Guideline No. 416: Labour, Delivery, and Postpartum Care for People with Physical Disabilities

Resources, relationships, and resilience: The psychosocial experiences of women with lower limb absence during pregnancy and postpartum

BACKGROUND

There is limited research on the unique needs of women with lower limb absence (LLA) during pregnancy and postpartum. The lack of information can negatively impact women's physical and emotional experiences.

OBJECTIVE

The purpose of this study is to explore the psychosocial experiences of individuals with LLA through the pregnancy and postpartum periods, and to provide information to women and health care providers (HCPs) on what they can expect.

METHODS

Semi-structured interviews were conducted with 19 women with LLA who had been pregnant in the previous 10 years. Interviews were analyzed using thematic analysis.

RESULTS

Participants experienced uncertainty due to a lack of information and limited resources related to pregnancy and LLA. While most women had strong support networks including family, other mothers with LLA and HCPs, some women faced stigma or judgement from HCPs and people in their social networks. Some women had periods where they struggled mentally due to a temporary loss of independence. Despite these challenges, they demonstrated tremendous resilience and noted that their ability to adapt helped them to navigate the difficulties they experienced in the perinatal period (PNP).

CONCLUSION

There is an immediate need to fill the 'information gap' about pregnancy and LLA. We recommend the development of support networks, informational guidelines, and further education for HCPs to better support women with LLA through the PNP. Further research is warranted to gain a better understanding of the mental health experiences of women with LLA in the PNP.

Physical disability and venous thromboembolism during pregnancy and the postpartum period: a population-based cohort study

BACKGROUND

Pregnancy and the postpartum period are a high-risk time for venous thromboembolism (VTE). Decreased mobility is also a major risk factor. However, the risk of peripregnancy VTE among individuals with physical disabilities is unknown.

OBJECTIVES

To compare the risk of peripregnancy VTE between people with a physical disability and those without a physical disability.

METHODS

This population-based cohort study comprised all births in Ontario, Canada, from 2007 to 2018. Physical disability was defined as a condition diagnosed before conception that was likely to result in restricted mobility. Modified Poisson regression was used to compare the risk of VTE during pregnancy and up to 6 weeks postpartum between people with a physical disability and those without a physical disability. Adjusted relative risks (aRRs) were calculated, controlling for demographics, history of VTE, thrombophilia, and other comorbidities. An additional analysis was used to evaluate the risk of peripregnancy VTE among people with physical disabilities who used a mobility aid.

RESULTS

Of 1 220 822 eligible people, 13 791 (1.1%) had a physical disability. VTE occurred during pregnancy or up to 6 weeks of the postpartum period in 0.85% of the individuals with a physical disability and 0.47% of those without a physical disability (aRR, 1.52; 95% CI, 1.26-1.83). The rate of VTE was notably higher in those with a physical disability requiring a mobility aid (3.0%), generating an aRR of 3.05 (95% CI, 1.45-6.41), than in those without a physical disability.

CONCLUSION

Pregnant people with a physical disability, especially those using a mobility aid, are at an increased risk of VTE. Anticoagulant prophylaxis could be considered in this group, especially in the presence of additional risk factors.

The disability-related education and training experiences of perinatal care providers in Ontario

We describe the disability-related education and training experiences of perinatal care providers in Ontario. Twenty perinatal care providers (e.g., obstetricians, midwives) participated in semi-structured interviews. Using a content analysis approach, we found most acquired disability-related training through their own initiative as opposed to education through professional training programs. Barriers to training included lack of data on disability and pregnancy, and limited experiential learning opportunities. Providers recommended that future training focus on experiential learning and social determinants of health, with people with disabilities involved in developing and delivering training. These efforts are vital to optimize pregnancy outcomes for people with disabilities.

Prevention of pre-eclampsia with aspirin: A systematic review of guidelines and evaluation of the quality of recommendation evidence

BACKGROUND

Evidence has shown significant benefits of aspirin for preventing pre-eclampsia.

OBJECTIVES

The objective of this study was to systematically review recommendations from clinical practice guidelines and other recommendation documents on aspirin for the prevention of pre-eclampsia.

SEARCH STRATEGY

Ten databases were searched for statements from December 1, 2013, to January 1, 2022.

SELECTION CRITERIA

Without language restrictions, the most recent version of documents was considered.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted recommendations. Guideline quality was assessed using a modified AGREE-II instrument and the AGREE-REX tool.

MAIN RESULTS

Out of 48 statements on the prevention of pre-eclampsia, 46 had recommendations on use of aspirin. Of them, 39 were supported by evidence from systematic reviews or randomized controlled trials. Three statements reported aspirin's significant reductions in preterm pre-eclampsia and one in perinatal death. Concerning quality, 41% of statements were rated as high quality in all domains of the AGREE-II tool, 15% were rated high quality in all domains of the AGREE-REX tool, and 11% were rated high quality in all domains on both tools.

CONCLUSIONS

While 96% of statements advocated for use of aspirin, only 9% reported a significant reduction in preterm pre-eclampsia or perinatal death. Based on the AGREE tools, future statements could use methodological improvement.

Prenatal Care Experiences of Childbearing People With Disabilities in Ontario, Canada

OBJECTIVE

To explore the care experiences of childbearing people with physical, sensory, and/or intellectual/developmental disabilities during pregnancy.

