Women with disabilities who want to become mothers are forced to overcome not only social barriers, but also often encounter prejudices and judgments in their surroundings. There is a general assumption in our society that if a woman is "worried about herself" she will not be able to take care of her child. However, people often do not realize that many women after a spinal cord injury live completely independent lives and that their handicap does not prevent them from raising their children. In fact, their children live with him quite naturally and naturally.
Women after a spinal cord injury have certain limitations during pregnancy and after the birth of a child and often need special support, but this certainly does not mean that they cannot become and be good mothers!
Let's look at the pregnancy of women after a spinal cord injury together from several angles.
PREGNANCY AFTER SPINAL CORD INJURY
TEXT: Petra Hladíková, general nurse at the Paraple Center, Iva Hradilová, occupational therapist at the Paraple Center, Jiří Kříž, head of the spinal unit of the Faculty Hospital in Motol
A woman after a spinal cord injury who wants to become a mother may ask herself and those around her whether it is okay, whether she will be able to take care of her child properly, or whether her child will be born healthy. However, it should be emphasized that such uncertainty and doubts are not typical only for women with disabilities. Almost every mother-to-be, especially one who is waiting for the mother role for the first time, thinks about such and similar questions.
A large part of all pregnancies are physiological. Only one quarter to one third
pregnant women will experience risk factors that can influence to a large extent
physiological course of pregnancy. Therefore, it is very important that every pregnant woman attends a prenatal consultation, where she will be given all the necessary preventive examinations, the aim of which is to prevent the development of a pathological pregnancy.
Pregnancy is often said to be one of the most beautiful stages in a woman's life. Sometimes yes sometimes no. In any case, however, from the point of view of various events and processes, it is not a simple period. The mother's body changes during pregnancy, and conditions appear that "first-time mothers" in particular do not know and are not used to. Therefore, it is really advisable to surround yourself with quality care, both medical and non-medical.
Women after a spinal cord injury should find a doctor and other specialists who have experience with clients with this diagnosis, and thus get the opportunity to consult a spinal doctor, spinal urologist, physiotherapist and occupational therapist about their condition. All this will help prevent possible complications or solve them correctly.
Planned pregnancy
It is always better for a woman to prepare her body for the arrival of the baby. This is doubly true for women after spinal cord injury. Given that many of them are taking some medication, e.g. to relieve spasticity, for pain, affecting the bladder, etc., it is very advisable to visit the spinal unit and consult the possibility of adjusting the medication in advance. It is also a good idea to adjust the weight or method of emptying in advance, see below.
Unplanned pregnancy
Given that a woman's reproductive function is not primarily impaired after spinal cord injury, it can easily happen that an unplanned pregnancy occurs in the event of insufficient use of contraception. In such a case, it is necessary to visit not only your gynecologist as soon as possible, but also the spinal unit for the above-mentioned adjustment of medication and consultation of other questions.
Something about birth control
TEXT: Hana Vatěrová, physiotherapist at the Paraple Center
There are many ways to prevent unwanted pregnancy, but each of them has its own but:
- Probably the easiest way to prevent pregnancy is to use a condom . However, it is entirely up to you and your health condition whether you will tolerate its use, either because of its material (latex) or for other reasons.
- Spermicide gels, foams and membranes they are subject to state control before or during intercourse, or even after it, so as a rule a partner must be involved.
- Use oral contraceptives (tablets) is relatively convenient and reliable, but it is associated with an increased occurrence of complications of the venous system, inflammation of the veins and blood clots, especially in women after a spinal cord injury.
- Intrauterine bodies can cause irritation or injury to internal organs when they move unintentionally. The impossibility of self-control is also a problem. Body slippage can cause protection that you don't know about to malfunction, or worse, an injury that you neglect.
- Contraceptive injection administration may seem like a suitable option to prevent pregnancy, but it should be noted that it also restricts menstruation and the normal hormonal cycle.
- Implantation of contraceptives in patch form may be a well-tolerated option. However, even here it is a disruption of the hormonal cycle with a possible influence on its course, which can further cause problems with menstrual management.
- Surgical ligation of the fallopian tubes is a sure but definitive method. It should therefore only be indicated if you are definitely not planning to become pregnant. A partner can also undergo a similar operation. In that case, it is a vas deferens .
Women after a spinal cord injury are advised to consult a spinal doctor regarding appropriate contraception and conception. In any case, you should continue to visit your gynecologist and undergo regular gynecological (and other recommended) examinations.
The most common complications of women with spinal cord injuries during pregnancy
Urological problems
- Complications occurring due to reduced bladder capacity
These complications cause frequent leakage of urine and a disproportionately high frequency of intermittent catheterization. Moreover, it becomes difficult due to the gradual change in anatomical conditions. The solution is usually the introduction of a permanent urinary catheter (PMK). However, its presence can be perceived negatively, due to the feeling of loss of achieved self-sufficiency, violation of intimacy or discomfort due to an obstacle in hygiene, dressing or mobility. In addition, with the introduction of PMK, the risk of developing a urinary tract infection increases.
- Urinary tract infection
It is the most common complication that can lead to hospitalization. Therefore, it is important to send the urine for microbiological examination every 2-3 months so that the correct antibiotics can be used if an infection develops. In case of symptoms of infection or any doubts, the condition should be consulted immediately with a spinal urologist.
- Vesicostomy and epicystostomy
With these methods of emptying the bladder, due to the change in anatomical conditions, difficulties may arise with the introduction or replacement of the catheter. Therefore, it is necessary to inform the urologist when becoming pregnant and to use a catheter through the urethra in case of unexpected complications.
Difficulty emptying the bowels
As pregnancy progresses, there are changes in the placement of internal organs, this also applies to the intestines. The most common complication is constipation, which should be solved by adjusting the diet, gentle laxatives to soften the stool or changing the mode of emptying, for example by using enemas.
Vegetative difficulties
Autonomic dysreflexia (AD) occurs in clients with spinal cord injury above the sixth thoracic vertebra. It mainly occurs during childbirth, but it can also occur during pregnancy. "Just" fetal pressure can also be the cause.
It is important for the doctor to rule out preeclampsia in the client, which affects 7% of all pregnant women. Like AD, it is manifested by increased blood pressure, but unlike it, it is accompanied by tachycardia.
Effective treatment of AD consists in removing the cause of its occurrence (e.g. kinked or blocked urinary catheter, incipient hemorrhoids, constipation). However, if the precipitating cause is fetal pressure, then it is necessary to temporarily change some habits and movement stereotypes. Here, too, it is best to contact a spinal doctor.
Spasticity
Spasticity symptoms may worsen during pregnancy. In general, it is recommended to discontinue antispasmodic medication before the planned conception. Therefore, any irritation can subsequently trigger a spastic reaction. Again, the growth of the fetus can cause irritation.
Although Baclofen has not yet been proven to have a negative effect on the fetus, it is always up to the doctor to weigh the benefits and risks that any medication can bring. If a woman has a baclofen pump installed, then the amount of active substance administered is much lower than with tablets. However, a planned pregnancy is certainly not a reason to introduce a baclofen pump.
Respiratory difficulties
As with the general population, the vital capacity of the lungs decreases and respiratory functions deteriorate due to the enlargement of the uterus in pregnant women with a spinal cord injury. If you develop a feeling of shortness of breath, you should contact a spinal doctor.
Vascular problems
Pregnancy and immobility during pregnancy increase the risk of thromboembolic disease. However, this complication is relatively rare, so preventive examination or treatment is generally not recommended.
Pressure ulcers and pressure sores
As weight increases during pregnancy, the risk of pressure ulcers also increases. These arise primarily in connection with the insufficient width of the wheelchair or an unsuitable seat cushion, etc. Even driving a car for a long distance without a seat cushion is risky. A spinal occupational therapist can advise on the selection of suitable aids.
Due to possible more frequent leakage of urine, even sitting in a humid environment can be risky, so it is recommended to check this area more often.
System of care for a pregnant woman after spinal cord injury
Care during pregnancy is provided by a gynecologist, who performs or sends for examinations in the framework of the prevention of disease states and early detection of deviations from the physiological course of pregnancy.
