What does it mean?
Approximately 12% of women of child-bearing age have a disability—that is, any impairment that results in a restricted ability to carry out social roles or access needed services. Still, little is known about the sexual, contraceptive, and perinatal needs of women with disabilities, and not much data are available to help doctors provide care for a disability during a pregnancy. Medical care (and available medical records and research) for these women tends to focus on the disability and not the pregnancy. Still, new data indicate that women with and without disabilities have the same chance of having a healthy, live birth.
A disability can be physical, mental, sensory, or learning-related. It may be a lifelong condition or a recent change in health status; it may be stable and require minimal support or it may require continual care and attention. When considering a pregnancy, disabilities need to be considered as part of a woman’s overall health and well-being and in relation to her coping abilities and family support.
What will it change?
Overall, women with disabilities are just as likely as women without disabilities to become pregnant. Having a disability does not immediately mean you will have a high-risk pregnancy, but you may be prone to certain complications. For example, women with spinal cord injuries are more likely to experience urinary tract infections and respiratory problems during pregnancy. Changes in weight can affect your balance and the way you walk or move, so if a disability already impacts these activities, pregnancy can make them even more challenging.
During labor and delivery, spinal cord injuries and other neurological conditions or musculoskeletal issues can impact the use of anesthesia. If possible, meet with the anesthesia team before labor and delivery (like in the last few weeks of your pregnancy) so they can be prepared for any special considerations associated with epidural or spinal anesthesia.
Women who take medications related to their disabilities during pregnancy should talk to their doctor or pharmacist about the safety of the drugs. Some medicines are not safe when you are trying to conceive or during pregnancy. Your doctor or pharmacist will help you decide which medications should be continued and which ones need to change.
What to expect
One of the most significant barriers faced by women with disability is the attitudes of other people. Social biases and assumptions about the wants, needs, and capabilities of people with disabilities are widespread. Many women with disabilities have even reported that healthcare providers assumed that they would never want to become pregnant, and, when they did, the healthcare providers questioned their abilities to care for a child.
What you can do
Women with disabilities have reported that planning ahead is the most important step to ensure a healthy pregnancy. Seeking out clinicians with expertise in their specific disability also led to improved labor and delivery experiences. Luckily, many obstetrical practices and hospital systems are developing programs with specialized care for many types of disability.
Women with disabilities are increasingly sharing their stories and experiences via social media platforms, support groups, and even formal, structured clinical research in order to assist healthcare providers in caring for other women during pregnancy and to offer advice and support to peers who are pregnant.
What it all means
Overall, healthcare providers, especially obstetricians and gynecologists, should focus more on a woman’s abilities than her disabilities. And, care and communication should empower, not discourage, women. Fortunately, an increasing number of resource are available to support women with disabilities (and their doctors) who are pregnant and transitioning to parenthood. Seeking out these resources and advocating for your own care is great preparation for parenthood!
Having a disability will likely pose extra challenges during your pregnancy, but, with the right support and care, you have just as much chance as any woman of having a happy, healthy baby.