Spinal cord trauma is most often due to accidents and usually involve the Cervical and Thoracic spine. Spinal cord injuries do not prevent conception, but they do increase the risk of other conditions that can have a huge impact on pregnancy. The degree of impact is dependent on the level of injury to the spinal cord.
What Are the Main Concerns for My Baby and Myself?
Fertility is not impaired by the spinal cord injury, and the baby is not affected by your problem and should grow normally. However, pregnancy can further increase the risk of urinary tract or kidney infections (UTIs), which can lead to preterm labor. Your urine should be checked for infection at each office visit or at any time you suspect an infection. If you are already Prone to get UTIs, medication may be started to prevent Urinary Tract Infection. If you intermittently catheterize yourself, you may need to do this more frequently due to the enlarging uterus, increased blood volume, and increased urine production. Self-Catheterization will also become more difficult as the uterus grows and your reach is limited. Urinary Incontinence (uncontrolled urinating) may become a problem and could be confused with the rupturing of your water. If you are unsure about the source of wetness, have this checked by your care provider. Constipation and problems with bowel evacuation programs may occur.
Autonomic Dysreflexia is a neurologic response characterized by a rise in blood pressure, a drop in heart rate, becoming flush above the area of the spinal cord injury, and very pale below it. This can lead to convulsions and an enlarged heart. Autonomic dysreflexia can be triggered by labor, an over-distended bladder, or a urinary tract infection. This problem occurs in women with a spinal cord injury at or above the seventh thoracic vertebra of the spine. The classic symptoms are profuse sweating, pounding headache, blotchy skin, and the small hairs on the skin standing erect. Other symptoms include feelings of anxiety, tremors, nausea, chest pain, shortness of breath, or nasal congestion. Your blood pressure is often elevated, and your heart can race or slow with autonomic dysreflexia. In labor, an epidural can help control autonomic dysreflexia if it becomes a problem. Treating a urinary tract infection or a distended bladder will usually resolve autonomic dysreflexia if they are the cause. High blood pressure medications such as Procardia or nifedipine (generic) may be the first line of treatment for elevated blood pressure.
How Can I Best Care for My Baby and Myself?
Pregnancy should not add any additional restrictions to your lifestyle. Transfers in and out of a wheelchair may become more difficult as the pregnancy advances. As stated before, Intermittent Catheterization becomes more difficult as your uterus enlarges. You may not be able to feel the baby move if your level of injury is too high, but movement can be felt with your hands once the baby is large enough.
You may or may not feel contractions, depending again on the level of your spinal cord injury. This can make it difficult to diagnose term or preterm labor. If you feel your belly tightening or “balling up” more than four to six times per hour, contact your care provider. You may be required to go to the hospital or office to be monitored for contractions.
Labor, Delivery, and Postpartum
Since labor can begin without your perception, your care provider may decide to induce labor. Spinal cord injury does not affect the muscles used in labor, but the muscles used during the pushing stage may not be Functional. The good news is that these muscles are not always needed. Your body may be able to deliver your baby without assistance. Forceps or suction assisted deliveries are also options. Your risk of cesarean section delivery is not increased by your spinal cord injury.
Remind your nurses that autonomic dysreflexia can be a problem during labor. Explain to them that frequent position changes and keeping your bladder from overfilling can help prevent this problem, and let them know your previous symptoms.
“Copyright © 1998 by Denise M. Chism and the RGA Publishing Group. From The High-Risk Pregnancy Sourcebook, by arrangement with RGA Publishing, Inc.”