Every pregnant woman should undergo some examinations during pregnancy. Cardiotocographic recording (so-called CTG), blood pressure measurement or urine examination for the presence of protein, sugar and ketone bodies are used in prenatal consultations according to the doctor's office for the early detection of congenital developmental defects and the detection of maternal diseases. The doctor also notices any swelling and asks about the movements of the fetus and the subjective feelings of the woman.
The gynecologist of a pregnant woman with a spinal cord injury should be familiar with the issues of this diagnosis and thus possible specific complications. Therefore, its selection is really very important. However, it is always advisable to consult the above-mentioned possible complications also with spinal specialists.
Preparation for childbirth
Some women with a spinal cord injury end their pregnancy by caesarean section. The reasons are various - unstable pelvis, the possibility of labor not progressing, worsening of stress incontinence, concerns about autonomic dysreflexia, etc. Spontaneous birth is, however, possible for most women.
Choosing a suitable maternity hospital plays an essential role in preparing for childbirth. We already consider the fact that it will be barrier-free completely normal. However, it is highly recommended that the selected hospital also includes a spinal unit.
During the first visit to the maternity hospital in the 36th week of pregnancy, the midwife takes a personal medical history. During this consultation, it is necessary to agree in detail what level of help the expectant mother needs. And it is also very important that the woman is sufficiently familiar with everything that will be performed on her during the examination or during hospitalization. Therefore, don't be afraid to ask everything that comes to mind and interests you!
Pregnancy from beginning to end, or the practical view of an occupational therapist
TEXT: Iva Hradilová, occupational therapist at the Paraple Center
At the outset, I will allow myself to be a little personal. At the time I am writing this post for you, I am finishing my second pregnancy myself and I am trying to pack my bag for the maternity hospital and not forget anything. What documents to prepare and what items related to hygiene and baby care must be taken with you? I think I can give you some recommendations based on my own experience.
For my birth, I again chose the University Hospital in Motola, which is barrier-free, so I will have up-to-date information for you in this regard as well for the next part focused on childbirth and postpartum.
But even without that, there are certainly enough things that are good to mention.
Changes during pregnancy
Sit down
If you are entitled to a new mechanical wheelchair in the near future and are planning to conceive at the same time, it is good to think in context. By this I mean choosing the stroller and its components so that there is at least a partial possibility of modifications when you need them during pregnancy. You have to take into account that your body will change during pregnancy (especially the center of gravity) and that these changes will last up to a year after giving birth, sometimes even longer. And that is quite a long time after all.
If you do not know how to adjust the wheelchair, contact the ergotherapists of the Paraple Center. They will help you not only with adjusting the seat settings, but also, if necessary, with finding suitable aids to borrow, either directly from the Paraple Center rental office or from other organizations.
Self-sufficiency
From the beginning, it is good to think about the fact that the increased demands for assistance or help from those close to you do not only concern the last trimester, but the entire course of pregnancy. In the first trimester, all pregnancies are considered risky, so don't be afraid to ask for help and take it easy.
At a higher stage of pregnancy, even normal activities will become more demanding for you, so I warmly recommend that you include more help from assistants, family and loved ones in your daily routine, and also use aids to facilitate your functioning.
Expectant mothers at risk of developing autonomic dysreflexia (damage to the spinal cord above the Th 6 vertebra) must be careful. This risk increases as the fetus grows, and the only way to eliminate or at least significantly reduce the risk is to change the position from sitting to semi-sitting or lying down for a long time. As a result, however, the demands for care from the neighborhood naturally increase considerably.
Emptying
During pregnancy, women with a damaged spinal cord very often switch to a different style of emptying, especially the bladder. Although they have not used it before, they have a permanent urinary catheter inserted. For more on this issue, see Pregnancy after spinal cord injury .
From the occupational therapist's point of view, I also have to draw attention to the possibility of a defect arising due to an increase in humidity in the sitting area, caused by leakage of urine, especially in the later stages of pregnancy. Therefore, if you do not have sensitivity in the sitting area, you need to include more frequent checks and also use incontinence aids (incontinence panties, insert diapers or pads).
Preparing for the maternity ward
What all needs to be arranged and packed before you set off on your journey to the maternity ward? I will divide this area into several parts - gathering the necessary documents, choosing a pediatrician and preparing the "bag".
When choosing a maternity hospital, find out in advance whether access to the toilet and shower is barrier-free, or whether it is possible to rent a shower trolley.
In the Faculty Hospital in Motola, there are barrier-free, high-standard rooms where your partner or companion can stay with you. If you have this option in any maternity hospital, use it, it is a huge bonus and a help at the same time.
Every maternity hospital informs you about what you will need when you are admitted to give birth, usually during registration (which, for example, takes place in Motola from the 14th week of pregnancy), or during antenatal check-ups. The requirements and the control system may differ slightly in individual maternity hospitals. If something is not clear to you or you do not have enough information, do not hesitate to ask.
Documents
There are quite a few documents that you will need and you will have to arrange some in advance at the office. Think about not stressing yourself unnecessarily at the end of pregnancy.
Married women
Identity card, insurance card, marriage certificate, pregnancy certificate, agreement on the child's name signed by both parents and the results of specific examinations focused on the development of the fetus and your state of health carried out during pregnancy.
Single women
Identity card, insurance card, birth certificate, pregnancy card, agreement on the child's name signed by both parents, proof of acknowledgment of paternity (issued by any registry office in the Czech Republic) and the results of specific examinations focused on the development of the fetus and your state of health carried out during pregnancy.
Divorced women
Identity card, insurance card, birth certificate, divorce certificate, pregnancy certificate, agreement on the child's name signed by both parents, proof of acknowledgment of paternity (issued by any registry office in the Czech Republic) and the results of specific examinations focused on the development of the fetus and your state of health carried out during pregnancy.
Pediatrician
Don't forget that you need to know the name of the child's future pediatrician even before the birth of the child. Choosing a doctor with regard to his professional and personal approach is a challenge in itself. However, you must also ask about other things - is the access to the doctor's office barrier-free, is the space in the doctor's office adapted so that you can undress the child before the examination, or does the selected pediatrician provide a home visit service?
"Bag"
With a little exaggeration, it can be said that this is the culmination of your pregnancy and preparations for childbirth. That is why I dedicate a relatively large space to this area.
Hygiene supplies
Disposable panties . After giving birth, maximum hygiene must be observed, so take plenty of them with you. You can use mesh panties with maternity pads, but the experience of some of our clients advises you to use classic stretch incontinence panties (you'll just need more of them). These may be more suitable due to easier handling during deployment, but also adjustment after moving. Also, don't forget to take with you the emptying aids that you normally use and one incontinence pad , even if they will probably provide you with one at the maternity hospital.
Also take at least two towels , ideally of different colors (one for the upper and the other for the lower half of the body). Furthermore, a toothbrush , paste , shower gel , shampoo , toilet paper , bra pads , deer tallow , unscented cream and mild deodorant . Leave the perfume at home, the baby needs to get used to your natural scent and it would also irritate him.
Clothes
In many maternity hospitals, some things are routinely available to patients, such as nightgowns . However, if you decide to make your own, count on at least three. At least two underwired nursing bras are also suitable . And due to the necessity of frequent showers, consider whether it would not be advisable for you to also equip yourself with rubber boots to prevent skin defects when moving .
Breast feeding
Some obstetricians recommend carrying your own breast pump , which has the task of stimulating the breasts and supporting the production of lactation, which can also be influenced by the style of delivery. Also pack nipple cream . They tend to be sensitive after birth and it takes a while for them to get used to the contact with the baby's mouth. Homeopathy to support milk production and postpartum recovery are also not out of the question.
Child care
baby diapers , as you will have them available in your room, as well as regular baby cosmetics , thermometers (both baby and water) , scale and navel alcohol . You can use your own clothes and diapers , but you don't have to. If you decide to use an errant, you will not have to worry about washing.
