Instructor: Terri Clinger
Maternal-Infant Nursing Spring 2013
John Tyler Nursing Program
Nursing Approaches to Care for a Pregnant Client with a Spinal Cord Injury
Women with spinal cord injuries may still desire to have children, but they may be anxious to become pregnant because of complications the spinal cord injury (SCI) can have on their pregnancy. Due to the limited amount of research on this topic, sources from several years back have been citied. Doctors have expressed the need to further explore this topic to offer healthcare providers with a better understanding in this area. Evidence-based practice has shown that most women with SCIs can safely delivery babies, where previous practice contraindicated women of this population to have children. Although this is considered a high-risk pregnancy, being aware of the problems that these women face will allow the nurse to provide safe and quality care to the client. Early interventions during a crisis such as autonomic dysreflexia will permit nursing personnel to counteract the possible life-threatening complications.
Most women in their child bearing years want to have children, and this is no different for women with SCIs. Because of the injury sustained by the body, doctors have delivered the fetus via cesarean section or have advised women not to have children at all. However, unlike men, women usually retain their fertility and are able to conceive. According to Dr. Mark Christopherson with the Physical Medicine and Rehabilitation at Mayo Clinic in Rochester, MN, about 14% of women with spinal cord injuries have at least one child (Mayo Clinic 2013). In the past, pregnancy was not recommended for a woman with SCIs because of the suspected defects with her reproductive system. But a woman’s reproductive organs usually function the same prior to the injury, despite the reduced mobility below the level where the lesion (nerve damage) is present (Mayo Clinic 2013). Another reason why healthcare providers advised against pregnancy is because their sensations are lowered, and they may not be able to tell when they are going into labor. The uterus will contract during labor, and a vaginal-instead of cesarean-delivery is possible (Klebine and Lindsey 2003). There are signs that the nurse can identify with the patient in order to determine if she is in labor. By knowing the potential dangers that these women face, nurses can properly care for pregnant women who have spinal cord injuries. Major complications associated with this pregnancy are autonomic dysreflexia, urinary tract infections, pressure ulcers, deep vein thrombosis and respiratory problems (Lee and Hickenbottom 2012).
Autonomic Dysreflexia Autonomic dysreflexia (AD) is a major concern for patients with spinal injuries, especially with lesions T6 (thoracic level 6) or higher. This is a complication that occurs when the sympathetic nervous system goes into overdrive because of a painful stimulus below the level of injury (Reeve Foundation 2013). The stimulus attempts to travel to the brain but it is stopped by the lesion on the spinal cord and causes a complex reflex. As a response, the blood vessels narrow, causing a dangerous increase in blood pressure. This is a life-threatening situation for the mother and fetus. Once the painful stimulus is removed, the body will return to its normal state if caught in time. The signs and symptoms of AD are high blood pressure, bradycardia, pounding headache, flushed face, diaphoresis, and nausea (Reeve Foundation 2013). Interventions for autonomic dysreflexia Nurses can teach clients the risk for AD, how to prevent it, and appropriate measures to alleviate it. There are many causes of AD including a full bladder, bowel impaction, changing a Foley catheter, pressure ulcers, restrictive clothing, major temperature changes, labor