplegia. Weight gain and altered posture, combined with decreased mobility, increase the risk of developing pressure injuries (pressure sores). Specialized monitoring, frequent repositioning, and appropriate seating are required to prevent skin breakdown. Urinary tract infections (UTIs) are also more frequent due to the neurogenic bladder and the use of intermittent or indwelling catheters. The growing fetus places additional pressure on the bladder, which can increase the frequency of catheterization needed. If a UTI is not aggressively treated, it can potentially lead to premature labor. Rigorous monitoring of the urinary tract and kidney function is integrated into the prenatal care plan.
Labor and Delivery Considerations
The onset and progression of labor present unique challenges, primarily related to the lack of sensation below the level of injury. Those with injuries at or above T10 may not feel the pain of uterine contractions, leading to the risk of “silent labor” or unattended delivery. Instead of pain, mothers may notice secondary signs such as increased muscle spasticity, changes in breathing, or the onset of AD.
To monitor labor progression, women are often taught self-palpation to feel the uterus hardening during a contraction. For those with limited sensation, obstetricians may begin weekly cervical examinations around 28 weeks of gestation to detect early changes. Continuous electronic fetal and uterine monitoring is standard practice once labor begins.
Vaginal delivery is the preferred method unless there are other obstetrical complications or pelvic contractures. A Cesarean section is reserved for standard obstetrical indications or when AD cannot be controlled. An early epidural anesthetic is highly recommended during labor, not primarily for pain relief, but to block the sensory impulses that can trigger severe AD. The epidural can also be kept in place postpartum to help prevent AD during immediate recovery.
Practicalities of Infant Care and Parenting
The daily logistics of caring for a newborn from a wheelchair can be managed effectively with adaptive equipment and a reliable support structure. Specialized tools and techniques are available to make tasks like feeding, changing, and comforting a baby accessible. Adaptive solutions include chest harness baby slings or wraps, which allow for hands-free carrying and safe transport from a seated position.
A transfer blanket with handles can safely move the infant without requiring the parent to bend or lift. Cribs and changing tables can be modified for height adjustment, such as co-sleeper cots that attach to the side of a bed to facilitate nighttime care. Occupational therapists can provide personalized assessments and recommend durable medical equipment to maximize independence. Minor home modifications, such as ensuring all necessary supplies are within reach, can also simplify the daily routine.
Despite these adaptations, many tasks, particularly those involving significant lifting or standing, require a robust support network. A partner, family members, or home health aides are often necessary in the initial postpartum period to ensure the safety and well-being of the infant.