So the only clothes you will really need for your baby will be for the trip home. Here, the weather must be taken into account, which can change significantly in the course of a few days in the maternity hospital. However, a simple rule of thumb is that a newborn needs one more layer of clothing than you do.
And if you are not opposed to pacifiers , then pack one too, just don't forget to boil it beforehand.
Other essentials
Medicines that you take regularly, a phone, possibly a camera, a charger, a notebook and a pen.
WOMEN TO WOMEN
TEXT: Lenka Honzátková, specialist in spinal issues at the Paraple Center
Mutual female support from the family or the community was historically a common practice, when experienced women accompanied pregnant, birthing and six-month-old women and passed on their experiences to them. It was a woman's thing.
Modern times are more professionalized and community women can replace midwives and doulas. Want to know more about their services?
Midwife
She is a university-educated healthcare professional. As in other countries of the European Union, here, too, it takes care of women with physiological pregnancy, childbirth and the postpartum period. You can meet a midwife in a maternity hospital, a gynecologist's office, midwifery centers or she can visit you at home. The range and scope of her care are determined by the place where she works.
What does a midwife do?
- During pregnancy
- conducts pregnancy counseling and antenatal courses
- supports a healthy pregnancy
- prepares you for childbirth and the arrival of the childconsults with you about the birth plan
- supports you in difficult situations
- offers you the possibility of pregnancy exercises and massages
- During childbirth
- he will help you time your departure to the maternity hospital
- he will accompany you to the selected maternity hospital
- cares for you and supports a smooth and safe delivery for you and the baby
- helps you relieve pain
- supports bonding and breastfeeding
- In the puerperium
- supports you and your family at home
- provides lactation counseling
- supports the healing of possible birth injuries
- offers exercises in the puerperium
- provides advice on child care
- provides medical care in the event of an ambulatory birth
- Doula
- A doula is one of the non-medical helping professions. It complements the work of midwives, doctors, nurses as well as psychologists and other professionals. It accompanies women and their families through pregnancy, childbirth and the postpartum period. With his work, he contributes to a good start for the entire new or newly extended family. According to scientific studies, the care of a doula has a significant positive effect on the physical and psychological health of the mother.
- What does a doula do?
- In pregnancy
- provides the woman with support and enough information to make independent decisions and
- maternal competence, so that she can go through this important period of her life strengthened and with the feeling that she has managed it well
- During childbirth
- creates a pleasant atmosphere
- provides psychological support, encourages and helps with pain relief
- she is ready to support every woman, no matter what kind of birth she chooses, or how the birth develops
- if the woman is accompanied by a partner or relative or friend, then the doula becomes a support for them as well
- During the six-month period, but also later after the birth of the baby
- it makes the sometimes difficult beginnings of motherhood easier for a woman
- supports a woman in her maternal competences and in contact with the baby and gives practical advice on breastfeeding and baby care
- helps the woman to relax and gain strength
- can help in the home, with older children or perhaps cook
- he accepts the woman with understanding, as she is, and listens to her patiently
The group of producers of the series Woman intimately approached the Czech Association of Doulas and the Union of Midwives, and in the coming months they will jointly address the possible support of mothers after a spinal cord injury and their families.
Resources:
https://www.unipa.cz/
https://www.duly.cz/
NUTRITION IN PREGNANCY
TEXT: Aneta Sadílková , nutritional therapist, 3rd internal clinic of the 1st Faculty of Medicine, UK and VFN in Prague
Already during the first nine months of life spent in your womb, the baby can be given the best possible start in life and the best can be done for his future health. Your mental well-being, health and nutrition before and during pregnancy play an important role.
Before pregnancy
If your pregnancy is planned, ideally the goal is to positively impact your health and fitness as much as possible.
Quitting smoking completely and significantly reducing or preferably eliminating alcohol is the number one principle. If you suffer from a chronic disease that requires a special diet (e.g. celiac disease), this diet should be followed as best as possible. If you are overweight or underweight, your goal should be to at least approach a healthy weight range.
In order to lose weight, it is certainly not advisable to choose a strict reduction diet or one of the fad diets with the elimination of important food components, such as sources of carbohydrates (bakery, side dishes, fruit, etc.), sources of quality proteins (meat, eggs, dairy products) and fats (vegetable oils , nuts, etc.).
It is recommended to increase the intake of folic acid even before pregnancy. Its good natural source is leafy vegetables, but as a rule, a dietary supplement must also be taken . Regarding the use of folic acid, but also vitamin D, calcium, iron, iodine or omega-3 fatty acids, it is a good idea to consult a doctor or pharmacist.
1st trimester
In the first trimester of pregnancy, there is no need to increase the intake of energy or nutrients.
Recommendations for the diet of pregnant women in this period do not fundamentally differ from the period before pregnancy. It is important to eat high-quality and varied food, which ensures the intake of all important nutrients, vitamins and minerals. Thanks to this, it is possible to positively influence the child's genetics and prevent the development of some diseases in adulthood (high blood pressure, diabetes, etc.). In this period, as a rule, folic acid is also taken in the form of a dietary supplement.
Because of nausea and loss of appetite, energy intake tends to be lower in the first weeks of pregnancy, and you may even lose weight, especially if you were overweight. But this does not endanger the pregnancy in any way.
Nausea of pregnancy
The period of the first two to three months of pregnancy is accompanied by minor or major nausea, loss of appetite, and sometimes vomiting in most women.
In that case it is good to:
avoiding places and foods with smells that do not make you feel good,
drink enough fluids (at least 1.5-2 liters/day),
eat regularly in smaller portions,
2nd and 3rd trimester
In the second and third trimesters, the need for energy and nutrient intake increases as the fetus develops and grows more intensively. During this period, your weight is also naturally increasing. Loss of appetite and nausea usually no longer occur, on the contrary, there is often a tendency to increase energy intake too much, which is not desirable.
It is necessary to ensure a sufficient intake of proteins, fats (especially unsaturated ones, including omega-3 fatty acids), vitamins and minerals. There are increased requirements for the intake of calcium, magnesium, iron, iodine, zinc, folic acid and vitamins D and C, which is why some of these elements are usually taken in the form of food supplements.
"Eating for two" is a myth, or a pregnant woman should not eat for 2, but only for 1.14
Eating for two during pregnancy has no justification. Rather, it is necessary to think of a "meal for two" in terms of the quality of the diet and the choice of food . A baby can't decide what to eat, so it's up to you to provide it with everything it needs for its proper growth and development.
Recommendations for optimal energy intake in pregnancy vary according to different expert advice. According to the World Health Organization (WHO), it should increase by 285 kcal (1200 kJ) per day throughout pregnancy. According to other recommendations, daily energy intake should be increased by 10% in the second trimester and by 25% in the third trimester.
The need to increase energy intake during pregnancy is to some extent very individual and depends on several factors, such as your pre-pregnancy weight or physical activity during pregnancy. It is good to follow your own feeling and also monitor weight gains. While pregnant women with overweight and obesity should have smaller weight gains, women with a normal weight should not exceed the specified weight gains.
What does it mean in practice to increase daily energy intake by 285 kcal?
Most women do not have an idea of the energy value of the foods they normally consume, and therefore the recommendation to "increase daily energy intake by 285 kcal (1200 kJ)" may be meaningless. In practice, however, it can be imagined, for example, as adding one larger snack.
If you were used to eating three times a day, then this means adding two smaller or one large snack between the main meals. If you were used to eating five times a day before pregnancy, you can only slightly increase the portions of meals, or instead of smaller snacks (e.g. an apple) include larger ones (e.g. bread with cheese and an apple).
It is definitely recommended that you get an idea of the energy value of foods and their nutrient content, ideally by writing down a menu before or during pregnancy. Applications that enable the calculation of energy and nutrient intake are very suitable for this (e.g. www.kaloricketabulky.cz ).
