A woman paralyzed from the waist down, typically due to a spinal cord injury (SCI), can conceive, carry, and deliver a baby. Paralysis below the injury level (paraplegia) affects motor and sensory functions, but it does not stop the female reproductive system from working. Successful pregnancies are common with appropriate specialized care, despite the unique medical complexities involved. This process requires careful planning and close collaboration with a healthcare team experienced in managing high-risk pregnancies associated with SCI.
Conception and Reproductive Function After Paralysis
A woman’s long-term fertility is usually unaffected by a spinal cord injury, meaning the ability to become pregnant remains largely intact. The hormonal axis that controls ovulation and menstruation is regulated by the brain and pituitary gland, a system that remains functional even after the spinal cord is damaged. Following the initial injury, some women may experience a temporary cessation of their menstrual cycle, known as amenorrhea, which typically lasts between three and six months. Once the body stabilizes, the regular menstrual cycle generally returns.
Specialized Medical Management During Pregnancy
Pregnancy in a woman with paraplegia is considered high-risk because it can significantly worsen existing health issues related to the spinal cord injury. These pregnancies require specialized care, ideally managed by a maternal-fetal medicine specialist and a multidisciplinary team familiar with SCI. Pre-conception counseling is important to optimize maternal health before the pregnancy begins.
One serious and unique risk is Autonomic Dysreflexia (AD), a sudden and potentially life-threatening spike in blood pressure. AD generally affects individuals with a spinal cord injury at or above the T6 level. The expanding uterus and developing pregnancy increase the risk of AD episodes because common triggers become more frequent.
Triggers for Autonomic Dysreflexia include irritation below the injury level, such as a full bladder, a urinary tract infection (UTI), or constipation. As the pregnancy progresses, the growing baby can exacerbate these issues, and labor contractions themselves are a powerful trigger for AD. AD symptoms include a pounding headache, facial flushing, sweating above the injury level, and a severe rise in blood pressure. This severe hypertension can lead to stroke, seizure, or death if not managed immediately.
Secondary complications are more likely during pregnancy due to changes in mobility and weight distribution. Pregnant women with SCI face an increased risk for pressure ulcers, or decubitus ulcers, as weight gain and decreased sensation make repositioning difficult. UTIs are a common concern, often being the most frequent reason for antenatal hospitalization. Spasticity, or involuntary muscle spasms, may also increase during pregnancy and require careful management.
Labor, Delivery, and Birth Planning
The process of labor and delivery requires careful planning, often starting early in the pregnancy, to ensure the safety of both the mother and the baby. One significant difference is how labor is recognized, as women with injuries above the T10 level may not feel typical labor pain. The onset of labor may instead be signaled by non-pain symptoms, such as increased spasticity, a change in breathing, or the appearance of Autonomic Dysreflexia.
Women with paraplegia can be taught to monitor for labor by feeling the uterus for contractions, and specialized monitors may be used for surveillance. For those with injuries at or above T6, an epidural or combined spinal-epidural anesthesia is often recommended early in labor. This regional anesthesia is primarily used to block the sensory input that triggers Autonomic Dysreflexia, providing a safer environment for delivery.
A vaginal delivery is often possible and is generally the preferred option, provided there are no obstetric reasons or physical limitations preventing it. The decision to proceed with a Cesarean section (C-section) is typically made for standard obstetric reasons unrelated to the SCI. Physical conditions like severe hip contractures or a small pelvis may also necessitate a C-section. Proper positioning and experienced care can help facilitate delivery, even if the second stage of labor is complicated by spasms.
Practicalities of Infant Care and Mobility
The transition to parenting involves adapting the environment and routine to accommodate the use of a wheelchair. Caring for a newborn while seated presents unique physical challenges, especially concerning lifting, carrying, and maneuvering the baby. Adaptive equipment is often utilized to make day-to-day tasks more accessible.
Specialized equipment is used to manage infant care while seated. Examples include the Gertie Crib, which features outward-opening doors for easy access without lifting the infant over a rail. Changing tables are often substituted with roll-under accessible surfaces to accommodate a wheelchair. A robust support system, including family or professional caregivers, is highly beneficial for managing the demands of newborn care. With the right medical support and environmental adaptations, women with paraplegia can successfully navigate pregnancy and embrace parenthood.