Childbirth: Paralysis, not a hindrance –Doctors

Specialised medical practitioners have debunked insinuation suggesting that people with spinal cord injuries may not be able to bear children because of their disabilities. ISIOMA MADIKE reports

 

A –Doctors young woman, who identified herself simply as Gloria, shared her story to encourage other women who are paralysed and have little information on how paralysis affects the body during pregnancy and childbirth.

 

She said: “Just a few years ago I was ignorant to the realities of paralysis. I didn’t know what it meant to have a spinal cord injury or what that world was like.” Gloria said she had no such information when she decided to take the plunge to and become a mother. “In 1996, I had a car accident that resulted in a complete Spinal Cord Injury (SCI).

 

I was a very young girl at the time of the accident and like most young people, had many aspirations to fulfill. One of those wishes was to become a mother. This dream came true in 2007 with the birth of my first child: a healthy baby boy.

 

 

“It was February 2007 when my doctor told me that I had conceived and was to become a mum. I was so excited, happy and thankful that I was able to conceive naturally – not that there was any physical reason why I couldn’t. Initially, I went to a hospital (Spinal Unit) and from there I was referred to a Professor of Obstetrics

 

“In the first three months of pregnancy (trimester), I had many sleepless nights due to relentless nausea and experienced a general feeling of being unwell 24 hours a day. I can’t recall how many times I threw up! Being nauseous is a common condition during pregnancy and had nothing to do with my paraplegia.

 

 

“Another symptom was frequent urination and it drove me insane! I was fortunate that I did not get any bladder infections and hence no medication was required prior or during my pregnancy. As a result of the physical stress on my body, I began to feel emotionally drained, unfocused and moody.

 

“Even with these symptoms, I found the first three months of pregnancy relatively easy. I was able to work up until I was five months pregnant. I didn’t need any special treatment or help at this stage. In order to get a grasp on the things that were happening to my body, I bought a few books on pregnancy and the effects it has on a woman’s body. I was of the opinion that I was not any different to able pregnant women.”

 

She said that her posture began to suffer as her abdomen began to sit on her lap, pulling her shoulders forward. She had to constantly make a conscious effort to hold herself upright and not slouch over.

 

Red marks began to appear on her bottom due to the increase of weight and bad posture. “It became increasingly difficult to do my lifts to relieve the pressure off my bottom,” she said, adding, “my balance was all over the place. I could not take the risk of getting a pressure sore while pregnant so I began to spend extra time lying down. I noticed my bowel regime had changed. Prior to the pregnancy I was regular but now it had become more difficult. “At times, I was constipated and felt as if I was going to explode. I ate lots of fruit in an attempt to resolve the problem.

 

 

However this was only effective part of the time. I can’t recall if I had any bowel accidents.” The day before she went into labour she began having tingles about 4.00pm. At first, she thought she had to pass urine, as that is what the tingling sensation usually indicated for her. However, on this particular day the tingles lasted longer and they were much more intense. She called her husband on the phone when she got the second bout of tingles and explained to him what she was feeling.

 

Gloria said: “I remembered him saying that I must be going into labour and I replied ‘No I’m not! I’m not supposed to be feeling anything’. At this stage I thought I had better tell one of the nurses, who had been looking after me for the past four weeks, that I was experiencing these strange sensations. The nurse examined me and said I was dilating and should get prepared for birth.

 

“Later on that afternoon my doctor examined me and I had become even more dilated. In the evening I was taken to the delivery ward. In the early hours of the next day the tingling and sweats intensified and by 7:00 am I was in a constant sweat.

 

I had also started to develop a headache. It felt as if I was experiencing an extreme bout of hyper-reflexia. In the later phase of labour, every time I had a contraction my abdomen felt as if there was a herd of elephants stampeding and I was being trampled on. “The closer the contractions became, the worse I felt. I was in agony and could barely catch my breath.

 

 

With every contraction I began to push and was sweating profusely. At this time a group of nurses, who had looked after me, came in to gain insight on a paraplegic giving birth. With the help of forceps and an episiotomy, at 9:33 am, my son was born fit and healthy. All the pain had gone and the sweat began to diminish.

