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3.3. Pregnancy and Women with SCI

"Pregnancy and Women with SCI" - Professional Level

Date: January, 1998
Developed by: Amie B Jackson, MD and Linda Lindsey, ME


Many women who receive spinal cord injuries are in their childbearing years. Following a spinal cord injury (SCI), there is no evidence that a woman's ability to conceive is affected. Observation has shown however, that women with SCI are usually older when they have their first pregnancy, than their able-bodied counterparts and therefore may have age related fertility issues.

Women with SCI do have unique obstetrical challenges. With increased awareness and support however, these women can have maternal experiences similar to their able-bodied counterparts.

One of the biggest problems reported by women during this time is finding a physician who understands their situation and is willing to learn about their unique bodies. Women with SCI have special concerns regarding the effects of pregnancy on their disability as well as the disability on their pregnancy. Obtaining information and allowing communication between the woman and her physician prepare all for the many changes to come.

Medical Problems for Woman with Spinal Cord Injury

Special ConcernsWomen with Spinal Cord InjuryMedical Personnel
Activities of Daily Living Body changes during last 3 months of pregnancy may affect one's balance, mobility, and ability to transfer. May be an awkward time. Assistive devices, like a reacher, can be helpful. Make needed referrals to occupational therapy and physical therapy as needed.
Autonomic Dysreflexia May occur from fetus growth, pressure sores, or bladder/bowel problems, as well as normal pre-pregnancy causes. Ask doctor before taking any medications. Monitor closely. Use blood pressure lowering medications cautiously. Discuss with delivering physician and anesthesiolgost.
Bladder Management Pressure from growing fetus decreases bladder capacity. If using intermittent catheterization (ICP), may need to cath more frequently. Bladder spasms may increase causing leakage with or without a catheter in lace. May need to change bladder management program during last few weeks of pregnancy. Monitor and make recommendations for changes in bladder management methods.
Bowel Management May have constipation due to increase in size of uterus and pressure on colon. Increase in hormone progestin and use of iron supplements can delay bowel movements. May need to change bowel program. Increase high fiber in diet, Use laxatives as doctor recommends. Increase exercise when possible. Eating more during pregnancy may require more frequent bowel program or use of stool softeners. Review all bowel medications, including supositories, for safety during pregnancy. Encourage diet high in fiber and fluids.
Deep Vein Thrombosis As fetus grows, pressure on the venous return of blood from the legs increases. May cause swelling/edema. In later stages may need to lay down and elevate feet. Elastic stockings may be used. Monitor closely for extremity assymetry.
Medications Keep all medications to a minimum. Examine medications used for spasticity, bladder & bowel management and Autonomic Dysreflexia each trimester. Discuss risks and benefits with the woman.
Nutritional Needs Calcium supplements are important. Anemia may occur, iron supplements usually recommended. Eat foods high in iron. Take pregnancy vitamins. Many need to change diet to suit bowel program Calcium deficits could promote post injury osteoporosis. Find a level of calcium to meet needs during pregnancy and does not increase frequency of urinary stones. Vitamin/iron deficiency delay healing of pressure ulcers and skin breakdown.
Pressure Ulcers More likely to occur since an increase in weight makes pressure reliefs and transfers more difficult. Pay attention to skin where pressure sores may form - sacrum, heels, ischia, elbows. Keep skin clean and dry. Observe skin at check-ups for signs of pressure sores.
Respirartory Capacity Decreases As fetus and uterus enlarge,,it may affect movement of diaphragm. Diminishes capacity of lungs. Predisposes to pneumonia, especially those with tetraplegia. May need regimme of incentive spirometry or other breathing exercises.Predisposes to pneumonia, especially those with tetraplegia. May need regimme of incentive spirometry or other breathing exercises.
Urinary Tract Infection UTIs increase in frequency during pregnancy as fetus presses on bladder, urinary tract, and/or catheter. Limited antibiotics available for use. Drink recommended amount of liquids each day. National Task Force on Sexuality and Disability has a partial lisst of antibiotics to avoid during pregnancy. A few represented are: aminoglycosides, erythromycin, nitrofurantoin, chloramphenicol, sulfonamides, and tetracycline. UTI may cause premature delivery and fetal death in the expectant mother.


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Published by: Medical RRTC in Secondary Complications in SCI
Training Office, Room 506, UAB-Spain Rehabilitation Center
1717 6th Ave. S, Birmingham, AL 35233-7330
(205) 934-3283 or (205) 934-4642 (TTD only) or Email: RRTC

Alternate formats available on request
1998 Board of Trustees of the University of Alabama

This publication is supported in part by a grant (#H133B30025) from the National Institute on Disability and Rehabilitation Research, Dept. of Education, Washington, D.C. 20202. Opinions expressed in this document are not necessarily those of the granting agency.

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