Pregnancy

Pregnancy care for people with spinal cord injury (SCI) requires specialised support due to a higher risk of secondary complications. Routine monitoring differs from that of standard pregnancies. Referral to a high-risk pregnancy clinic is recommended for personalised assessment and management.

Preparing for pregnancy 

Gynaecological check-up: A long appointment is recommended. This can be arranged through a GP and may include a cervical screening test, review of immunisations, family history, and screening for genetic conditions (if indicated).

Medication review: Some prescription and over-the-counter medications may not be safe during pregnancy or while trying to conceive. This review can be done with a GP, obstetrician, or spinal injuries rehabilitation specialist.

Renal check-up: Annual renal surveillance should be up to date before conception. A complete assessment of the kidneys, bladder, and ureters should be conducted before conception. X-rays may be required, but timing is important as they pose risks during pregnancy.

During pregnancy 

The body will experience many changes during pregnancy. As the pregnancy progresses, SCI-specific considerations should be monitored:

Bladder

• Pressure from the growing uterus may increase the risk of urinary leakage due to reduced bladder capacity.
• Consideration of insertion of an indwelling catheter may be necessary for those that would normally perform intermittent catheterisation, due to increased difficulties accessing the urethra to perform this task.
• Urinary tract infections (UTIs) are more likely and can lead to early labour if untreated.

Bowel

• Increased risk of constipation and hard stools.
• Haemorrhoids may develop due to constipation or labour strain.

Skin

• Pressure injuries can result from weight gain, posture changes, and reduced ability to perform skin checks or pressure relief.
• Consider different cushions or mattresses for better pressure redistribution and support.

Autonomic dysreflexia

• Pregnancy and labour may trigger autonomic dysreflexia (AD) in people with injuries at the level of T6 or above.
• Epidural anaesthesia during labour may be considered to help prevent or reduce autonomic dysreflexia.

Spasticity

• Triggers below the level of injury may increase spasticity.
• Medication changes can also affect spasticity levels.
• Some medications used for spasticity may need to be reduced or ceased during pregnancy and this should be discussed with a specialist.

Oedema

• Increased risk of developing oedema later in pregnancy.
• If there are concerns about lower limb swelling, see venous thromboembolism section below.

Mobility, balance and transfers

• The shifting centre of gravity may affect mobility, balance and transfers.
• Transfer methods, routines and equipment may need review to optimise safety (e.g., use of slide boards, electric beds or care supports).

Hypotension (low blood pressure)

• Monitoring for symptoms is required.
• If present, consider conservative measures, such as:
  • increasing fluid intake
  • encouraging gradual movement, especially in the morning
  • hiring a power wheelchair with tilt-in-space, if needed.

Venous thromboembolism

• Risk of VTE increases due to fluid retention, vasodilation, and reduced mobility.
• Monitoring for signs of venous thromboembolism (VTE), especially post-partum, is required.

Respiratory function

• The growing uterus can place pressure on the diaphragm, impacting respiratory function, causing shortness of breath, especially with exertion.
• Postural re-assessment and adjustments to wheelchair set-up are commonly required.

Pain

• In some cases, there may be an increase in neuropathic pain, below the level of injury.

Fatigue

• Fatigue is common, encourage a balance of activity and rest.
• Consider screening for anaemia if fatigue is ongoing.

Mental health

• Support should be available to address both emotional and physical stressors.
• Screening for existing mental health conditions and for pre-/post-natal depression is important.

Sleep and positioning

• Side-lying will reduce pressure on the major blood vessels, especially from the second trimester.
• Sleeping with the head slightly elevated can help with indigestion and skin checks.

Planning the birth  

Collaborating closely with the maternity care team enables informed decision-making and helps develop a birth plan tailored to the individual’s needs.

Planning may include consideration of the following options: 

• Waiting at home for labour to begin may be appropriate if the person has sensation in the abdomen or pelvis.

• Planned hospital admission before labour starts, depending on the level of impairment and any secondary conditions. Options may include:
  • Admission before the due date for monitoring labour onset.
  • Induction of labour with early epidural use to reduce the risk of autonomic dysreflexia in individuals with SCI at or above the T6 level.
  • Planned Caesarean section, if medically indicated.

Additional considerations for hospital care are:

• Accessible bathrooms.
• Specialist equipment (e.g. hoist, pressure-redistribution mattress, mobile shower commode chair).
• Support from the person’s regular care providers, if needed.

Post-partum care 

After birth, ongoing care should address:

• Recovery from Caesarean section and safe return to activities like transfers and driving.
• Monitoring for venous thromboembolism due to vasodilation, fluid retention and, in some cases, reduced mobility.
• Managing vaginal stitches, swelling, discharge, and skin care, especially when using a wheelchair.
• Resuming usual bowel and bladder routines.
• Vigilant skin monitoring.
• Practicing parenting tasks in a supported setting to build confidence
• Breastfeeding – the initiation of the milk-ejection (“let-down”) reflex may be affected by reduced or absent nipple sensation. However, the reflex can also be triggered by psychological cues, such as hearing a baby cry or thinking about the baby, which may stimulate oxytocin release, even without direct nipple stimulation.