 

“The birth of my son was the most unbelievable experience I have ever had. I was overwhelmed with joy and happiness that I could bring a new life into the world. When I held him in my arms for the first time I began to question my ability to look after him. I am so glad that I did not miss out on the motherhood experience because of paraplegia.”

 

However, women are not alone on this as there was also a story of a popular gospel singer, Yinka Ayefele, who had triplets 22 years after spinal cord injury. When, three years after the accident that damaged his spinal cord and left him permanently on the wheelchair, the said musician got married to his heartthrob in the year 2000.

 

Many questioned if the man and the woman signing up for a lifetime of love knew what they were doing. Fate proved everyone wrong when the man announced the birth of his triplets to the bewildered audience via a live programme on a popular radio station in Ibadan.

 

Said to consist of two boys and a girl, Ayefele made the confirmation in a programme titled “Let’s Talk About It” which he anchored with another person shortly after reports began circulating that the famous musician is now a father of triplets. The confirmation however, came barely a month after he was forced to deny a trending story that his wife had given birth to triplets.

 

This may be the reason why the announcement further left many people confused. But, such sweet stories of those confined to wheelchair are not common everywhere. For some, their stories took a different pattern. Bridget, in her early ‘40s, for instance, had an accident a few years ago, which cramped her to a wheelchair.

 

She was newly married at the time but her husband, Olayemi, was quite supportive. In spite of Bridget’s paralysis, Olayemi provided all that could help her pretty wife live well. “I didn’t see what happened to her as an impediment to our marriage in any way or having children.

 

Though there are things one would have loved to see and enjoy in marriage which was absent right from the time the accident happened,” Olayemi said. Little wonder, pressure sets in after seven years in the union without a child of their own.

 

“Our inability to have a child naturally pitched my husband against his parents as they wanted him to marry someone they believe could give him a child. To solve this debacle, we had to agree to adopt in other to calm nerves and the trick worked. So, as I speak with you now, we have two lovely girls via adoption, and the way we went about it, many really did not understand what happened.

 

We did it as if the children came naturally,” Bridget told Saturday Telegraph, smiling. Reacting to the possibility of those paralysed having their own children, a public health physician, Professor Bayo Onajole, said that having spinal cord injury does not prevent people from having children.

 

Though he said that depends on the level of spine that has the injury. “If the injury is not above certain point, it may not affect the reproductive organ, it’s just that it affects the muscles of the leg. So, that does not exclude the person from having children. However, there are other methods of having children like the In-vitro Fertilisation (IVF) technology where the sperm can be extracted and used to fertilise the egg.

 

In another scenario, doctors have various terms as long as there is an agreement between the two that is concerned and the female party is impregnated and then can also have children,” Onajole, a doctor from the Lagos University Teaching Hospital (LUTH), said. He however, said that such special people could chose to have a biological children or through adoption. The decision, he said, depended on the couple and the state of their minds.

 

Those without such injuries, he added, could also decide to have their children through adoption. To him, there is nothing special about that. “The difference of what you want is the state of your mind. The persons with spinal cord injury could perfectly have children provided the injury does not affect their reproductive organs. However, if there are other issues, technology- assisted birth could be employed to help, especially for the woman.

 

Generally, they can have normal intercourse like any other person even though they may not be able to feel the same sensation like those without such injuries, which is understandable,” Onajole said.

 

 

Another Consultant Neurological Surgeon, Dr. Biodun Ogungbo, also said pregnancy was relatively safe in women with Spinal Cord Injury (SCI). However, disability-related issues, he added, could be exaggerated during pregnancy, delivery and post-partum periods. Thus, understanding common issues related to pregnancy in this population, according to him, is important.

 

Though he said specialised obstetric care with rehabilitation input throughout antenatal and postnatal care was crucial for the overall outcome of a pregnant woman with SCI. Ogungbo said: “Yes, it is possible for people with SCI to bear children like any other person and have them like normal people without injury. Everything depends on the couple and also depends on the type of injury.

 

People that have those injuries have control of their passing urine and erection and could still have their ability to have intercourse. “Don’t forget, regardless of whether they have such an injury or not, they still have their organ for reproduction. So, even if the man does not have an erection, the doctors have a surgery to get that happen and be able to disseminate into the woman.

