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Pregnancy After Spinal-cord Injury

Reprinted from PN May 2012

More women of reproductive age are becoming pregnant after spinal-cord injury.

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Most women with SCI can have healthy babies, even twins, as long as they take appropriate precautions, and prevention is considered key. Unfortunately, because most people with SCI are men, not a lot of research is available on pregnancy and females with SCI. On the flip side, however, because more women with SCI are becoming pregnant and having babies, most of the available research is recent and more relevant.

The decision to have a baby is a very personal one, and it requires you be as knowledgeable on the topic as possible. Of course, due to the risk and complications involved, it is a good idea to consult a specialist before attempting to become pregnant.

The Reproductive System

The sexual anatomy of a woman consists of the uterus (a muscle with nerves of its own), the fallopian tubes, ovaries, urethra, vagina, and clitoris.

The uterus is where the egg travels after it is released from an ovary. After reaching the uterus, if the egg is fertilized by a sperm it implants itself into the wall of the uterus and there grows into a baby. If the female does not become pregnant, the uterine lining sheds and leaves the body in the process known as menstruation.

After initial SCI, women normally stop menstruating from three to 12 months. Once their bodies have stabilized and accepted the changes, menstruation should begin again along with fertility and the potential to become pregnant.

Although each SCI is different and results in varying levels of functioning, SCI usually does not permanently affect the female reproductive system. Once pregnant, the female will go through three different trimesters.

Trimester One

By this point, an obstetrician (OB) should have already consulted along with an SCI physician regarding the pregnancy. This is the trimester where women are at greatest risk for experiencing a miscarriage, so it is important that preventive measures and precautions have been discussed with the OB and SCI doctor.


Other things that might need to be considered are accessibility barriers at the OB’s office, such as exam tables that do not lower or inaccessible offices/exam rooms. Is there a wheelchair or bed scale? As the pregnancy progresses, mobility will become more challenging.

Another thing that needs to be discussed with the OB is level of injury; this will determine whether more extreme precautions are needed. Women with injuries at T10 or above may not feel the early stages of labor, placing them at greater risk for an unexpected or unattended delivery.

Medications should also be discussed and changes made as needed, because some may be dangerous for pregnant women.

During this trimester, the woman, regardless of SCI, might begin to experience hormonal changes, nausea, breast swelling and tenderness, increased urination, changes in appetite, and constipation. If constipation does occur, the woman might need to consult with her OB about increasing fiber and water intake.

Trimesters Two & Three

During the second trimester, weight gain will become more noticeable. As weight continues to increase, mobility devices and cushioning should be reevaluated and readjusted as needed. This will assist in preventing pressure ulcers, as well as allow the baby room for proper movement and positioning.

There may also be discussion of switching to a power wheelchair if added weight is contributing to increased fatigue and decreased range of motion. Transferring might become increasingly difficult with the added weight.

Another risk factor affecting transferring and mobility is hypotension or low blood pressure. Women in the second trimester are more susceptible to low blood pressure, which can result in increased dizziness. This should be taken into consideration when transferring to prevent falls and injury.

Other risk factors that become more prevalent during the second and third trimester include the following:

- Bladder Management: Urinary incontinence may become a problem from the increased pressure on the bladder, as well as urinary tract infections (UTIs). Women with injuries higher than T6 who get a UTI are at greater risk to experience autonomic dysreflexia (AD)—high blood pressure, sweating, flushing, muscle spasms, and anxiety. They might have to switch from intermittent catheterization to an indwelling catheter and should increase fluid intake to flush the bacteria from the bladder.

- Pyelonephritis: If the UTI is left untreated, the infection can spread to the kidney.

- Muscle Spasms: Muscle spasticity will change. It can increase or decrease.

- Blood Clots: During pregnancy, there is increased swelling in the extremities, especially in the legs and feet in someone with SCI. The increased swelling can impede blood flow in the veins and cause a clot to form. Compression hose or range of motion exercises might help reduce the swelling and increase the blood flow.

- Anemia: People with SCI are already at risk for anemia. Pregnancy and ever-changing nutritional needs compound that risk.

- Folate Deficiency: People with SCI are also at risk for folate deficiency (the blood has a lower than normal amount of folic acid, a type of B vitamin), so it is important that it be increased during pregnancy to help prevent major birth defects.

- Respiratory Problems: If a woman’s level of injury is higher thoracic or at the cervical spine, she could experience decreased respiratory function from the baby pressing against the diaphragm.

Labor & Delivery

Although many women with SCI tend to have a higher caesarean-section rate, vaginal delivery is encouraged and quite possible for most.

The mode of delivery is something that should be planned and discussed with the OB prior to delivery. As previously mentioned, for women with injuries at T10 or higher, labor signs may not be detectable.

To be cautious, the OB should start routinely examining these women at 28 weeks to detect any signs of premature labor. After 35 weeks, they should be admitted to the hospital for closer monitoring.

Other signs of labor in women with SCI include changes in breathing and spasticity, backache, pelvic pressure, abdominal tightening, increased anxiety, and AD. Usually, the woman will be given an epidural to prevent AD.

In short, women can and do get pregnant after SCI, regardless of level of injury. Most females with SCI can experience normal labor and delivery and even breast feed, as well as successfully manage the physical demands of pregnancy and parenting.

Contact: PVA Medical Services, 800-424-8200. 

References

National Spinal Cord Injury Association. Reproductive Health for Women with SCI. spinalcord.org

Ethans, K. Pregnancy in Women with Spinal Cord Injury. spinalcord-injury.com

Reyes, M. (2005). Women and SCI. Health and Wellness: Opportunities and Challenges. University of Washington Rehabilitation Medicine.sci.washington.edu

 

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