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8.2. Reproductive Health for Women with SCI

Women with a spinal cord injury represent about 20% of all individuals with SCI/D and the majority of these women are of childbearing age. Regardless of a woman's level of injury or dysfunction, women with SCI can engage in sexual activity, can have children and will need to use a contraceptive method if they choose not to have children. Education is the key for women with SCI/D to understand the facts related to pregnancy, labor, and delivery.

The first step in the journey towards motherhood is visiting with an obstetrician. If your obstetrician has limited experience in managing pregnancies of women with SCI/D, it is recommended that you take a "team" approach to your pregnancy. You and your obstetrician can consult with an experienced physiatrist, nurse, urologist, anesthesiologist, neurologist, respiratory therapist, physical therapist, and occupational therapist on specific concerns about pregnancy, labor and delivery.

Although women with SCI/D may be considered to have "high risk" pregnancies, it does not mean that pregnancy should be avoided. It simply means that you need to take precautions to prevent and treat complications. Pregnant women with SCI/D are at greater risk for developing:

Many prescribed and over-the-counter medications normally used by women with SCI/D can cause problems during pregnancy. Some medications can also have an adverse affect on fetal growth. Therefore, it is essential that all medications be evaluated by your obstetrician before pregnancy and continually re-evaluated each trimester. Some conditions that you might manage with medications include bowel management, pain, sexual dysfunction, muscle spasms, and urinary tract infection (UTI).

Some women with SCI/D may have signs of labor, while others may not. Theref with SCI/D must be aware of the common signs of labor, including abdominal tightening, changes in breathing, backache. Autonomic Dysreflexia is common during labor and can be life threatening if not managed properly.

Most women can, and should, deliver vaginally whenever possible. Some may deliver with ease, while others may need the assistance of a vacuum device or forceps. Some women with SCI/D have skeletal abnormalities such as curvature of the spine, pelvic fracture, or hip dislocation. These conditions can limit the space in the abdomen necessary to carry a full-term fetus. These abnormalities can make vaginal delivery difficult. In these cases, a Caesarean section (C-section) may be necessary.

Once the baby is born, the decision on whether or not to breast-feed must be made. Although breast-feeding is possible for most women, you may notice an increase in your spasticity as you breast-feed. Also, breast-feeding normally stimulates the production of breast milk, so women with limited sensation in their nipples may notice a reduction in milk.

Although there are risks for complications related to pregnancy, risks can be reduced and managed through proper prenatal care and adequate planning.

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