Examples of a suitable snack with an energy content of 1000-1200 kJ:
200 g white yogurt (4% fat) + 100 g banana
150 g white yogurt (4% fat) + 75 g blueberries + 20 g nuts
50 g rye bread + 30 g Lučina + 150 g apple
Pregnancy cravings
For the prevention of pregnancy cravings or their mitigation, we recommend above all sufficient sleep, a drinking regime and a regular eating regime. The main meals of the day (breakfast, lunch, dinner) should consist of high-quality sources of carbohydrates (rye or whole grain bread, legumes, potatoes, oatmeal, etc.) and proteins (meat, eggs, milk and dairy products). Adequate intake of fiber from carbohydrate sources and from fruits and vegetables also helps to moderate blood sugar fluctuations.
Important components of the diet
Proteins
During pregnancy, it is recommended to increase protein intake slightly, from the usual 0.8-1 g/kg body weight to 1.1 g/kg body weight in the second and third trimesters. The WHO recommends taking protein from common foods.
Vegans, but also vegetarians or women who, for health reasons, follow a diet restricting the intake of protein sources (e.g. lactose intolerance) face a higher risk of insufficient protein intake.
Folic acid
The recommended daily dose of folic acid during pregnancy is 600 µg/day, which is double the recommendation for non-pregnant women. It is important for the proper development of the brain and nervous system of the unborn child, it also acts in the prevention of miscarriage and premature birth.
It is taken in the form of a dietary supplement, it does not rely on the amount received in the diet, as folic acid in natural sources is simply degraded by the action of light and heat treatment.
Iron
WHO recommends iron supplementation throughout pregnancy, in developed countries in the amount of 16–20 mg/day, with a total recommended daily intake for pregnant women of 30 mg. Iron ensures the supply of oxygen to both mother and child. The best usable iron is from red meat and egg yolk.
Vegetarians and vegans are at risk of low iron levels, as well as women who consume meat, for example, only once a week. Excessive fatigue and shortness of breath even during moderate physical exertion can be caused by a lack of iron.
Calcium
An unborn child needs a large amount of calcium for the proper development of bones and teeth. The recommended daily intake for pregnant women is 1200 mg/day.
In the case of insufficient intake, the quality of the mother's teeth may deteriorate, and in extreme cases, her bones may decalcify.
Foodstuff
|
Calcium (mg/100 g) (food)
|
Emmental
|
1020
|
Parmesan
|
1290
|
Milk
|
123
|
Kefir
|
123
|
Edam 45%
|
680
|
Sardines
|
200
|
Yogurt 1.5%
|
115
|
Cottage cheese
|
85
|
Nuts
|
270
|
Vitamin D
It is essential for proper baby growth and bone development and is also important for the mother's health. Its recommended daily intake does not change during pregnancy, but you really need to pay attention to it. Vitamin D is formed in the skin by the action of UV radiation from the sun, it can be taken from the diet from fatty fish and fish oil (e.g. salmon, cod liver).
A large part of the population is deficient in vitamin D, especially in the winter months and spring, so the use of a dietary supplement should be considered.
Iodine
An element necessary for the proper development of the child's brain and the proper functioning of the thyroid gland. In the case of using iodized salt, its necessary daily intake is met without any problems. Other sources are sea fish, milk and milk products or some mineral waters.
Omega-3 fatty acids
They significantly influence the development of the child's nervous system, their sufficient intake has a positive effect on the child's cognitive and intellectual abilities. Sources of omega-3 fatty acids are marine fish (especially salmon, herring, mackerel), nuts (especially walnuts), seeds (especially flax) and vegetable oils (especially rapeseed). Some of these foods should be in the menu every day.
Drinking regime during pregnancy
Neither the mother nor her unborn child can survive without sufficient fluid intake. The absolute minimum is 1.5 l of fluids per day, the optimal intake then varies between 2-3 l/day. Sufficient fluids help, among other things, against fatigue and constipation. Unflavored water, either tap or natural spring, weakly and moderately mineralized, is ideal. Even a small amount of alcoholic beverages cannot be recommended for pregnant women. On the other hand, in the case of caffeine, a safe amount can be set at around 200 mg of caffeine per day, which represents, for example, two espressos.
Resources:
Tsakiridis, I., Kasapidou, E., Dagklis, T., Leonida, I., Leonida, C., Bakaloudi, DR., & Chourdakis, M. (nd). Nutrition in Pregnancy: A Comparative Review of Major Guidelines. OBSTETRICAL & GYNECOLOGICAL SURVEY , 75 (11), 692–702. https://doi.org/10.1097/OGX.0000000000000836
MOVEMENT ACTIVITIES AND YOGA DURING PREGNANCY IN WOMEN WITH SPINAL INJURY
TEXT: Sylvie Dundáčková, head of the movement therapy section of the Paraple Center
Dear women, givers of life, mothers and maintainers of family traditions, this text, which focuses on physical activities during pregnancy, could become your guide and companion while experiencing one of the most beautiful periods of a woman's life.
Pregnancy is a period that is often also called another condition. And it is really a different, exceptional state, which could also be aptly called a life within a life or a stage of a miracle, from the very conception to the gift of life. During it, many changes occur in the body of women, which have only one goal - to ensure the development and arrival of a new person into the world. And that's really not enough!
What is different
The mentioned changes include, for example, an increase in blood volume, an increase in body weight or hormonal changes.
Physical fitness also changes in connection with pregnancy. The heart beats 20 to 40% faster, and even light physical exertion increases the heart rate to a slightly hectic level. It will also increase its ability to carry oxygen, and by the end of pregnancy it has to pump one and a half to two liters more blood than usual.
The growing fetus puts pressure on the diaphragm, and this restricts the space for the lungs to expand, which can make breathing difficult. Women with high levels of paraplegia and tetraplegia, who have limited diaphragmatic function, may experience breathing problems more intensely. Damage to the spinal cord below the Th 5 level affects the abdominal muscles involved in breathing, and damage above the Th 1 level affects the chest muscles.
In these cases, include breathing exercises every day. Placing a pillow under your thoracic spine so that your upper body is higher may also help. In the case of a weak cough or morning sickness, it is recommended to take a position on the side with the stomach padded.
All women gain weight during pregnancy, but it is especially important for women with spinal cord injury to watch their weight, as it affects your mobility and also because it will be more difficult to lose weight after giving birth. From this point of view, it may be advisable to consult a nutritionist about how to eat during this period.
Movement recommendations
Women with spinal damage can continue physical activity during pregnancy, but the chosen exercise should be of low intensity. You can recognize the low intensity of the exercise by being able to talk continuously while performing any movement activity, without much shortness of breath. If you're thinking about how often to exercise, it's a good idea to refer to Canadian exercise guides for people with spinal cord injury. The recommendations fall into two areas. The first area focuses on cardio-metabolic health . To improve or maintain this health, physical activity of an aerobic nature is recommended three times a week for thirty minutes. For the second area focused on cardio-respiratory health is the recommendation to include aerobic exercises twice a week for twenty minutes and twice a week for twenty minutes exercises aimed at strengthening larger muscle groups.
Regular physical activity during pregnancy brings many health benefits and has a proven positive effect on the health of the mother and the fetus. However, every mom-to-be is currently in a different situation and it is always important to be aware of your own body and feelings. For some women, physical activity will not be a problem all the time, and some may feel that it is the last thing that would be appropriate during pregnancy.
BOX/HIGHLIGHT
Consult your attending physician or gynecologist regarding physical activity and its amount during pregnancy. It is not recommended to start a new physical activity in the first trimester, but wait until the second trimester, which is described as more stable.
Yoga during pregnancy
Gravid yoga, or yoga for pregnant women, is a gentle style of yoga suitable for expectant mothers. Individual positions should be supplemented with other practices that yoga offers. These include, for example, relaxation, meditation and conscious breathing. In general, it is recommended to practice postures to relax and stretch the back, postures, shoulder stretches, chest relaxation and opening, arm and shoulder blade strengthening, hip release, pelvic floor relaxation, and very gentle and careful upper back rotations , shoulders and cervical spine. During pregnancy, it is not recommended to perform rotations and bends, especially in the lumbar spine.
