Women with physicaldisabilities have normal fertility, are capable of falling pregnant and canexpect pregnancies that do not differ significantly from other women. Prenatalcare does require quite frequent visits to a health care provider though, andfacilities may not be accessible.

Unfortunately, pregnantwomen with disabilities often experience negative reactions from familymembers, health care providers and society. Women with a disability shouldplan, just like every other woman, in order to ensure their own, and thebaby’s, safety and wellbeing. Yourplanning will just be a little more involved!

Physical disability isoften the result of a medical condition so pregnancy related risks could behigher. Pregnancy entails some risk to all women but for women withdisabilities these risks may be greater. Weight gain and changes in body habitsfrom the enlarging uterus also pose special risks for women with impairedmobility.

Spinal Cord Injury (SCI)

Statistics for women inSouth Africa with spinal cord injuries are scarce but most would appear to besurvivors of acute traumatic injury. When this occurs during the reproductiveage many will experience hypothalamic amenorrhea or other menstrual disruptionsimmediately after the injury, but this usually resolves over the next eightmonths.

According to thelimited data available pregnancy outcomes are generally favourable and, whencompared with other pregnancies, there were no differences in numbers for livebirths, miscarriages or stillbirths in women who deliver after SCI. Urinarytract infections (UTI) were significantly more common though as a result ofincreased bladder spasms and incontinence with baseline bladder functionusually restored after delivery.

There is an increase incaesarean deliveries, but this may not be as a result of obstetric indications.They are usually performed under a general anaesthetic because of dysreflexiaand to avoid worsening the lesion.

If a caesarean sectionis required the presence of scarring may make it more difficult with increasedrisk of complications.

Some women may find,especially later in the pregnancy, that the ability to propel the chair andtransfer independently may be impaired. Spasticity may also worsen. The excessweight may result in excess pressure and, therefore, pressure sores. Vigilantskin inspections are required. Breathing problems may also develop with theincreasing size of the uterus.

Decreased mobility mayincrease the risk of venous blood clots and the use of blood thinners needs tobe individualized. Dietary deficiencies are also common and bowel movements maybe affected. Supplementation may be needed which could make constipation worse.Risk of babies that are small for gestational age and pre-term births may beincreased but the reason is unknown. Frequent UTIs may be related. Women withSCI may experience unusual labour including pain above the level of the lesion,increased spasticity or symptoms of autonomic dysreflexia.

Breastfeeding ispossible in women with SCI although impaired breast and nipple sensation maypose difficulties in lesions above T6.

Rheumatoid Arthritis

Systemic autoimmune inflammatory arthritis occurs worldwide in about 1% of the population. Women are affected three times more than men and the age of onset is between 25-50 years. Pregnancy rates tend to be lower but outcomes are generally good. Adverse outcomes are more common. Hospitalisation, blood pressure disorders, early labour and caesarean deliveries are increased.

Multiple Sclerosis (MS)

Flare rates seems to decline in thethird trimester but increase in the first three months after delivery. Flaresin pregnancy are usually mild and managed without medical treatment. Pregnancy in MS does not appear to adversely affect the long-term course of the disease.

Other Conditions

There is very little data on pregnancy outcomes for women with cerebral palsy and spina bifida.Outcomes are usually favourable and there is no clear evidence that rates of miscarriage, malformations, fetal growth restriction or pregnancy induced hypertension is elevated. Higher doses of folic acid are recommended.Complications include UTIs, pressure ulcers, stomal problems, back pain,constipation, early labour and increased caesarean sections.