Pregnancy and Delivery for Women with Disabilities

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Women with disabilities face some problems with pregnancy and delivery that are related to their disabilities, but with knowledgeable health care providers, most are able to give birth to healthy babies.

In national studies, women with disabilities have reported negative experiences with pregnancy and childbirth because they had difficulty finding health care providers and hospitals that had experience managing pregnancy and childbirth in women with disabilities. This lack of experience has been particularly true for disabilities that are uncommon in women, such as spinal cord injury.

One study demonstrated that future internists and obstetricians had marked deficits in knowledge about possible disability-related complications of pregnancy with spinal cord injury, indicating that these knowledge gaps are likely to continue into the future. This lack of knowledge and experience has led some doctors to communicate unwarranted negative expectations about pregnancy outcomes to women with disabilities who become pregnant or who express the desire to have children.

In some cases, pregnant women with disabilities have been advised to end the pregnancy and to have a tubal ligation (i.e., "have her tubes tied") or have a hysterectomy to prevent future pregnancies. An often overlooked solution for local obstetricians who lack experience is to search nationwide for a doctor who is experienced with the disability

Most women with disabilities can manage pregnancy and give birth to healthy babies if they have a health care team that is knowledgeable about potential risks related to the women's disabilities. Typically overlooked difficulties that are common to women with many types of physical disabilities are greater limitations in physical functioning that increase the need for assistance from others, physical and occupational therapy, or upgraded equipment to help with mobility and daily activities.

Also common to women with various types of physical disabilities are increased problems with bladder function, such as infections, bladder spasms and leakage, and difficulties surrounding catheter usage which may require a change in the bladder management program.

• Frequent infections are particularly problematic because they can lead to spontaneous abortion and miscarriage, pre-term labor, and low birth weight babies.
• Skin problems typically increase with physical disabilities during pregnancy, which can range from more pressure ulcers with spinal cord injury to more skin overgrowth and hardening with scleroderma.
• The risk of blood clots increases as the pregnancy progresses for women who use wheelchairs.
• Breathing difficulties and risk of pneumonia increase as the pregnancy progresses for women who already have respiratory impairment.
• Pre-existing bowel problems may increase during pregnancy, particularly constipation and risk for bowel impaction.
• Spasticity tends to increase during pregnancy for women who have neurologic conditions, such as multiple sclerosis, spinal cord injury, spinal bifida and cerebral palsy.
• Risk of autonomic dysreflexia, a life-threatening sudden rise in blood pressure, increases for women with high-level spinal cord injuries, and may be misdiagnosed and incorrectly treated as pre-eclampsia.
• The frequency of seizures tends to increase during pregnancy for women who have already have seizures with their brain injury.

Some chronic conditions, such as multiple sclerosis and rheumatoid arthritis improve during pregnancy; while others, such as lupus tends to worsen.

Neurologist Emma Ciafaloni and maternal-fetal medicine specialist Eva Pressman, both at the University of Rochester (N.Y.) Medical Center, wrote the following insert about pregnancy and neuromuscular disease. "Great Expectations: Pregnancy and Childbirth With Neuromuscular Disease," was published in the July 2010 issue of Quest, MDA's quarterly magazine.