What if labor starts without my noticing it! How will I know when I don’t have any feeling?

Study your body early on during pregnancy. Labor pains/contractions differ from Braxton Hicks contractions because they occur regularly. Watch for other signals from your body, such as rising blood pressure, difficulty breathing, changes in spasticity or malaise. If your water breaks, that is a sure sign. If you have a complete injury above T10, childbirth may be painless. However, most women with spinal cord injury can feel that something is happening in the body.

Why is it so important to avoid urinary tract infection during pregnancy?

Non-pregnant women are usually treated only for urinary tract infections that cause symptoms. However, in pregnant women, asymptomatic infections increase the risk of triggering premature birth. The reason is that in pregnancy, urinary tract infections may often travel back up through the ureters into the kidney and cause infection there. A kidney infection causes the release of inflammatory substances throughout the abdominal cavity that can trigger premature labor. Therefore frequent urine cultures are important, at least in connection with prenatal checkups, to detect and prevent possible infection at an early stage.

Why should you get pain relieving medication when you do not feel pain?

People with spinal cord injury above the T6-8 level may develop autonomic dysreflexia (AD). This condition is triggered by painful stimuli below the level of injury such as bladder distension, pressure, constipation, inflammation of the skin or nails, and tight clothing. AD causes blood pressure to rise sharply. Symptoms include throbbing headache, skin redness above the level of injury, nausea, heart arrhythmia and visual disturbances. Childbirth is a major triggering factor, but administration of pain relieving medications (epidural anesthesia) below the level of injury can prevent AD.

With spinal cord injury, is Caesarean section better since it allows more control?

Usually a woman with spinal cord injury can give birth vaginally, unless complications arise during pregnancy or delivery. Prior to delivery a doctor must assess whether vaginal delivery is possible. Potential obstacles include severe spasticity, new bone formation in soft tissues around joints below the level of injury (heterotopic ossification), or hip joint contractures. However, vaginal delivery is usually preferable because it is less invasive.
Labor and delivery can even be faster and less painful since body muscles do not offer much resistance. The uterus is supplied by nerves from the autonomic nervous system. That means that the nerve impulses in the uterus are not controlled by the central nervous system in the spinal cord, but are governed by a different part of the nervous system under its own control. That is why a woman with spinal cord injury can give birth without voluntary muscle contractions. If the abdominal muscles are not active enough to push the baby all the way out, the birthing process can be assisted through other means, such as vacuum extraction. Vaginal delivery is preferable because cesarean section is a complex surgical procedure and leaves a skin wound on the stomach that needs time to heal. In addition, many women bear witness to an almost magical feeling when their body is able to give birth.

How can I give birth the “usual way” when I am unable to push?

The uterus is supplied by nerves from the autonomic nervous system. That means that the nerve impulses in the uterus are not controlled by the central nervous system in the spinal cord, but are governed by a different part of the nervous system under its own control. That is why a woman with spinal cord injury can give birth without voluntary muscle contractions. The uterus takes care of itself which is why even unconscious women can have an uncomplicated vaginal delivery. If you don’t have enough muscle power to push during the final stage of delivery your obstetrician can assist the birth with vacuum extraction or forceps.

This text was reviewed for medical accuracy by Karin Pettersson, consultant, Obstetrics, Department of Women’s and Children’s Health, Karolinska University Hospital Huddinge