How to do it in the first trimester
The first trimester is a very unpredictable period. Although expectant mothers are usually not yet aware of pregnancy, major hormonal and physiological changes are taking place in their bodies. Most women feel tired, the need for constant food, or, on the contrary, nausea, so physical activities usually recede into the background.
It is not recommended to start yoga during this period. It is recommended to wait until the second trimester before the fatigue subsides and the energy and desire for physical activity begins to return. However, if you have been practicing yoga before you got pregnant and have the energy to continue, there is no reason to stop. However, it is important to be aware of current changes, even if they are not visible, and to respect them. Slowing down and discovering the power of deep breathing and relaxation is highly desirable. When tiredness overwhelms you, use yoga practice to induce positive and pleasant rest, for example in a modified sitting shavasana position.
How to do it in the second trimester
The second trimester is a wonderful time for most pregnant women who enjoy themselves and want to be active. The initial nausea recedes, energy returns and a beautifully rounded belly grows, which, however, does not interfere with movement so much. You can start with yoga and tune into your body and intuition.
How to do it in the third trimester
In the third trimester, it is advisable to focus on breathing and relaxation techniques, as well as relaxing and stretching positions focused on the area of the chest, cervical spine and upper limbs. The third trimester may be characterized by a slowing down and deepening of the aforementioned practices.
Yoga positions suitable for the entire period of pregnancy
Urdhva Hastasana – Crescent Pose
Yoga set for pregnancy
The set is designed so that it can be used during the entire pregnancy. Rest as often as your body needs between poses. You can rest in a position where you slightly "undercut" your pelvis towards the front and lean your back firmly against the backrest. Pay attention to your breath and how you are and feel right now. Make sure there is enough fresh air in the room. Throughout the exercise, do not forget your intuition, which is stronger during pregnancy. Feel what is comfortable for your body and skip positions that make you uncomfortable. It is quite possible that what benefits you one day may not be pleasant the next. And that's totally fine.
In the photos you can see my friend Mirka Košťanová, whom I would like to thank for her help with the realization of this article. At that time, Mirka was the only pregnant woman in the area. Although she is a walker, I am glad that she accepted my offer.
Relaxed sitting and breathing techniques
Before starting the yoga practice, find a comfortable and relaxed seat. Gently lower your shoulder joints back and down. Also move the shoulder blades down and to the sides. Relax the muscles in your face. Bring the chin closer to the chest, gently pull the head upwards and try to straighten the spine along its entire length. Even when the spine is straight, the body remains relaxed. You can place your palms on your belly area if you feel comfortable and tune in to the emerging life within you. Begin to focus on a gentle inhale and exhale under your palms. With each breath, the palms rise slightly and with the exhalation, they return a bit back. In your mind, connect to the baby once more and send energy through your palms. Stay in this position for at least ten breaths that are gentle, deep and long.
Urdhva Hastasana – Crescent Pose
With an inhale, bring the joined hands upwards. Look up behind the joined palms. If your cervical spine hurts, you can look down. Gently pull the shoulders away from the ears, tuck the ribs towards the abdominal area so that they do not protrude. Stay for three to five breaths.
Virabhadrasana II. – fighter position II. (edited)
With an exhalation, put your right upper limb on your forearm and hold your left or lean it behind you on the backrest. Look over the third toe of the outstretched front limb. Both upper limbs are active up to the fingertips. At the same time, you loosen the shoulder joints downwards. Stay for three to five breaths.
Garudasana – Eagle Pose
With an inhale, bring the left upper limb to the right, and with an exhale, put the left elbow under the right, interlace the forearms and bring the palms together. If it is not possible to connect the palms, let them go where they can. Rest the backs of your hands against each other. Actively push your palms or forearms towards each other. Gently pull the head upwards. On the contrary, relax the shoulders downwards. With an inhale straighten the spine and with an exhale look forward through the joined hands.
Stay for three to five breaths. With another breath, untangle the upper limbs and return them to the Warrior II position.
Parsva virabhadrasana – inverted warrior pose
Lean your left upper limb behind your back or the backrest so that it feels stable. Bring the right upper limb up and stay in this variation, or make a very gentle and small bend in the area of the thoracic spine. Look up at the outstretched upper limb.
Stay for three to five breaths.
Dandasana – stick pose
With an inhale, bring your upper limbs back down and rest your palms next to your hips or on your sides. As you inhale, gently press into your palms and straighten your spine. At the same time press the shoulders down. With each inhale, gently push up from your palms and with each exhale, relax your shoulders, shoulder blades and facial muscles.
Stay for three to five breaths.
Upper limbs in cactus position
With an inhale, bring the joined upper limbs above the head, and with an exhale, bend the elbows, which stop at the level of the shoulder joints. Open the chest and gently push the sternum forward. It is a very small but important movement. It helps with greater opening and relaxation of the chest area. With each inhalation, the chest moves a little forward, and with each exhalation, you move the elbows back a few millimeters. Watch your lumbar region to avoid slouching.
Stay for three to five breaths.
Opening the chest
As you inhale, place your right forearm on your thighs and keep your left upper limb still in the cactus position. Gradually, gently and slowly open the chest to the left and up. If you have pain in the cervical spine, lower your head. Breathe consciously and deeply into your chest.
Hold for three breaths and then repeat on the other side.
Pulling one upper limb upwards
Place your right palm in your lap, pull your left upper limb upwards and bend your torso slightly to the right. Start breathing into the torso area, especially the left side. Imagine sinking your sit bones down and your left upper limb as if trying to pluck an apple from a tree. With an exhalation, release the upper limbs into the lap and bring the body back to the center. Switch sides.
Meditation and the final pose of Shavasana
Take the most comfortable seat that your body will allow at this very moment. Lean back and relax as many muscles as you can. A short meditation awaits you, which can be an opportunity to consciously and lovingly experience the unrepeatable moments of merging two beings into one, and thanks to which you will strengthen yourself in listening to your intuition and in self-confidence.
Place your palms on the abdomen area and gently begin to breathe under them. If your seat is stable, close your eyes. Imagine where your baby is and what it's like inside. Feel gratitude for what is arising within you. Stay for about ten breaths. It is possible that you will be disturbed by other thoughts, or that the sitting becomes uncomfortable, this is completely natural. Return your attention to yourself and the baby.
Rest and exhalation can be found in the final position of Shavasana. Remain in a comfortable seat and let everything go and be - all inhalations, exhalations, correct body adjustment in individual positions. Just be with yourself and your breath. Savasana is the gateway to the world of peace and harmony. Stay in this position for as long as you feel comfortable, maybe five to ten minutes.
Namaste
Place your joined palms against your chest or between your eyebrows. Thank yourself for making time for yoga and yourself. And I thank you!
Resources:
HERBS FOR EXPECTING MOMS
TEXT: Petra Hloušková, general nurse of the Paraple Center, Iva Leszkowová, external general nurse of the Paraple Center
Now that a new life is being born in you, you may be thinking more about how to solve various health problems or how to contribute even more to the successful development of the baby. And perhaps more often than at other times, the choice falls on natural remedies during this period. But beware, not everything is safe and harmless even in nature. It depends on the dose and how often you use a particular herb or mixture. It can also be important which part of the plant you use, because the distribution of active substances is not the same throughout the plant. And finally, time also matters. Some herbs/plants are not suitable for example at the beginning of pregnancy, but at the end they can significantly help you during childbirth. Such a plant is, for example, the raspberry, which we will mention more about later. However, as always, and doubly so during pregnancy, you should consult your doctor or pharmacist before starting to use any products (be they medicines or "just" natural preparations).
When looking for suitable plants that can be used during pregnancy, you will often come across conflicting opinions. In general, you should avoid herbs that perfuse the pelvis and genitals, especially in the first trimester.
Certain herbs can be great helpers during pregnancy. Here are examples of two that might work for you during pregnancy and postpartum.
Common raspberry ( Rubus idaeus )
This well-known plant only became popular in the 19th century, mainly due to its delicious fruits. These contain vitamin C, B vitamins, provitamin A, citric acid, malic acid, pectin, dyes, mineral salts, etc. In addition to great taste, they also have antioxidant and anti-inflammatory effects.
