Possible Body Changes During Pregnancy
Women experience many changes during pregnancy. The image below describes some of these changes. Everything here may not apply to you; it’s just meant to get you started. As a woman with an SCI, some of these changes may have a bigger effect on you. Other sections will help you think about how a pregnancy might affect your physical function, as well as your health and wellbeing.
Mental Health
– Mood swings
– Psychiatric medication prescription safety during pregnancy
– Depression during and after pregnancy
Cardiac (Heart)
– The heart works harder
– Low red blood cell counts are common
– Swelling in legs and feet
Bladder
– Common to have to urinate more and need to get to the bathroom quickly
– Urinary tract infections are common and often happen without symptoms
Labor and Delivery
– There are different pushing techniques and positioning
– Vaginal delivery is still common
– Anesthesia is usually recommended
Bones and Spine
– Increasing back pain due to size and location of growing baby
– Risks of heterotopic ossification
Respiratory (Breathing/Lungs)
– Shortness of breath
– Taking lots of small breaths, harder to take deep breaths
Gastrointestinal
– Increased constipation, hemorrhoids, heartburn, and cravings
– Bowel accidents and incontinence
– Consult with your physician about over-the-counter medications and bowel regimens that are safe in pregnancy
Postpartum Care
– Postpartum birth control options to consider
– Planning ahead for breastfeeding/pumping, infant care, home modifications, and increased support
– Continuing and/or restarting medications you might be on
Caring for an Infant
How you will care for an infant is an important thing to think about when considering a pregnancy. You may think about things like modifying/adapting baby care equipment, adapting your home, finding useful information, identifying support from others, having strategies to keep baby safe, and determining the role of other caregivers.
Your level of independence and function will affect how many adjustments will need to be made. You may only need to make minor adjustments or you may need increased help from family, friends, and health care providers, like an occupational therapist. One important thing to keep in mind when thinking about how you will care for an infant is that many government agencies only allow care providers to assist the individual with the disability, not the child.
“Know you and your baby will adapt to each other once they come. You don’t have to have all the answers now. And that you will find a way that works best for you and your abilities.”
Focus Group Participant
To help you get started thinking about this, this worksheet includes some common things to think about when caring for an infant that could influence your decision making. Keep in mind this is not a list of every possible thing involved in caring for an infant you might need to think about.
Every woman with an SCI will solve problems and work around her limitations in different ways — caring for an infant is no different. Knowing how other women with SCI have taken care of an infant can help you think through how this might affect your decision making.
Your Health & Wellbeing
Knowing how your health — physical, mental, and emotional — could be affected during and after a pregnancy is an important consideration in your decision making.
When thinking about whether a pregnancy is right for you, your health is a very important consideration. No two SCIs are the same and your health needs may be very different from another woman’s. The important thing is figuring out what is right for you. It is also possible that your SCI and health will make a pregnancy very difficult or not possible. Before you make your decision, work with your care teams to make sure your support systems know how best to help you.
Your Team**
**Your team may have more or less people depending on your needs
Family Physician
– May also care for your pregnancy
– Trained in obstetrics & gynecology and pediatrics
– Can help manage your mental health and other health conditions
OB/GYN or Nurse Midwife
– Trained specifically for pregnancy care and women’s health
– Can provide prenatal care, postpartum care, as well as help with your delivery
– Maternal fetal medicine specialists: OB-GYNS with extensive training in higher-risk pregnancies
Physiatrist
– A physician that specializes in physical medicine and rehabilitation
– Works with a variety of specialists and focuses on physical function & independence
– Can help create a plan on how to handle your SCI during and after pregnancy
Therapist or Psychologist
– Someone trained to deal with emotional coping strategies for psychological distress
– Provides supportive non-medication-based techniques to help manage stress, mood, and thought disorders
Psychiatrist
– A physician who specializes in mental health disorders
– May already be part of your team or may be a consulting doctor during your pregnancy
Other Specialists
– Neurologists: Doctors trained to manage neurologic effects of SCI and other conditions
– Urologists: Doctors trained to deal with the urinary tract system
– Anesthesiologists: Doctors who manage pain, blood pressure, and other aspects during labor
– Occupational Therapists: Clinicians who help others recover and/or develop skills needed to do activities needed in everyday living and work
– Physical Therapists: Clinicians who focus on improving the movement of the body
Your Support System
– Family, friends, spouses, partners, doula, work colleagues, and community
Physical Health
During a pregnancy, women with SCI may receive care from several different health care providers. This team can help advise about modifications to drug regimens during pregnancy, special equipment to consider, and other testing or treatment to prevent problems. Drug routines, whether they are prescriptions, over-the-counter medicines, or herbal supplements and vitamins, should be discussed with your care team prior to becoming pregnant to ensure the best possible treatment options to keep you and your baby safe. If you have other secondary conditions due to SCI, it’s not unusual to experience changes in those during pregnancy. These changes may be managed by a large health care team so that they can treat these new changes.
