Frequently Asked Questions

Pregnancy

Can I become pregnant after my spinal cord injury?

Yes! You will find it just as easy or difficult to become pregnant as before your spinal cord injury. In the time immediately following your injury it is common to stop menstruating, but after a few months your period will usually return to normal.

I’m a woman with a spinal cord injury, can i give birth vaginally?

Yes, the spinal cord injury in itself is not an obstacle to vaginal delivery. However, you may experience certain complications from your spinal cord injury that make vaginal delivery more difficult. Examples include severe spasticity, new bone formation in soft tissues around joints below the level of injury (heterotopic ossification), or hip joint contractures.

How do I know what medicines i can take during pregnancy?

We recommend that you contact your obstetrician and the doctor who takes care of your spinal cord injury for advice concerning medications. Many people with spinal cord injury take medications that are unsuitable during pregnancy and breastfeeding. However, some people may find it difficult to manage from day to day without their medications. In some cases there may be alternative choices that pose less risk to the fetus than others.

Can someone with a spinal cord injury breastfeed her baby as usual?

Yes, you can nurse even if you have a high-level spinal cord injury. You may need a little more support to find a good position for breastfeeding that works for both you and the baby. Many find that a nursing cushion helps. People who lack sensation in their breasts should be a little extra cautious since skin lesions can easily occur. You should also check that the breast tissue does not become hard, which may be a sign of a blocked duct.

Studies show that breastfeeding can be affected if you have an injury above Th6 as the communication between the breasts and midbrain does not work correctly.

The Canadian SCIRE Project, Spinal Cord Injury Research Evidence, together with i.a. The Spinalis Foundation has produced guidelines regarding breastfeeding for mothers with spinal cord injury. Read the guidelines here.

Will I need a larger wheelchair when i am near the end of my pregnancy?

Weight gain and weight distribution during pregnancy depend on the individual woman. Some women need a wider wheelchair, others manage with their regular wheelchair and for some it is sufficient to broaden the chair a bit with spacers on the rear wheels. However, it is important to continuously monitor your sitting position as your body changes to avoid pressure sores.

Why is the risk of urinary tract infection greater when you are pregnant?

The risk of urinary tract infection is twice as high for a pregnant woman as for a non-pregnant woman. The hormone progesterone relaxes the smooth muscles of the ureters, which causes the urine to flow more slowly from the kidneys to the bladder. The pressure of the growing uterus on the bladder also slows urine flow, while making it more difficult to completely empty the bladder. Taken together these factors increase the risk of urinary tract infection. Pregnant women with spinal cord injury who have problems with recurrent urinary tract infections are often given antibiotics to prevent these problems.

Does pregnancy increase the risk of blood clots?

Spinal cord injury in itself increases the risk of blood clots due to increased sitting and decreased circulation. Pregnancy also increases the risk of blood clots because of higher blood estrogen levels and slowed blood flow caused by increased pressure from the uterus on blood vessels. Women with spinal cord injury are therefore frequently prescribed blood thinning medications during portions of their pregnancy and after childbirth to reduce the risk of blood clots.

Is there a higher risk of pressure ulcers when i am pregnant and how can i avoid them?

Changes in hormonal balance, low blood count and weight gain all increase the risk of pressure ulcers during pregnancy. Therefore it is important both during and after pregnancy to be alert for skin lesions. It may also be necessary to reassess your wheelchair and sitting position as your body changes. Finally, it is even more important than usual to remember to change your sitting position often and relieve the pressure on your skin.

Can pregnancy affect my breathing?

As the uterus grows it displaces other organs, including the lungs. This may pose an extra burden, especially for women with high-level spinal cord injuries that affect the respiratory muscles. Injuries above T5 affect the abdominal muscles, which contribute to breathing, while injuries above T1 also affect the chest muscles. In some cases, treatment with oxygen may be needed in late pregnancy and during childbirth. One example is oxygen treatment at night. Such treatment is especially appropriate in tetraplegia/quadriplegia since only the diaphragm muscles can be used for breathing. If the woman has significant oxygenation problems during late pregnancy, her doctor may choose to deliver the child somewhat early.

What effect dose pregnancy have on my bladder and intestines?

As the uterus grows it puts pressure on the bladder and intestines, which may worsen existing bladder and intestinal problems. Constipation is common among pregnant women and may be made worse by spinal cord injury. The condition can be prevented or treated by high-fiber diet, adequate fluid intake and medications. It is also common for pregnant women to receive iron supplements, which add to the constipating effect. To avoid this problem, iron supplements may need to be given intravenously instead of by mouth.

Can I go to a regular pregnancy center, or do I need a high-risk pregnancy center?

The general recommendation is that pregnant women with spinal cord injury should be monitored at both a regular pregnancy center and a high-risk pregnancy center. The high-risk pregnancy center formulates a pregnancy plan for any additional monitoring or examinations that may be considered necessary, and determines whether vaginal childbirth or cesarean section is preferable. Many women with spinal cord injury have completely uncomplicated pregnancies and require little extra assistance from the high-risk pregnancy center. It may also be appropriate to maintain contact with the spinal cord injury unit for questions regarding the spinal cord injury, the need for new adaptive equipment, etc. Ideally, your obstetrician and rehabilitation specialist should discuss your pregnancy and potential complications.

Childbirth

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