However, pregnant women look more for raspberry leaves containing tannins, flavonoids, vitamin C, fragarin (uterotonic) and many other substances. An infusion of raspberry leaves has been used as an aid during childbirth for many years. This is evidenced by many satisfied mothers.
Perhaps the main effect of raspberry is the significant support of the uterine muscles, which a woman will appreciate most during the second stage of labor. It also helps reduce pain and, according to some sources, reduces the risk of cesarean section. It is also suitable for the treatment of urinary tract and kidney infections, colds and diarrhoea.
There are quite different opinions on when to start using raspberry during pregnancy. According to some herbalists, it is advisable to drink it from the first trimester, when it can help alleviate nausea and replenish minerals. However, most experts agree on recommending the use of raspberry until six weeks before delivery, one to two cups each day.
It is good to continue using raspberry even after six months of pregnancy. It improves the healing of the uterus and supports the production of breast milk. In addition, it has the already mentioned anti-inflammatory effects. It is also used for painful or prolonged menstruation and for spasms of the smooth muscles of the uterus or intestines.
It should be avoided by pregnant women with any high-risk pregnancy or those expecting multiples. In any case, it is a good idea to consult your gynecologist before using raspberry.
Stinging nettle ( Urtica dioica )
Much has already been written about this plant miracle. Nettle is an ideal herb for purifying the blood, for all skin problems, stool conditioning, treatment of rheumatism and gout, anemia, for speeding up wound healing and much more.
It also has its place during pregnancy, mainly thanks to the presence of iron. Pregnant women often lack this element. There are many products on the market that can be used to supplement iron, but these sometimes have unpleasant side effects, such as constipation or other digestive problems.
Nettles are a relatively safe option in this case. In addition to iron, they also contain other minerals, of which magnesium is particularly important, as well as carotenoids, flavonoids, organic acids, carbohydrates, vitamins (e.g. B 2, B 6 and, especially in young leaves, vitamin C) and many other substances. They have also proven to stop bleeding and support the production of breast milk. Thanks to their diuretic action, they rid the body of swelling, can harmonize blood pressure and much more. Their use is therefore suitable even after childbirth.
The nettle treatment should last for one to two weeks for expectant and new mothers in the form of using an extract from the leaves (one to two cups a day). Even in this case, however, the rule is to discuss everything with the doctor first.
Common health problems in pregnancy
Let's now take a more specific look at some of the problems that can plague you during pregnancy. The most common ones are nausea, bladder infections, hemorrhoids and constipation.
Nausea
If you are troubled by nausea, which appears mainly during the first trimester, you can use the recommended combination of vitamin B 6 (pyridoxine) and ginger ( Zingiber officinale ) to alleviate it . However, be careful, the daily dose of ginger for pregnant women is a maximum of 250 mg four times a day.
The rhizome of ginger has antibacterial and anti-inflammatory effects at the same time, so you can use it together with echinacea for colds or flu.
Ginger is most easily used as a tea, when the peeled rhizome is simply poured with hot water. It is also possible to take it candied or in the form of a lollipop.
Urinary tract infections
In this case, prevention is the best treatment. The well-known cranberry extract is very effective. It is a cranberry plant ( Vaccinium viti-idaea L.) and the substances contained in it prevent the attachment of bacteria to the wall of the urinary tract. The recommended dosage is 500 mg of extract twice a day.
Hemorrhoid
It is a nodularly expanded vascular plexus in the area of the anus. During pregnancy, they are caused by compression of the veins by the growing fetus and impaired blood flow from the pelvis and legs. Constipated stools and prolonged sitting also contribute to hemorrhoids.
With the help of herbs, you can relieve the unpleasant symptoms associated with hemorrhoids, such as itching and pain. Oak bark has astringent effects due to its tannin content. Oak bark sitz baths are mainly used in the care of the anus during pregnancy, as it is not recommended to use it internally during this period.
A sitz bath can also be prepared with the help of self-collected bark, from which you make a decoction. However, if you buy a ready-made product, stick to the dosage indicated on the package or use a decoction of 5 g of oak bark per 1 l of water. The bath should be approximately the temperature of the human body.
You can also buy oak bark in gel form.
As a supplement in the treatment of hemorrhoids, you can also use cranberry ( Vaccinium myrillus L.). Among other things, blueberries are also good for preventing urinary infections.
Use blueberries as a tea by steeping one to two tablespoons of the dried fruit in boiling water and drinking it several times a day, or consume 20-60g of the dried fruit during the day.
Constipation
It is a condition that can really torment a person. When you are constipated, it is especially important to watch your diet so that there is enough fiber in it. The basic prevention of constipation is also compliance with a sufficient drinking regime.
As a safe support agent against constipation, the use of whole linseed from the flax plant ( Linum usitatissimum L.) is recommended.
How to properly prepare linseed? Pour one tablespoon of whole seeds in 0.5 l of cold water and let them swell overnight.
Resources:
DUGASOVA, Aurélia, DUGAS, Dionyz. Grandma's Herbs. Prague: Ottovo nakladatelství, 2010. ISBN 978-80-7360-970-2.
JAHODÁŘ, Ludek. Pharmacobotany. Karolinum Publishing House, 2011. ISBN 978-80-246-2015-2.
QUESTIONS AND ANSWERS
TEXT: Hana Vatěrová, physiotherapist at the Paraple Center
To what extent is the possibility of pregnancy affected by a spinal cord injury?
Women usually do not have a regular menstrual cycle shortly after a spinal cord injury, or they lose their periods for some time. This affects up to 85% of women with cervical spinal cord injury, but overall 50-60% of all women after an injury or sudden event. Up to 90% of these women will usually menstruate again within six months.
Getting pregnant is usually not a problem, better said the same as in the healthy population. About 12% of women have problems with ovulation, uterus or ovaries. It is then treated in the usual way.
What should I expect and consider if I plan to become pregnant?
It is a purely personal matter if/when you decide to have a child. Due to the increased physical demands, many women after a spinal cord injury think about it more. However, with good preparation and support, all kinds of obstacles can be overcome.
Pregnancy and childcare is directly related to physical fitness. There are many challenges that you will have to solve with your partner. Careful planning and anticipation of change will help you navigate the complications that the burden of family brings. Life will change for both of you, and the more you overcome various complications together, the easier your family and parenting life will be.
Before planning a pregnancy, it is a good idea to consider the following:
Are you and your partner really ready to be parents?
How will pregnancy affect you physically, are you ready for it?
Do I need any special medical tests before pregnancy?
Even before you get pregnant, it is a good idea to find out your state of health, for example, from blood tests (examination of the kidneys and liver to compare with the state during pregnancy, etc.). Furthermore, it is advisable to plan all medication with your general practitioner, neurologist or spinal doctor, throughout the entire period of pregnancy, or adjust it depending on the pregnancy. With regard to the possible negative effect on the fetus, it is necessary to think primarily about the use of antispastic treatment, medications for bladder and bowel function and pain medications.
Also discuss with your doctor the need for an X-ray examination before or during pregnancy. X-ray examination should not be planned in the state of pregnancy, and on the contrary, it should be used only in the most necessary case.
A urologist should evaluate the condition and care of your bladder and urinary tract throughout your pregnancy.
I am pregnant. What are the most important things I need to consider given my health limitation?
Not every gynecologist and obstetrician is familiar with the issue of spinal injury. That is why it is necessary that your "team" includes a spinal specialist who is able (or in the best case is able to) communicate with the gynecologist and vice versa.
If you get the right doctor in advance and know that you are being looked after properly, you will certainly feel much better throughout your pregnancy.
The information that doctors need to know about you during pregnancy (and subsequently childbirth) is:
What are your physical limitations due to the height of your spinal cord injury? Do you have impaired trunk stability, changes in the spine, damage in the pelvic area or hip joints? Simply everything that could be related to the normal course of pregnancy and the growth of the fetus, but also to childbirth.
Will I be able to feel fetal movements?
