Obstetrical Care for Women with Disabilities

“When I found out I was pregnant, I was overjoyed, but also apprehensive,” writes Erin E. Andrews, in an article for the American Psychological Association (1). She goes on to explain:

“I am a congenital triple amputee who uses a power wheelchair for mobility. I was less concerned about the effects of my disability, and more concerned about the attitudes of others towards my pregnancy. As a rehabilitation psychologist, I am well aware that women with disabilities face barriers to reproductive health and that social biases exist which portray women with disabilities as asexual, infertile, and incapable as mothers.”

The effects that a mother’s disability will have on pregnancy and childbirth vary greatly depending on the nature of her disability. Some may require certain accommodations, but no extra medical care. For example, a hearing-impaired mother may need an interpreter to be present at medical appointments, but her disability should not affect the likelihood of experiencing pregnancy complications (unless her hospital fails to provide proper interpretation services). Others are referred to a doctor who specializes in high-risk pregnancies, in order to avoid or treat complications that they are predisposed to because of their disabilities.

Although some pregnant women require accommodations and/or extra medical attention, this does not mean that they are incapable of motherhood. With proper medical management, many women with disabilities are able to have safe pregnancies and deliveries, and go on to raise happy, healthy children.

Expectant Mothers with Disabilities Face Barriers to Healthcare

Unfortunately, the social biases that many disabled women face during their pregnancies are often reflected in the ways they are treated by medical professionals. The National League for Nursing (NLN) notes that,

“…women with disabilities may be hesitant to seek care because they anticipate negative reactions from others, including health care professionals…Women with disabilities have reported that health care providers’ initial reactions to the idea of pregnancy is to try to discourage them from considering pregnancy, to assume they are seeking termination of their pregnancy, or to make negative comments about them being irresponsible in considering pregnancy and motherhood (2).”

Even if a disabled mother-to-be finds an obstetrician who treats her respectfully, there may still be other barriers to accessing healthcare. For example, medical facilities are often inaccessible. Many women report that their doctors do not have accessible scales, or that their exam tables are non-adjustable, making wheelchair transfers difficult (1, 2). Moreover, medical professionals often lack knowledge about how specific conditions can impact pregnancy and birth, or have minimal experience treating pregnant women with any sort of disability. Naturally, this lowers the quality of healthcare that these patients receive, and makes it difficult for them to make informed decisions (3).

Healthcare Considerations: Navigating Pregnancy and Birth with a Disability

Women with physical disabilities are more likely to experience a number of pregnancy and delivery complications. Doctors should discuss these possibilities with their patients and create a plan to minimize risk.  Of course, their level of vigilance for specific issues should be based on an individual patient’s disabilities and other preexisting conditions. However, here is a general list of complications that may arise in expectant mothers who are disabled:

Medication Issues

Medications to manage disability-related symptoms may affect the fetus. Doctors should advise mothers of this and discuss any alternative options (temporarily going off the medication, finding another medication that is safe to take during pregnancy, etc.)

Urinary Tract Infections

Women who lack bladder control or have a urinary catheter are more susceptible to urinary tract infections (UTIs) (4,  5). These infections are also more common among pregnant women; therefore, pregnant patients with impaired bladder function are at particularly high risk. UTIs can lead to dangerous kidney infections, and also pose a major threat to a developing baby. Doctors should discuss these risks with all pregnant patients, but especially those with disabilities that may heighten their risk, and provide information about UTI prevention.

Problems with Balance and Mobility

Existing issues with balance and gait may become more pronounced during pregnancy, due to a change in center of gravity (2). Normal pregnancy weight gain can also impact overall mobility and ease of transferring (1). During pregnancy, women with disabilities may need to rely more heavily on assistive technology or seek help from family and friends. Doctors should be able to discuss with them how pregnancy may affect their overall function.

Skin Problems

Wheelchair users are at higher risk for developing skin-related issues such as chafing and pressure ulcers, especially if they are unable to frequently switch positions. During pregnancy, these risks can be exacerbated because of the increase in weight, and possibly because mobility is further impaired (6).

Autonomic Dysreflexia (AD)

Autonomic dysreflexia (AD) is a serious complication that may occur in pregnant women with spinal cord injuries and other disorders such as multiple sclerosis. It can cause life-threatening hypertension, and may manifest similarly to preeclampsia it is important for doctors to distinguish between the two. It can be caused by intense stimuli occurring below the level of injury (such as a urinary tract infection, constipation, or a pressure ulcer), and is frequently triggered by uterine contractions during labor and delivery. AD may cause signs of fetal distress (2, 7).  

Anesthesia Issues

Women with spinal cord injuries, spina bifida, osteogenesis imperfecta, cerebral palsy (CP), and other conditions may react differently to anesthesia. Therefore, if they plan on receiving epidural anesthesia for delivery, they may need to be referred to an anesthesia team in advance in order to identify potential complications (2).

Painless Uterine Contractions

Women with spinal cord injuries often have reduced labor pain, and in some cases uterine contractions may be completely painless. While this may not seem problematic, it means that they may not recognize the onset of labor, and therefore may not get to a medical facility in time to deliver. Because of this, doctors should coach patients with spinal cord injuries on other ways to recognize labor; for example, they may experience shortness of breath or spasms in the abdomen or legs. Doctors can also teach their patients uterine palpation techniques used to detect contractions (8).

Conclusion

This is by no means a complete list of potential complications that women with disabilities may encounter. However, it outlines a few of the most common concerns. Some women with disabilities will encounter none of these issues, while others may experience several on this list, along with other pregnancy complications. Please check back for future posts, in which we will discuss obstetrical considerations for specific disabilities.

Do you have a disability? Have you been pregnant or given birth? Please feel free to share your experiences in the comments!

Sources

  1. APA – Pregnancy with a physical disability: One psychologist’s journey
  2. NLN – Pregnancy in Women with Disabilities
  3. Disabil Health J – Pregnancy among women with physical disabilities: Unmet needs and recommendations on navigating pregnancy
  4. Transl Androl Urol – Urinary tract infection in the neurogenic bladder
  5. CDC Urinary Tract Infection
  6. Acta Obstet Gynecol Scand – Effects of Disability on Pregnancy Experiences Among Women with Impaired Mobility
  7. United Spinal Association – Pregnancy and Women with SCI
  8. ACOG – Obstetric Management of Patients with Spinal Cord Injuries

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