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3.4. Pregnancy after SCI: A Story of Two Women
Pregnancy after SCI: A Story of Two Women
by Shirley Estill
Having children is a dream that starts at childhood for most women. Maternal instincts are usually strong, and the desire to have children often becomes a top priority in life.
As a woman with spinal cord injury (SCI), you are likely to want to have children. Only now you may think that you cannot become pregnant or that your body cannot handle a pregnancy. You may feel that you can no longer perform the duties of a parent because of your physical limitations after injury.
However, the truth is completely opposite. Women with SCI have children. They are fully able to become pregnant and manage the physical demands of pregnancy and parenting.
When Angeline decided to have a baby in 1968, no one knew what to expect. At the time there was very little information available on SCI and even less on pregnancy after SCI. But that did not stop Angeline. She had always figured out ways to accomplish her goals. "I was so naive back then," Angeline recalls. "I didn't worry about things that I couldn't control. I lived my life from day to day and did everything I wanted. My family encouraged me. We lived by the philosophy that life goes on, and we'll do what needs to be done."
After Angeline graduated from college, she decided to marry Don, who is now her husband of 35 years. "We didn't talk about my disability or about having children. We just knew that we were in love and wanted to get married." When she became pregnant, Angeline was well adjusted to life with a disability. She had the self-confidence and self-assurance that she would need to be a parent. "I felt I didn't need to worry about having a baby in advance when I didn't know what would happen. I'd been independent enough to know I could handle the challenges ahead," she explains.
And the challenges did come. One problem that Angeline encountered during pregnancy was a decrease in mobility due to weight gain. This made it harder for her to do transfers. There were problems managing daily living activities. For example, it became more difficult for her to get dressed and complete her bowel program. She solved the problem by allowing extra time to do everything slowly and cautiously. She also had trouble distinguishing false labor from true labor. Close monitoring was necessary during the last few weeks of the pregnancy.
With challenges of pregnancy met, labor and delivery went smoothly. Angeline and Don welcomed their first daughter, Meri Kelly. Three years later Angeline gave birth to their second daughter, Alexandra, who also arrived without any problems.
Angeline and Don figured out ways to simplify parenting tasks. Don built a table that Angeline could roll her wheelchair under to allow her to change diapers. He further modified the table by cutting a hole in the top for an infant's bathtub. When shopping and doing other activities, Angeline devised a strapping system to keep the children secure in her lap. A strap was attached to her wheelchair and around the children. This kept them from sliding out of her lap.
Today, Angeline has three grandchildren and continues to lead an independent and productive life. Her advice to women with spinal cord injury who want to have children, "Don't let your concerns outweigh your opportunity to try something you really want to do. Everything may not turn out the way you expect, but at least you've tried and you can look for different ways to accomplish your goals."
Pregnancy was also a time for adjustments for Melissa, who has a T5 level of injury from a car accident at age 17. Thinking back on her pregnancy, Melissa remembers, "The extra weight gain made transfers more difficult, and I was afraid of falling." Her husband, Bo, built a ramp that led to a level platform beside the bed. This raised Melissa's wheelchair to the same level as the bed, making the transfer less difficult. Bo adjusted the couch with blocks to raise it up and help make her transfers to the couch easier.
Melissa also had to change her bladder management program during the pregnancy. With her intermittent catheterization program, she was experiencing frequent bouts of incontinence. Changing to an indwelling catheter for the remainder of the pregnancy resolved this problem.
However, things got complicated during labor. After experiencing false labor, Melissa's true labor started late at night seven weeks before her due date. She felt her stomach tightening and called 911. Paramedics soon arrived to find Melissa with a severe headache, high blood pressure, and blurred vision. The paramedics were not familiar with people with spinal cord injury. They did not know Melissa was experiencing Autonomic Dysreflexia (AD) and needed urgent medical attention. AD is a life threatening condition that can occur in persons with spinal cord injury at or above the T6 level. Melissa remembers, "I was really scared! When they took my blood pressure I thought it was too high, but they said that wasn't unusual."
Fortunately, Melissa arrived at the hospital just in time. She got there at 12:52 in the morning and her daughter, Carly, arrived at 1:05. Melissa had a normal vaginal delivery and the effects of AD soon diminished. Being premature, Carly had to stay at the hospital for twelve days with a collapsed lung. Now two years old, Carly is a beautiful, outgoing toddler exhibiting no evidence of her dramatic entry into the world.
Despite the dangerous labor and the lifestyle inconveniences of pregnancy, Melissa feels fortunate. She explains, "I call Carly my little angel. Several years ago an abscess formed in my abdomen that scarred my ovaries and fallopian tubes. I was told that I would have a very slim chance of getting pregnant. Then I got pregnant and I couldn't believe it!
Having a baby can be a dream come true, but it requires sacrifice and commitment. Women with spinal cord injury may find it necessary to change personal care routines during pregnancy, such as bowel and bladder programs. You may need to modify your home to better manage parenting tasks. It may also be necessary to get a different vehicle to allow easier access to the rear seat to put your baby in and out of the car.
Advanced planning and preparation will help prevent some problems. Consult your doctor before becoming pregnant to determine if any changes in medication will be needed because some medications can be harmful to the fetus. Interview obstetricians in your neighborhood and find out which doctor has experience with women with SCI. Then, take a team approach to your pregnancy. Make sure that your obstetrician consults a physiatrist (doctor specializing in rehabilitation medicine) on issues such as AD, bowel and bladder management, and pressure sores.
Parenting is a team effort. You can share responsibilities to help make your pregnancy manageable. As with Angeline and Melissa, their husbands played important roles in modifying their home. Some women may also have support from their friends and relatives when needed. You may even have times when you need help from others. Most people are willing to help when they know what needs to be done.
It is important to remember that the opportunity for marriage, family, and happiness is available for everyone. Sometimes the approach must be different, but the path is accessible. Anything is possible with a good attitude and the right planning and preparation. Angeline and Melissa are two real life examples.