 

 

 

That way, the couple can have a child through assisted birth like IVF technology. “If the woman is the one that is paralysed, it will mean that she might not be able to feel the penetration or total sensation of intercourse, but all her organs are there. So, she can still be impregnated if the man is active.

 

She could carry the pregnancy like any normal person but this time she may have to deliver the baby via injection to push the baby out.”

 

For Dr. Waheed Abayomi, managing director of Crest Hospital, Egan-Igando, Lagos, people with paralysis could totally be intimate and enjoy sexual life as others. “I don’t want to get graphic or anything but let’s think about the anatomy of the human body for a second. “It’s not like shop closes up down there just because you are paralysed. Is feeling compromised? Well for some, absolutely. But often times other erogenous zones become even more sensitive in this case.

 

Research has also discovered that there are nerves associated with sexual pleasure that completely bypass the spinal cord. “Paralysis affects feeling and movement, not the uterus. There are factors that would make it difficult for them such as low blood pressure and nerve pain.

 

Pregnancy is relatively safe in women with SCI. However, pregnant women with SCI experienced 25 per cent more complications compared to able-bodied women. The complications encountered are usually related to the disability. “Impaired sensation makes the presentation of labour in SCI unique.

 

They commonly complain of pain either above the level of injury or a nonspecific pain, rupture of membrane, occurrence of autonomic dysreflexia, increased bladder spasm or increased spasticity without other obvious cause.

 

Therefore, daily vaginal examination should be advocated from 32 weeks of pregnancy. Although relative number of women with SCI may experience the same labour symptoms as non-SCI women do. “Half of the women with SCI do not require analgesia during labour.

 

However, when indicated, especially to prevent autonomic dysreflexia, regional analgesia is proven effective. The autonomic dysreflexia management during labour will require a thorough assessment to remove the noxious stimuli, positioning, close monitoring of blood pressure and conventional management using fast-acting antihypertension when all failed.

 

“Due to the concern of pure autonomic dysreflexia during labour, cesarean delivery is not a recommended method of delivery, except for poor hypertension control despite maximum effort.

 

 

Early anticipation and preventive intervention is crucial,” he said. The doctors however agreed that more than half of the women with SCI successfully delivered vaginally either spontaneously or assisted with vacuum or forceps. Cesarean section rate, according to them, is higher by 9.5 per cent when compared to pre-injury status; nonetheless, there is no elaboration on the indication, they said, except for higher fetal malpresentation and prolonged second stage.

 

Precaution, they also said, should be imposed on regular turning to prevent development of pressure ulcer. In view of some unforeseen challenges, most people who are paralysed via spinal cord injuries take to adoption while others prefer surrogacy. The word, which comes from the Latin word “subrogare”, means to substitute. The process of using a surrogate mother to have a baby is tricky and so many argue that it is not right.

 

But, some have also argued that it is an option for a woman, who cannot carry a baby for a number of medical reasons. In the traditional surrogate, a woman gets artificially inseminated with the father’s sperm (or a donor’s sperm).

 

Then she carries the baby and delivers it for the couple to raise. A traditional surrogate is the baby’s biological mother because it was her eggs that were fertilised by the father’s sperm.

 

The second is known as gestational surrogate. This is usually through IVF. In this form, eggs will be gathered from the mother, fertilised with the father’s sperm, and then place the embryo into the uterus of another woman (gestational surrogate). She then carries the baby until birth. A gestational surrogate has no genetic ties to the child at since it wasn’t her egg that was used.

 

 

Although she will still be called the birth mother, the mother whose egg was fertilised, is the biological mother.

 

This is less legally complex, and the gestational surrogate can’t be of any trouble in the future.

 

Even though this practice raises the hope of the infertile couple, especially where natural conception is impossible, like women with severe uterine factors, opinions are still divided on the morality, legality and ethics of surrogacy. While proponents point to the validity of informed contract between surrogate mothers and intending couples as well as the hope given to childless couples, opponents say that the practice is dehumanising and exploits a vulnerable population.

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