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

Published:February 21, 2021DOI:https://doi.org/10.1016/j.jogc.2021.02.111

      Abstract

      Objective

      To describe evidence-based practice for managing the labour, delivery, and postpartum care of people with physical disabilities in Canada.

      Target Population

      This guideline addresses the needs of people with physical disabilities, with a focus on conditions that affect strength and mobility, as well as those that affect neurological or musculoskeletal function or structure. Although aspects of this guideline may apply to people with solely intellectual, developmental, or sensory disabilities (e.g., hearing and vision loss), the needs of this population are beyond the scope of this guideline.

      Outcomes

      Safe and compassionate care for people with physical disabilities who are giving birth.

      Benefits, Harms, and Costs

      Implementation of this guideline will improve health care provider awareness of specific complications people with physical disabilities may experience during labour, delivery, and the postpartum period and therefore increase the likelihood of a safe birth.

      Evidence

      A literature review was conducted using MEDLINE (474), Embase (36), and the Cochrane Central Register of Controlled Trials (CENTRAL; 28) databases. The results have been filtered for English language, publication date of 2013 to present, observational studies, systematic reviews, meta-analyses, and guidelines and references in these publications were also reviewed.

      Validation Methods

      The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations).

      Intended Audience

      Maternal–fetal medicine specialists, obstetricians, family physicians, nurses, midwives, neurologists, physiatrists, and those who care for people with physical disabilities.

      RECOMMENDATIONS

      • 1
        In verbal and written communication and documentation, clinicians should use people-first language (e.g., “person with a disability” rather than “disabled person”), which emphasizes the person over the disability (strong, low).
      • 2
        Clinicians should screen for and mitigate risk factors for preterm birth, such as bladder infection (strong, low).
      • 3
        Clinicians should teach patients who cannot feel contractions, such as those with spinal cord injuries, how to identify signs of labour (strong, low).
      • 4
        Clinicians should offer induction of labour to avoid issues associated with transportation and to facilitate neuraxial analgesia for patients at risk of autonomic dysreflexia (strong, low).
      • 5
        Consultation with an obstetrician or maternal–fetal medicine specialist should occur in the pre-conception period or early in pregnancy to outline a plan of care, including location of birth, taking into consideration the availability of and access to equipment and personnel and the ability to monitor maternal cardiovascular status and fetal status on an individualized basis (strong, low).
      • 6
        Clinicians should consider the patient's underlying health concerns, obstetrical indications, and wishes and preferences when planning mode of delivery. Consultation with an interdisciplinary team is recommended (strong, low).
      • 7
        Clinicians should be aware of a patient's risk for autonomic dysreflexia and consider evaluating patients for autonomic dysreflexia and preeclampsia when signs and symptoms of these conditions are present (strong, low).
      • 8
        Clinicians should treat autonomic dysreflexia in people with spinal cord injury by recognizing and addressing the underlying cause, which may require expediting delivery (strong, low).
      • 9
        Care providers should create a delivery plan for people with physical disabilities that includes anaesthesia. This planning should include antenatal consultation with the department of anaesthesia when significant obstetrical or anaesthetic risk factors are present (strong, low).
      • 10
        Patients who wish to breastfeed should be encouraged to do so; this may require access to a lactation consultant. When counselling patients on breastfeeding, clinicians should address the risk of autonomic dysreflexia, the possibility of impaired letdown, difficulties in mobilization that may hinder the patient's ability to exclusively breastfeed, how the patient's required medications might affect breastfeeding, and how breastfeeding might exacerbate fatigue or underlying conditions (weak, very low).
      • 11
        Clinicians should screen for postpartum depression and make referrals for psychological support when indicated (strong, low).

      Keywords

      Abbreviations:

      CP (Cerebral palsy), MG (Myasthenia gravis), SB (Spina bifida), SCI (Spinal cord injury)
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