PREGNANCY, LABOUR AND DELIVERY

Spinal Cord Injury does not interfere with a woman's ability to become pregnant. The menstrual cycle is controlled by the hormonal systems inside a woman's body and these are unchanged after SCI. Some women notice that their period does not happen for several months after the injury or is irregular for a few months. Generally, these menstrual disturbances are short-lived.

The decision to have a child is a serious one no matter whether you are able-bodied or disabled. If you do not want to get pregnant now or at any time in the future it is important to use [birth control: link to section on birth control]

Having an SCI can mean that the pregnancy is more difficult and results in more lifestyle changes than it would have when you were able-bodied. Going through labour and delivering the baby is also different once you have an SCI.

But... getting pregnant and having a healthy baby can be a part of your life!

Having the healthiest baby possible while keeping yourself well requires a few vital ingredients:

• ? Make sure that you have all the right information and a good understanding of what you will need to do before, during and after the pregnancy.
• ? Make sure that you have a pregnancy support team (doctor, obstetrician, nurse, or midwife) that is also well-educated about spinal cord injuries and the special considerations for pregnancy, labour and delivery with an SCI. You can print out this section and the section on [pregnancy, labour and delivery: link to the professional side content on pregnancy, labour etc] located on the professional side of this site and give it to them to read.
• ? Make sure that your partner or labour support person is well-informed about SCI and labour and delivery, is able to provide comfort to you and act as an advocate when necessary.

When I found out I was pregnant, I was really excited. I wanted to find out everything I could about what to do and what it would take. Also, I wanted to know what my risks were and what were my chances of being able to have a successful pregnancy. And then I thought I would go for it.
--- Sharon

A really important step if you are considering having a baby is to visit your doctor ahead of even trying to conceive. It is important that your bladder and kidneys are functioning well and it is best if you do not have any pressure sores that would be difficult to cope with during the pregnancy. Talking to your doctor about proper diet, vitamins (especially folic acid) and reviewing any medications you may be taking in case they could have detrimental effects on the fetus is also important.

Pregnancy

? Mobility

As the pregnancy progresses your body will get larger and you will be carrying increased weight. This has implications for many aspects of your personal care and mobility. Washing, dressing, transferring and driving may all be affected. It may be helpful for you to begin planning for any additional care you may require or learn about modifications that will make it easier for you to manage these activities.

? Pressure sores

Your increased size and weight can make weight shifts more difficult and increase the pressure on your skin at the same time. Difficulty with your transfers may also adversely effect your skin. You will need to plan to pay special attention to frequent weight shifts, increasing how often you inspect your skin and having good nutrition. When you are in the hospital for labour and delivery make sure you tell the health care team to take special care of your skin and not to leave you in one position for too long a time.

? Bladder management

Many women get more frequent UTI's or bladder infections when they are pregnant because the growing uterus puts increased pressure on the whole urinary system. This can cause increased frequency and incontinence. In addition, your bladder management program may need to be modified - particularly if you are doing self-catheterization (it is quite challenging to reach over a pregnant belly to do this!) Following delivery it may take a period of time for your normal voiding patterns to be re-established.

? Bowel management

The hormones associated with pregnancy can cause an increase in constipation and more difficulty doing your own bowel program (more difficult to reach!) You will need to plan to have lots of fluids and fiber in your diet during the pregnancy.

? Medications

Medications that you may be taking for spasticity may have negative consequences to the baby - both during the pregnancy and when breast-feeding. You should talk with your doctor about the medications that you take, what the specific risks are and how you will manage your spasticity with non-medical means if you decide to stop taking your medication.

? Autonomic Dysreflexia

Autonomic dysreflexia in women with injuries above T6 can occur during pregnancy, labour, delivery and even for a short time after the delivery. If you have ever had dysreflexia you will know what it feels like. If you have not had dysreflexia before but have an injury above T6 please read our information about it. [Link here: link to page on Autonomic dysreflexia] Talk with your doctor or obstetrician ahead of time about managing dysreflexia if it occurs during delivery. When you are in labour, the nurses will probably keep an especially close eye on your blood pressure.

? Breathing

If you have a spinal cord injury in the upper part of your back or neck, pregnancy can put extra stress on your lungs and your breathing. Talk to your doctor to see if you would need to use modifies coughing techniques and/or extra oxygen during the later stages of the pregnancy.

Knowing when you are going into labour

If your spinal cord injury is above T10 it may be difficult for you to know when you are going into labour. There is higher incidence of premature deliveries in women with spinal cord injuries so it is good to be aware of the possible symptoms.

You may notice:

• ? Pain above the level of your injury
• ? Increased spasticity
• ? Bladder spasms
• ? Abdominal or back pains

If you place your hand over your stomach you may also notice strong tightening or extreme hardness of the uterus. Make sure that you call your doctor if you notice any of these symptoms. Some women plan to do regular checks of how hard their uterus so that they can be aware of when labour starts. Your doctor may wish to admit you to the hospital early so your pregnancy can be more closely monitored at this time.

Labour and Delivery

For women with injuries below T10 there may be some pain with labour. In fact, if you have an incomplete injury you may experience all of the sensation of labour. In this case, you will want to talk to your doctor about what pain management methods you can use.

If your injury is above T10 your labour may be pain-free. Where there is a concern about autonomic dysreflexia the doctor may wish you to have an epidural anesthetic anyway, since this is the best method of managing dysreflexia during delivery.

Having a spinal cord injury does not mean that you cannot deliver the baby vaginally. Many women with SCI have delivered babies this way. There is an increased incidence of cesarean sections in women who have SCI and this is something you definitely should discuss with your doctor ahead of time.

After the baby is born

? Breastfeeding

You may need to be shown suitable positions to use when breastfeeding if this is something that you have chosen to do. Using special pillows and slings might be helpful to you.

For women whose SCI is at T6 or above, there may a decrease in your milk production after the first 6 weeks. This is related to a lack of nipple sensation and the interruption of the nerve messages to your spine.