There’s no reason why SCI women shouldn’t have healthy babies – but there are a few things to bear in mind.
Are you a young woman with spinal-cord injury (SCI), perhaps already married and wanting to start a family? Then this article is for you. SCI does not prevent healthy young women from having successful pregnancies, labour and healthy babies. Journal articles suggest that, increasingly, SCI women are delivering healthy infants. Of course, there are issues to be taken into account. But you don’t need to be put off – you just need to equip yourself with knowledge beforehand, so that you can manage any complications that arise.
First of all, note that SCI does not affect fertility in women. After an acute injury there may be some time – anywhere between a few months to a year or more – where menstruation (amenorrhoea) does not occur. However, when normal monthly cycles return, fertility is unaffected, so adequate contraception is important if you don’t want to fall pregnant.
Probably one of the most serious complications of pregnancy is the potential for autonomic dysreflexia (AD). AD essentially is a life-threatening complication in some SCI persons with a lesion at or above T6, causing dangerously high blood pressures which may lead to stroke. Various stimuli (including pregnancy and breast feeding) can trigger severe AD. It is vital, if you suffer from AD and become pregnant, that a gynaecologist and obstetrician with some insight to AD is advised. Your gynae might never have heard of AD – if so, get them to contact your rehab doctor for advice.
Labour and childbirth can be complicated by AD attacks so they require analgesia – either a spinal epidural or general anaesthesia. Remember too that if you have a high lesion, breastfeeding can trigger AD. Women who have lesions above T6 are generally also unable to breastfeed due not only to AD risk (if present) but also due to the lack of adequate breast milk production due to disturbed autonomic control.
Increased risk of UTI
Pregnancy in an SCI woman carries a higher risk of urinary tract infection (UTI) than for an uninjured woman. For women on intermittent catheterisation (IC), it may become difficult to continue IC due to increasing abdominal girth. In addition, the growing foetus will push on the bladder, reducing capacity and increasing the risk of leaks. An indwelling catheter may be required in the later phases of pregnancy.
Just as the bladder routine may become difficult, so could the bowel regime. The pregnant woman may have to increase laxative use if constipation becomes problematic.
Higher incidence of DVT
The risk of deep vein thrombosis (DVT) for an SCI person is higher than for the uninjured person. Pregnancy in SCI further increases that risk. You should take any lower limb swelling seriously, as a DVT may occur.
As the woman’s weight increases, so does the risk of pressure sores.
In summary, women with SCI are able to fall pregnant and have healthy babies, but there are challenges to consider. Follow up with your rehab doctor as well as a gynaecologist.
Dr Ed Baalbergen is the medical officer at the Vincent Pallotti Rehabilitation Centre (Cape Town) and is a member of the International Spinal Cord Society and the Southern African Neurological Rehabilitation Association. email: email@example.com