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Planning to start a family? For an adult woman with Spina Bifida there are many things to consider. Balanced nutrition, regular exercise, and vitamin supplementation are key not only to your health, but to the future of your children.
If you are overweight, consult with your family doctor about losing weight prior to becoming pregnant. Maternal obesity has been linked to adverse affects, posing fetal and maternal risks.
For women with Spina Bifida who are not yet pregnant, discussing your medical and surgical history with your Spina Bifida team and high-risk obstetrician before conceiving can maximize the preparation for a healthy delivery.
Schedule a consultation with an obstetrician in your community. Please advise the receptionist and or nurse what accommodations you may need. If you have limited range of motion or unable to transfer to a pelvic table, please inform the staff. If the physician’s office is in or near a large medical facility, they may be able to acquire a portable lift system to assist you. Also let them know if you have a latex allergy.
It may also be helpful to journal your questions and concerns prior to your appointment. Keep in mind that an obstetrician is caring for two people, you and your baby. Your doctor needs to be aware of your medical history. Providing copies of medical records are very important.
You may find SBA’s YAA e-community very helpful. You may post a question to the group about OB GYN care in your community.
You are now pregnant and have an obstetrician for prenatal care. Continue taking vitamins as prescribed, along with healthy nutrition and exercise. Please continue to consult with your primary care physician and specialists throughout your pregnancy. Women with Spina Bifida may already experience constipation, urinary tract infections, and incontinence, during pregnancy these symptoms may worsen.
During pregnancy it is very likely that you will gain weight. A healthy weight can be very challenging to maintain for an adult with mobility limitations, even more so during pregnancy.
Preparation for the newborn is vital to easing anxiety prior to delivery. Designing a Birth Plan with your spouse or significant other can be a wonderful bonding experience. Meeting with an anesthesiologist about pain control is especially important, as some clients with defects in there spine may not be a candidate for an epidural. Meet with a birthing coach or Doula to see if modifications can be made for you to assist in a healthy delivery. Doulas may also be hired for post–partum care.
Getting Your Home Ready
When the baby arrives it is important to have your home ready! When purchasing baby furnishings, remember that you need to be able to reach the baby. Changing tables and cribs may need to be modified.
Practice loading a doll in and out of a stroller, car seat, and crib. Some people living with Spina Bifida may have fine motor deficits and may need assistance with these tasks.
It is important to identify your support systems early on in your pregnancy. If you are planning to utilize childcare, interviewing caregivers early in the pregnancy is vital. Many childcare centers have long waiting lists.
You may also take this time to consider your baby’s nutrition. Breast feeding and bottle feeding may take a little more planning for a mother with Spina Bifida. Nursing pillows and furnishings may need to be adapted. You may want to work with an occupational therapist to practice nursing in a wheelchair.
If bottle-feeding, it is important to be able to prepare and clean bottles throughout the day. An OT can also help assess these needs in your home.
Bathing and diapering the newborn may also be a challenge. Practicing with a doll in your home and consulting with an OT would prove to be beneficial. Safety is very important!
The Big Day!
You are ready to have the baby! The type of delivery you have depends on multiple physical factors, including:
- sensation level
- ability to push with pelvic muscles
- size of the pelvis
- 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 an elective Cesarean section is chosen, the urinary tracts should be evaluated (particularly if there has been re-implantations, diversions, or conduits) to make sure they are avoided during the delivery incision.
Women who have Spina Bifida have successfully and safely received epidural anesthesia for their delivery. Because the anatomy of the spine is different in Spina Bifida, 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.
Effects after Pregnancy
Long-term effects after pregnancy in Spina Bifida have been reported and include:
- changes in mobility
- bladder function
- lower body sensation.
The exact risk numbers are not known, but reports are usually isolated cases rather than common experiences. The birthing process, with deep pushing and drawing back of the legs, has occasionally caused tethered cord symptoms. Most resolve with rest and anti-inflammatory medication, but rarely women have eventually undergone a tethered cord release as a result of the birthing process.
Now that you have a beautiful new baby, its more important than ever you are still meeting your personal needs. Your local Spina Bifida Chapter should continue to serve as an added support.
Call upon family and friends to assist you with personal care-giving, house cleaning, laundry, and meal preparation.
You will need to schedule well child visits regularly and also your own medical appointments. Keep in mind, when scheduling appointments that you may need more time to get ready for you both.
You will need to make a six to eight week appointment with your OB. Discuss with your doctor any concerns you may have. It is important that you maintain a healthy lifestyle after the birth of your baby. Continuing vitamin supplements, good nutrition, and exercise will help you return to your pre-pregnancy weight.
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