Pregnancy for Wheelchair Users

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Published on Tuesday, 10 April 2012 02:40

Child-Bearing can be a joyous and difficult time all at once. There are many excitements, changes, challenges and emotions. It can be even more challenging when you face it with a disability that confines you to a wheelchair. But is this an impossible challenge?

Since persons with disabilities are already a minority in our country, it is rare to see a disabled person with children, let alone pregnant. This contributes to the opinion shared by many that children of persons with disabilities will not be properly cared for or parented. But in actuality, studies show that children of disabled parents are more caring and responsible and have a better understanding of how to deal with hardships they will face in life. The fact is, parents with disabilities are not as rare as they seem. There are many women around the world who are faced with this challenge and who go on to become successful parents with productive children. When you are deciding whether or not to embark on this new adventure you should:

• Decide whether you are emotionally, financially and physically prepared for the responsibilities of having a child.
• Speak to a physiatrist, a rehabilitation physician. They are familiar with the reproductive health concerns of women with physical disabilities or neurological disabilities like Multiple Sclerosis (MS) and spinal cord injuries (SCI). Those who do not know about issues faced by persons with disabilities may try to encourage you to not become pregnant. Encourage your entire medical team to work together.
• Understand the risk involved. There is a chance that your condition could worsen after child birth if you are women with an illness such as MS or Rhuematoid arthritis. So consult with your Primary Care physician about the possibilities so that you can weigh the Pro's and Con's.

After you have made the decision to have a child, understand that good planning and preparation are essential to being successful. So, what changes should you expect? How should you prepare for your little bundle of joy?

Like anyone else, once you become pregnant your body starts to change in preparation for the baby. Since being aware of your body, how it functions and what it can and can't do is an important part of living with a disability, these changes can be a source of confusion and frustration.

Find an obstetrician who understands, or is willing to learn, your unique needs. This is important because many are not familiar with the issues of women with disabilities.

Know that Breathing will become more Difficult. The amount of weight gained can cause any expecting mother to have difficulty breathing. But with a mother who has a disability the risk is even more dangerous because their pulmonary function is already compromised due to the type of injury and the lack of mobility. You can decrease this risk by focusing on proper sitting positions, breathing exercises and getting plenty of rest especially in the 3rd trimester. If the situation becomes severe ventilator assistance may be needed.

There will be Changes in your urinating and bowel program. As the fetus grows it will place additional pressure on these areas. This can cause diarrhea or constipation. It will also cause an increase in bladder spasms which will increase urinating frequency. If an indwelling catheter is not already used it may be now necessary. If a person does intermittent catheterizing, changes in the vaginal area may cause it to become more difficult and it will become necessary to cath. more times a day.

Be on the lookout for Urinary tract infections. While your risk for contracting a UTI does not increase with pregnancy it, like any infection, can affect the unborn child. It can even lead to premature labor.

There is an increased chance of preterm delivery. Because of the increased stress pregnancy can put on the body of a disabled women's body it may be necessary for the doctor to induce labor to reduce the risk of injury to the mother or baby. Even more often the mother's body may go into premature labor on its own.

You will become less mobile. With the increase in weight it will become more difficult to move yourself around independently. As the need to not put pressure on your stomach becomes more important things like rolling and sleeping on your stomach may become impossible. Plan to have a caregiver during the last few weeks/months of pregnancy to assist you with daily living activities.

Your body will tire quicker than normal. The increase of difficulty in breathing or moving around combined with the weight gain will make it difficult to complete task normally. Plan for this by decreasing you activity as you get closer to delivery. If you use a manual wheelchair you may want to consider renting an electric one for the last few months of pregnancy.

Watch out for signs of Autonomic Disreflexia. It is a reaction caused by the involuntary nervous system due to over-stimulation. It is most often found in persons with SCI. It is caused by nerve signals below the level of the spinal cord lesion trying to send messages back to the spinal cord and brain. It can cause a significant increase in blood pressure, throbbing headaches, profuse sweating, nasal stuffiness, flushing of the skin above the level of the lesion, bradycardia, apprehension and anxiety, and can be accompanied by cognitive impairment.

What to remember during your pregnancy:

• Stay current with your visits to the doctor. Because the pregnancy will be considered "high risk," it is important to regularly visit all of your health care team of specialist so that all conditions are properly managed and there are no conflicts with medications.
• Ensure the size of your wheelchair remains big enough as you grow. A too small wheelchair could lead to pressure soars.
• Prepare for the possibility of an increased recovery time after delivery
• Consult with the Physiatrist to evaluate the need for a support belt.
• Learn to understand your pains. As they can be signs of serious illness or the start of labor.
• Consider the pros and cons for each type of delivery (vaginal or Cesarean).
• Increase the frequency of pressure releases.
• Early admission to the hospital may be necessary if you feel unable to manage things at home
• Visit the hospital ahead of time to prepare what accommodations may be needed for you to be independent post-delivery.
• Address the father's needs also. Their bodies may experience changes such as sleep deprivation. They need to be just as informed about the needs of mom and baby. If they are disabled, they may want to find accessible furniture so they can be avid participants in their child's life.

Information for Health Care Professionals