DESIGN

Descriptive qualitative.

SETTING

Ontario, Canada, where physician and midwifery care during pregnancy are provided at no direct cost to residents.

PARTICIPANTS

Thirty-one people with physical, sensory, and/or intellectual/developmental disabilities (who self-identified as cisgender women [n = 29] and trans or nonbinary persons [n = 2]) who gave birth in the last 5 years.

METHODS

We recruited childbearing people with disabilities through disability and parenting organizations, social media, and our team's networks. Using a semistructured guide, we conducted in-person and virtual (e.g., telephone or Zoom) interviews with childbearing people with disabilities in 2019 to 2020. We asked participants about the services they accessed during pregnancy and if services met their needs. We used a reflexive thematic analysis approach to analyze interview data.

RESULTS

Across disability groups, we identified four common themes: Unmet Accommodation Needs, Lack of Coordinated Care, Ableism, and Advocacy as a Critical Resource. We found that these experiences manifested in unique ways based on disability type.

CONCLUSION

Our findings suggest the need for accessible, coordinated, and respectful prenatal care for people with disabilities, with the requirements of such care depending on the needs of the individual person with a disability. Nurses can play a key role in identifying the needs and supporting people with disabilities during pregnancy. Education and training for nurses, midwives, obstetricians, and other prenatal care providers should focus on disability-related knowledge and respectful prenatal care.

Obstetric and neonatal outcomes in people who acquired a spinal cord injury during pregnancy

OBJECTIVE

(s):The objectives of this study were to determine the obstetric and neonatal outcomes of people who acquired spinal cord injuries (SCI) during pregnancy.

METHODS

This is part of an international observational questionnaire examining pregnancy outcomes of people with SCI. The outcome measures included demographics, such as level of injury and American Spinal Injury Association (ASIA) scores, prenatal and postnatal complications, and neonatal outcomes.

RESULTS

Of 780 responses, 14 (1.79%) participants reported acquiring an SCI while pregnant. 64.2% (9/14) of injuries were due to trauma. Of 14 pregnancies, 1 person miscarried and 3 pregnancies were terminated. There were 11 live births. One participant had twins and 9 live births were singletons. Six participants delivered vaginally, 3 had cesarean delivery (CD) and 1 was unreported. The preterm birth (PTB) rate was 54.5% (6/11). Approximately 36% (4/11) of newborns were admitted to the neonatal intensive care unit (NICU). The average birthweight reported was 2409.7g (453.6-3458.6g). Forty percent (4/10) of participants reported experiencing postpartum blues or depression. Sixty percent (6/10) of participants breastfed for over 2 weeks.

CONCLUSION

(s):This is the largest known cohort to date of individuals acquiring SCI during pregnancy. The most common cause of SCI was motor vehicle accident. Complications included PTB and NICU admission. People who have an SCI during pregnancy are at risk for complications, however positive pregnancy and neonatal outcomes are possible. Absolute small numbers of this event limit the ability to assess incidence of outcomes.

OBJECTIF

Les objectifs de cette étude étaient de déterminer les issues obstétricales et néonatales des personnes ayant subi une lésion de la moelle épinière pendant la grossesse. MéTHODOLOGIE: L'étude fait partie d'un questionnaire d'observation international examinant les issues de grossesse de personnes atteintes d'une lésion de la moelle épinière. Les critères de jugement concernaient les caractéristiques démographiques, telles que le niveau de la lésion et les scores de l'American Spinal Injury Association (ASIA), les complications prénatales et postnatales ainsi que les issues néonatales. RéSULTATS: Des 780 réponses, 14 (1,79 %) participantes ont signalé avoir subi une lésion de la moelle épinière pendant leur grossesse. De ce nombre, 64,2 % (9/14) des lésions étaient dues à un trauma. Pour ces 14 grossesses, 1 personne a eu un avortement spontané et 3 grossesses ont été interrompues. Il y a eu 11 naissances vivantes issues de 1 grossesse gémellaire et de 9 grossesses monofœtales. Les accouchements se sont faits par voie vaginale dans 6 cas et par césarienne dans 3 cas, le mode d'accouchement n'ayant pas été déclaré pour 1 de ces naissances vivantes. Le taux de prématurité était de 54,5 % (6/11). Environ 36 % (4/11) des nouveau-nés ont été admis aux soins intensifs néonataux. Le poids moyen rapporté à la naissance était de 2 409,7 g (453,6-3 458,6 g). Quarante pour cent (4/10) des participantes ont signalé avoir souffert de dépression ou du blues du post-partum. Soixante pour cent (6/10) des participantes ont allaité pendant plus de 2 semaines.

CONCLUSION

Il s'agit de la plus importante cohorte connue à ce jour de personnes ayant subi une lésion de la moelle épinière pendant la grossesse. L'accident d'automobile était la plus importante cause de lésion de la moelle épinière. Les complications observées comprennent l'accouchement prématuré et l'admission aux soins intensifs néonataux. Quoique les personnes qui subissent une lésion de la moelle épinière pendant la grossesse soient à risque de complications, les issues obstétricales et néonatales positives sont possibles. Le faible nombre absolu de ces événements limite la capacité d'évaluer la fréquence des issues.