Question of the Month: I have Spina Bifida and I am pregnant now. What type of delivery should I expect – natural or C-section. Will I be able to have an epidural if I choose to? Are there any long term effects after I have the child?

Congratulations on your pregnancy! Continue taking 4mg of folic acid daily through the first 3-4 months of your pregnancy to maximize the health of your baby.

Type of Delivery
The type of delivery depends on multiple physical factors, including:

• sensation level,
• ability to push with pelvic muscles,
• size of the pelvis, and the
• 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.

Delivery options
Women with 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, and
• 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.

Plan before you try to get pregnant
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.

For more information on the genetics and factors associated with Spina Bifida, please visit the Spina Bifida Association fact sheet.

Interested in submitting a question for Question of the Month? Email us at sbaa@sbaa.org.

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