If you have reduced sensitivity at the height of the uterus or if you have spinal cord damage corresponding to the higher parts, then you may not be able to accurately feel the movements of the fetus. However, you will be able to perceive them using your hands. As the baby grows, you will also see movements on your tummy.
Can I sleep on my back during pregnancy?
During the first months of pregnancy, it is possible to sleep both on the back and on the stomach. But as your pregnancy progresses, you probably won't sleep well either on your stomach or on your back. This will happen because the growing weight of the fetus and the uterus will begin to press even on the deep large vessels. A symptom of oppression of these vessels can be feelings of vomiting and dizziness. Women with tetraplegia should also be more aware of complications, which can be manifested by autonomic dysreflexia, breathing difficulties or problems with coughing. So try to lie on your sides with cushions, changing the position of your limbs, consistently monitor the condition of your skin and its blood circulation. Be aware of shear forces that may occur during positioning or movement. Pay extra attention to the redness of the skin, which does not subside even after thirty minutes.
A positioning bed is one of the most popular aids during pregnancy and positioning in general. Especially if you feel breathing or heart problems. An anti-decubitus mattress is also an advantage. It is possible that you will have to change its properties during the night (or even during the day). Also consider adjusting it for increasing personal weight. However, be aware that your ability to move will change as the mattress (or its properties) change.
How about exercise during pregnancy?
If you were used to exercising before you got pregnant, you can gently continue. Of course, a certain caution applies, especially in the first trimester, valid even for healthy women. If you were not used to exercising, but would like to start now, then in any case choose a lower intensity of the load, rather include breathing, relaxing, stretching and relaxation exercises.
If you exercise with your physiotherapist, you don't have to change practically anything, the therapist will take your condition into account. But keep in mind that your pregnancy is always considered high-risk.
From exercises at home, you can apply, for example, the SM system according to Smíšek (spiral stabilization), it is good to focus on strengthening the upper limbs and shoulder blades. To strengthen the trunk, you can also use the appropriate position lying on your side during exercise.
From the beginning of the second half of pregnancy, if possible, avoid static positions with the upper limbs held at the level above the head, as well as forward bends of the torso, which are gradually replaced by gentle bows to the sides.
Can I attend physiotherapy during pregnancy? Is it possible to somehow relieve back pain or other problems?
Occasional interventions by physiotherapists during pregnancy in connection with acute pain are possible, but they are always evaluated individually according to the current state and situation.
With caution, manipulation techniques can be performed even at a higher stage of pregnancy. For mechanotherapy of the motomed type and verticalization, expect a gradual reduction in connection with the growing belly. It is more appropriate to use a verticalizing table instead of a setting stand. Otherwise, there are no significant restrictions, but your state of health may exclude mechanotherapy due to possible increased difficulties (spasticity, autonomic irritation, weight gain, etc.).
For pain relief or to keep fit, you can use commonly used nursing pillows when lying down in bed, during the day to rest or as an aid during exercise.
You can also use, for example, tape for pregnant women, which normally helps with muscle pain, joint pain or swelling. During pregnancy, it is ideal for relief from pain in the hips or to help with leg swelling. It improves blood circulation, supports the washing away of waste substances, regenerates muscles and supports the strengthening of the spine. Tape can also benefit you in the period after childbirth, for example with faster wrapping of the uterus. You can also help yourself with a pregnancy belt, which is also supportive and helps strengthen the torso, similar to a lumbar belt.
Furthermore, during pregnancy you may suffer from, for example, reflux or other difficulties. To a certain extent, these are physiological difficulties that should disappear spontaneously after childbirth. If this does not happen, it is appropriate to start dealing with them professionally at least after the end of the six months.
How can my spinal cord injury affect my pregnancy?
As discussed in Pregnancy after spinal cord injury , there are several areas where pregnancy-related complications can occur – eg bowel movements, spasticity, respiratory and vascular difficulties, etc.
I will add two more important ones here, in which there will be changes that you should prepare for.
Body center of gravity and balance
Your body's center of gravity will shift forward during pregnancy due to the growing fetus and belly.
Your center of gravity changes when sitting in the wheelchair, especially when driving, which can affect stability and ride characteristics.
Your body weight, stability and trunk momentum will change. There will be an overall decrease in your physical condition.
Solution:
Consider changing your wheelchair and seat settings.
Try practicing things in different ways as long as your growing belly allows.
Get help with activities that are already difficult for you.
Mobility, mobility
The change in your body's center of gravity will also affect your mobility and mobility.
Solution:
Consider increasing the angle between the seat unit and the backrest on the wheelchair. It can improve your overall mobility as well as stability.
Your backrest can be adjusted or replaced to improve mobility and comfort.
Even other modifications to the wheelchair or the use of aids can make it easier to ride in a wheelchair or improve your stability while sitting in a wheelchair.
Additional drives can keep your mobility at the original level during pregnancy, but also after childbirth.
Source:
"The impact of a spinal cord injury on pregnancy, labor and delivery: What you need to know" , Brisbane, Queensland: Queensland Health; Australia 2017.
Pregnancy - my story
PS, 33 years old
When my partner and I started to actually talk about the desire to have a child together, I actually only had basic information, which was absolutely enough for me until then. This means: yes, you can have a child, all the processes of its conception take place naturally for you as a girl with a spinal cord injury, and if there is no gynecological reason, which would be regardless of the wheelchair, there is no need to interfere in the conception process. If it doesn't work, of course, contact us, the Spinalka in Motola, and we will help you solve it. Basically, from the beginning, when I found myself in a wheelchair, I knew about girls in wheelchairs who went through pregnancy, childbirth and life with children and are going through it, so that's fine.
Taking into account the fact that I take long-term drugs to suppress spasms and neuropathic pain, I decided to have a spinal consultation in Motola before I got pregnant, because my local gynecologist and neurologist did not know how to deal with it. They said me that I should not take it because there is no information about it. They also consulted Dr. Ivana Špálová from the gynecology-obstetrics clinic on spinal medication. The doctor probably has the most experience with mothers after a spinal cord injury. I was assured that the specific medications and dosages I am taking do not need to be changed in any way.
Very soon came minor nausea, changed tastes of some foods (peppers, onions) and dislikes (until then my beloved coffee), I basically couldn't pass by kebabs and fried foods. Also unusual tiredness and the need to sleep, for example, at eight o'clock in the evening. That? Positive pregnancy test. Oh, so we're about to start an unsuspected adventure. I started to find out what and how, to interview friends who were mothers-in-wheelchairs, to read the foreign internet, because there was not much information to be found on Czech websites.
How much can I continue to exercise? What can and can't I afford? I can't harm the fetus by making a noise somewhere, but due to the loss of sensitivity in the abdominal area, I won't even realize it? What if I fall off the cart, will it hurt? The answers were very general - yes, but reasonably and by feel. That was easy to say, I wasn't wise about it, when you can't deduce much from the sensations from the lower half of the body. It was actually another level of perception of one's own body.
Gynecologically, everything was perfectly fine. And so during the first trimester, I gradually stopped lying on my stomach, because maybe it's a bit uncomfortable for me, I moved on the handbike exclusively to smooth asphalt paths, because the rattling is probably kind of weird and I probably don't like it from hills and corners little by little I was surprised by the completely spontaneous onset of a kind of greater caution for myself and for the little one in the belly. Since I had the wheelchair set up very actively, I moved the center of gravity to reduce the risk of throwing my back. The first trimester seemed to me to be unaffected by being in a wheelchair. I passed it without health complications.
With the growing belly and increasing weight in the second trimester, I started to deal with the rather lowered seat on the wheelchair, so as not to complicate my pregnancy with pressure ulcers in any case. I definitely don't regret buying a new one (because I wasn't eligible for the insurance company yet) with a lower risk of pressure ulcers, and I would do it again! I constantly monitored the width of the seat, but my wheelchair at the time accommodated everything perfectly and I didn't have to deal with a wider wheelchair. With the growing belly, the first changes in the vasculature began. As if the inclination of the urethra were changing . There were weeks when I managed to urinate only on the toilet, other times only in bed. It sometimes worked on the wheelchair and sometimes not at all. This varied until the end of the pregnancy. Before pregnancy , I like him in every way.