Mental and Emotional Health
Pregnant women experience changes in their hormones during and after pregnancy. Mood swings, depression, anxiety, and “baby blues” (feeling sad or moody after having a baby) can happen during these times. Many women with SCI may struggle with depression, anxiety, and a lot of life stressors even before pregnancy. Pregnancy can be a stressful time, as you may need to deal with additional medical needs, getting access to new adaptive equipment, not being able to get to a doctor’s office or clinic with the right medical equipment, and disability-related stigma.
Unfortunately, women with SCI and pregnant women can be at a higher risk for potential physical and emotional abuse from partners and caregivers. Keeping yourself mentally, emotionally, and physically safe is the most important thing, and is something both you and your care team can work on together.
“Think about your future. Weigh out the pros and cons of being a mother with a disability. Think of your health, if it could affect it from declining.”
Focus Group Participant
To help you think through how a pregnancy might affect your mental and emotional health, see the worksheet below that lists some common things to think about. Some topics may not apply to you. Keep in mind this is not a list of every possible thing you might need to think about. There is room to write down additional questions you may have that aren’t already listed.
While no two women are the same, it can help to know how other women with SCI have handled changes in their function and independence during a pregnancy and how potential changes affected their decision making. Their advice that might be helpful as you consider what is right for you:
Your Physical Function & Independence
Your physical function and independence can change a great deal during a pregnancy. Knowing what to expect and how these changes might affect your life are important things to consider in your decision making.
It is normal for some activities, such as getting around in your wheelchair, to change or become more difficult during a pregnancy. You may find getting measured for equipment, like a power chair or manual wheelchair may be helpful. Even if weight changes don’t cause a lot of difficulty in getting around, you may still experience increased back pain, pelvic pain, or joint pain.
“One of my biggest things was being aware of what pregnancy could do to my body, and if it would affect how I would be able to care for a child after giving birth. I definitely didn’t want it to have a negative impact and add on to long term health issues I already deal with.”
Focus Group Participant
No two SCIs are the same. The important thing is figuring out how a pregnancy might affect your physical function and independence. Specialists can help with your functional changes during pregnancy. These specialists can learn the way you function in your everyday life and make recommendations for the best ways to set up your day so that you can keep the highest possible level of independence.
To help you get started, use the worksheet below to see some things to think about. Some topics may not apply to you. Keep in mind this is not a list of every possible thing that could change for you. You can also use the worksheet to write down specific questions you may have to go over with your health care providers and other people in your life.
SCI Life Post-Pregnancy
When thinking about whether a pregnancy is right for you, re-adjusting to your SCI after a pregnancy may seem so far in the future that it may look like something you don’t have to think about now. But, there will be an after if you decide a pregnancy is right for you. For now, it is important to carefully consider possible changes and challenges of re-adjustment, taking into account who you are, how your injury affects you, and your life situation.
To help you get started, there are some common things to think about when thinking about what re-adjustment might be like. Keep in mind this is not a list of every possible thing that may apply to you.
Adjusting to New Body Changes
– Getting a new wheelchair to accommodate wider hips after birth
– Slowly returning to pre-pregnancy weight if you choose to
– Healing from either a vaginal or cesarean birth
– Regaining physical fitness (ex. returning to physical therapy)
“There is no ‘one size fits all’ formula. What works for one person doesn’t work for another […] For example: […] Some people make do with (and prefer) normal cribs.”
Focus Group Participant