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Pregnancy and SCI by Kelly

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Sexuality, Pregnancy, and Parenting

Pregnancy and Spinal Cord Injury

 

For women, it seems that many of us come to a point in our lives when we feel compelled to procreate. Some women feel the urge before others. Some women put off those feelings for quite some time, before realizing that pregnancy, child birth, and parenting can be accomplished in various situations and circumstances. What I am saying is that you do not need a perfect life to make the decision to have children. If you are waiting for the perfect time, you may be waiting indefinitely.  So, for individuals living with a spinal cord injury, although thinking of carrying a baby and caring for a baby might seem impossible, rest assured, it is very possible, and just like any other woman, you need not give up your work or other life goals to be a parent.  Having a physical disability does not mean that as a woman you will not feel the urge to carry your own baby and, if in good health otherwise, simply having a spinal cord injury does not mean you cannot carry and care for a baby. Ladies, face your fears and read on because I am going to share with you the experience of pregnancy with a spinal cord injury.

 

Wow, no way I am pregnant! Eight months after suffering a spinal cord injury, I found that I was pregnant, and shortly thereafter, I found out I would be having twins. My pregnancy was quite unplanned. However, I have spoken to women with spinal cord injuries who have planned pregnancies and utilized in vitro fertilization to become pregnant. I have personally spoken to one other woman with a C-6 spinal cord injury who carried and gave birth to twins.  She utilized in vitro fertilization to become pregnant. Whether working to become pregnant naturally or through in vitro fertilization or if pregnancy happens quite by surprise, in any case, a few health issues to watch for specific to women with spinal cord injury include:  DVT (blood clots), AD (Autonomic Dysreflexia), and bladder infections.  Most of us women living with spinal cord injury are very familiar with these three particular health issues. During pregnancy, these three issues take on a new dimension because some of the medications we might use on a regular basis to reduce blood clots and/or bladder infections may need to be changed due to pregnancy.  Also, pregnancy may increase the risk of AD because of the changes pregnancy causes in a woman's body and the stress of labor.

 

In my case, shortly after learning I was pregnant, my obstetricians took a urine sample and had it tested by an infectious disease specialist. After testing the urine, taking into account that I was pregnant, the specialist was able to prescribe an antibiotic that was safe to use during pregnancy and would deter bladder infections. Regarding blood clots, I was very lucky that I had not been prone to blood clots prior to pregnancy. However, I did experience swelling of my ankles and feet while pregnant.  Wearing pressure stockings can help, but as some of us might know, they are not easy to get on nor are they pleasant to look at!  Keeping your legs moving is the best possible way to avoid blood clots, so stretching frequently and getting assistance with moving your legs as often as possible is a good way to avoid blood clots that might occur as a result of pregnancy. Finally, my doctors were especially concerned about AD during pregnancy. Thankfully, I did not experience any AD whatsoever during my pregnancy. However, I have read about women who experience AD throughout their pregnancy and during labor.  Autonomic Dysreflexia (AD) is caused by any noxious stimulus below the injury point, and can result in severely high blood pressure, headaches, or even coma, stroke, or death.  Women with spinal cord injury should be especially aware of the increased threat of AD during pregnancy and labor and be particularly watchful. Prior to delivery, arrangements can be made to monitor for the high blood pressure associated with AD.  In my case, my obstetricians and I planned a cesarean section and utilized an epidural prior to surgery.  I was awake for the delivery of my girls.  The delivery went extremely smooth. I credit the smooth delivery to the preparedness of planning ahead, my willingness to assert myself as the major participant in understanding my injury and care, and a willingness on the part of my obstetricians to trust my judgment.  I have read about women with spinal cord injury who have delivered their babies naturally, and I would encourage any woman with spinal cord injury wishing to do so to simply do your research and plan ahead. 

 

My experience trimester by trimester, begins with a very quiet first trimester, except for the morning sickness, which was not exclusive to mornings!  Watching for the issues mentioned above, sometimes the nausea associated with the morning sickness made me dizzy when getting into my wheelchair.  When transferring myself, I made certain I had a spotter present.  Thank goodness, I never ended up on the floor. 

 

The second trimester of my pregnancy included almost weekly trips to the obstetricians for ultrasound monitoring. During this period of time, a concern of my obstetricians was the possibility that my cervix would dilate too soon.  As a means of keeping ahead of such a possibility, the doctors felt it best to check my cervix weekly with cervical ultrasounds.  On a positive note, lots of trips to the doctors kept me active and got me out of the house!   Had my cervix begun to dilate, which happens at times to pregnant women whether spinal cord injured or not, the doctors would have stitched my cervix to avoid dilation leading to premature birth.  However, stitching the cervix is not ideal, as there is a risk of infection.  Also, during the second trimester, some women are placed on bed rest due to concerns of premature delivery or difficulties with respiration (breathing difficulties).  If placed on bed rest, women with spinal cord injury must be diligent regarding positioning and turning, due to the risk of developing pressure sores.  Changes in weight can add to the possible risk of developing pressure sores. Remember, use all your available resources for help and have your obstetrician include skin inspections as part of your prenatal examinations starting in the second trimester.

 

Women with spinal cord injury may suffer loss of respiratory muscle control, which weakens the pulmonary system, decreases lung capacity, and increases respiratory congestion. As a result, it can be more difficult to take deep breaths and cough, increasing the risk for respiratory complications such as pneumonia. With this in mind, in the third trimester, women with spinal cord injury may experience further decreases in lung capacity due to growth of the fetus placing pressure on the diaphragm.  In the third trimester, respiratory problems can be avoided by remaining as active as possible, if on bed rest, regularly practicing breathing exercises, and consulting with doctors to determine if you may need to monitor your breathing function or use the assistance of a ventilator.  Luckily, I did not experience any skin issues or respiratory problems anytime during my pregnancy.  The third trimester, I was much less active, but not on bed rest.  Ladies, let this be an inspiration!  Yet, if you do experience issues or complications, remember, spinal cord injured or not, pregnancy can be challenging.  You will not be pregnant forever, so make needed adjustments and remain strong.  The doctors, nurses, and hospital staff are there to help you. 

 

Finally, we are ready for delivery.  Believe me you WILL be ready to deliver!  I do not think I have ever heard any woman wish to stay pregnant for just one more day, week, month, etc…  However, because my girls were twins, the delivery team did decide to induce labor early.  My girls were small, and remained in the Neonatal Intensive Care for two weeks.  As I mentioned before, the delivery itself went smoothly.  Planning ahead is key.  If arrangements are made in advance, if an emergency should arise, the professionals will have a plan in place and your anxiety can be reduced, which is important for keeping blood pressure in check during labor.  Remember everything may seem overwhelming when the experience is taking place, but try to take time to enjoy and memorialize this special time.  If you are a woman with spinal cord injury, dreaming of pregnancy, birth, and parenting, go ahead and be brave enough to follow your dreams.  Memories fade quickly, so take lots of pictures, write your thoughts and feelings, and share with others the knowledge you gain from your experience.

 

Kelley McKee