Towards the end of the second trimester, I had one bladder infection. It must be added that at that time I was running to my doctor with a test tube quite often. Even the toilet, because the capacity of the bladder began to be even more useless than usual. Which fortunately stabilized again after the birth.
During the pregnancy, I gradually decided how I would take care of the baby so that I could be as independent as possible. It was perfect, for example, when a friend lent me her baby in a sling and I could test that it would be comfortable to wear. The adjusted bed (height, opening, on wheels) and changing mat, which can be rolled under, were a hit. For other accessories, such as various scarves, carrying bags, bags, etc., it's nice to borrow them from friends (when this is possible), because only with the baby will it become clear what suits both of them best.
But back to the pregnancy itself. Sometime during it, and I vaguely remember that it was more advanced, I had a check-up and consultation with Dr. Špálova, where we agreed to give birth in Motola. After all, he has the experience. "Emperor" was indicated strictly and without discussion because Th 6 and above. The impossibility of discussion made me sad at the time. On the other hand, as a matter of course, I was offered my own room with barrier-free sanitary facilities for me and the accompanying person after the birth. But it was actually a bit of a duty, I was told flat out that the nurses would not have the capacity to take care of me beyond the normal care they provide to mothers on the go. The opportunity to be with your partner and baby together in the first days and to find out together what and how was great. And that moral support, sharing and yes, even physical help, was needed.
In the last trimester, all movement became difficult. I no longer loaded the wheelchair into the car by myself, I suspect that the transfer plate, which I had only used briefly in the beginning on the wheelchair, came up several times. Also, bending to the side to pick up items from the ground no longer felt realistic, not to mention the forward bending that I stopped using many months earlier. For the last month and a half, an "extended hand", a feeder for dropped objects, would be useful at home. Around the same time, I also greatly appreciated any additional help when moving - lifting my legs onto the bed. Fortunately, this more demanding period passed very quickly.
From the gynecological point of view, the pregnancy was completely standard throughout with regular check-ups at my local doctor plus about two check-ups at the gynecology clinic in Motola.
Pregnancy - my story
LH, 34 years old
My name is Lucka, I am a quadriplegic with C6 and C7 lesions (accident in a car, passenger) and the mother of a five-year-old daughter, Helena.
My pregnancy was actually quite peaceful, if I compare it with other babies on the wheelchair. But not to get ahead of myself. My husband and I have been together for almost eleven years and we have been trying for a baby for about two years. We wanted to conceive "normally" without the help of doctors. After some time we stopped trying and started solving other things…
I will never forget the date I found out I was pregnant. It was the last day of January 2016, and my husband had just gone to Moldova for assembly (he makes and repairs organs). It was ugly that day, it was windy and I wasn't feeling very well. So I took a test for fun (I was late with my period) and it was positive. It was a ride from that point on. The first people I told were my nurse (she went to buy me a second test) and my parents. I didn't tell my husband until a few days later, when he came back from the installation.
As I wrote, the pregnancy was beautiful and I enjoyed it a lot! For my first official check-up, I went to my doctor at the gynecology clinic in Lipník. We were both excited and the doctor was amazed - she had never seen or examined a pregnant wheelchair user before. After the examination and consultation, she referred me to gynecology at the Olomouc University Hospital to make sure that no one knows how it is for girls in wheelchairs with pregnancy, and let us be sure that we will be fine with the baby.
So I signed up for gynecology at a hospital in Olomouc. The first visit was so different. I was examined by a young female doctor who first wanted me to walk around her examination room so that the baby would wake up, then she wanted to weigh me, and finally she scared me about the risk that the baby might have Down syndrome. So I left crying and really devastated. But the next visit was already much more pleasant. I was already examined by a lady doctor at an elegant age (roughly 60 years old) and she reassured me that everything was completely fine. She just wrote in my card that I was classified as a high-risk pregnancy and that I should rest a lot and not switch my body unnecessarily.
The biggest problems I had during pregnancy were with vascularization and with a growing belly and then with moving anywhere. And very swollen feet too! Coiling was difficult because I needed to drink but also pee a lot… In the end we all made it. Throwing them up somewhere and cooling them was the hardest thing for my swollen feet.
The pregnancy somehow went by itself and very nicely. Visits, trips, cuddling with my tummy... Until the seventh month, when I got nasty burns on my stomach and thighs. I spilled hot water on myself while I was cooking. At that moment, I didn't even think about how much it all burned and hurt, but I thought about the baby! God, I burned him! It will have lifelong consequences, a burnt face... Such thoughts ran through my head before we reached the emergency room, where the doctor reassured me that the baby was very well protected, rather than being harmed by the superficial burns on my abdomen. So I went to bandages for almost a month, but everything turned out well and I'm the only one with scars.
The seventh month of pregnancy was quite a turning point for us. I went for a check-up in the third trimester and we learned that our baby will be a girl, until then only the back was showing. I remember exactly how the doctor did an ultrasound with a photo and asked me if I wanted to know the sex of the baby. Of course yes! And you know what he told me? "So here I present to you Pippinka your Pippinka." I burst out laughing. So baby girl, yup! This was my husband's wish from the first day we started talking about a baby. The doctor also took a photo of me, it was beautiful.
After the examination, we started talking about how, when and where the birth will take place. We scheduled the birth date fourteen days before the due date, on September 22nd, by caesarean section. I wanted to give birth in the Krnovsk hospital, where they have facilities for "home and family birth", but in the end my husband and I agreed that I would give birth in the Olomouc University Hospital, because if there were any complications during the birth, I would be able to stay together with the baby. which would not be possible in Krnov (it does not have an ICU for babies).
I had my last check-up with my gynecologist about ten days before the due date and everything was fine, the baby's pulse and heartbeat were 100 percent.
But the biggest fun was yet to come. It was Monday 9/19 and my husband wanted a memento of my mega giant belly. So he put plaster on me to make a cast. It was a horror. The plaster dried up, the cast came off and I had to take a shower. And that's how it all started.
morning of September 20, I woke up wet at half past five. Oh yeah, I peed again (this was nothing unusual for me during pregnancy). But this time it was different. As the due date was approaching, I checked the "wet" with litmus paper and it turned blue. So I found out that my water broke.
I woke up my husband that I was about to give birth. My husband Roman was more shocked than I was. "But I still have to go to work at seven," he said. Meanwhile, with slight pain in my lower abdomen, I got dressed and literally climbed onto the wheelchair. I called the hospital and my mom and told them what was going on. We got to the car where we found out that our tank was almost empty. So we refueled in Bruntál and I prayed that we would arrive at the hospital in Olomouc on time. It's only an hour away. The parking lot at the hospital was chaos, my wonderful mom was directing the traffic there so we had somewhere to park. With contractions after five minutes, we finally got to the maternity ward, and there I just breathed a sigh of relief that everything would be fine. It was around 10:30 in the morning and the nurse said to me: "But you are not supposed to give birth until Thursday." So I gave birth on Tuesday with permission.
First I had to take care of the paperwork, then the nurse recorded the baby's sounds, then another nurse came and told me that it was a shame that the baby was not head down, because otherwise I could have given birth normally. And from then on, I was in a fog until half past one, when I got to the hall where Helenka was born at 12:42 p.m.
What I remember is that the doctor explained to me that it is better to put me under complete anesthesia, because no one knows what it looks like inside me and with the baby, so let Helenka be out quickly. I woke up in the ICU a few hours later. When I saw Helenka for the first time, I cried a lot with happiness and I was very proud of us!
I was also lucky that after the birth my husband had the opportunity to use bonding. And for one more thing, I am grateful that my parents could be there for the birth of our daughter.
When they released me from ICU the next day, they put us in a barrier-free room in the postpartum ward, where I, Helenka, and Roman were alone together for four days. It was beautiful!
I went home on the fourth day after the "emperor" and on the eighth day I went to have my staples removed.
All the staff were very pleasant, although they were always surprised by my condition in the wheelchair. For me, the Olomouc University Hospital was a great experience!