How do the physical changes of pregnancy affect a woman with a spinal cord injury?

Many times when I find out one of my patients is, are pregnant, I will put them in therapy in the second trimester, for a number of things. One, is that they as gain weight; it's going to change their center of gravity. Things that they might have been independent in doing before—transfers, dressing their lower extremities, putting on their shoes, doing their bowel program—they may not be able to do one because of their changing in balance, and two, they've got all this belly out in front of them. So they might become a little more dependent in their third trimester, so we put them in therapies to work on balance. How are you going to transfer?—if they could do a lateral transfer without a sliding board before, they might need a sliding board during pregnancy. So a lot of times I'll put them in therapy to practice that kind of stuff. They can put a ball down their shirt so they can't lean forward, they can do a number of things. Other things to think about are fatigue; they're going to tire more. We all know that a woman who's pregnant has so much pressure on her bladder it feels like her bladder is about as big as a marble—not different for women with spinal cord injuries. So women who are doing intermittent cath, it's really a pain to do intermittent cath every hour and a half, like a pregnant woman to go to the bathroom. So they may have to have an indwelling catheter in for the final few weeks. So those are some of the issues. The other thing to consider is maybe renting a power chair for the final weeks of pregnancy so there's increased mobility, and then if you can rent it a few weeks after the baby is born, it's also increased mobility. So there's a lot of those kinds of issues. Now as far as weight gain and the chair, generally you can adapt that, you know, take off the side rests or something like that. But there's definitely a change in center of gravity, there's definitely a change of balance, and for a lot of women, there's a change in level of independence.