Q: My girlfriend is now pregnant and is using M.A.C.E to help her go to the bathroom. She uses glycerin and salt and water. Can this affect the baby?
A: The M.A.C.E. (Malone antegrade colonic enema) procedure has been very useful in helping individuals with Spina Bifida become more continent of stool and have controlled bowel movements. Glycerine is used to help move the stool through the colon and is not absorbed into the body. Therefore, there is no risk to the developing baby. The salt and water will mostly be flushed through the colon with the stool. A small amount will be absorbed into the body, but salt and water are natural to the body and won't cause any harm.
Q: As a mother-to-be with Spina Bifida what type of delivery should I expect – natural or C-section?
A: The type of delivery depends on multiple physical factors, including:
sensation level, ability to push with pelvic muscles, size of the pelvis, and flexibility around the hips and knees. The more conducive these factors are to the birthing process, the more likely a vaginal delivery can be performed. If it appears the baby will not be able to be pushed safely through the pelvic area and down the birth canal, a Cesarean section will be recommended. If a C-section is chosen, the urinary tract should be evaluated for re-implantations, diversions, or conduits to make sure they are avoided during the delivery incision. Women with SB have successfully and safely received epidural anesthesia for their delivery. Because the anatomy of the spine is different, the epidural may need to be placed using ultrasound guidance. There are reports of successful epidurals for most myelomeningocele lesion levels, with or without scoliosis. As with all pregnancy issues in Spina Bifida, monitoring the effects of the epidural is trickier than in usual pregnancies. Therefore, it is best to deliver with an obstetrician and hospital experienced in high-risk pregnancies. For women with Spina Bifida who are not yet pregnant, discussing your medical and surgical history with your SB team and high-risk obstetrician before conceiving can maximize the preparation for a healthy delivery.