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
- 1In 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).
- 2Clinicians should screen for and mitigate risk factors for preterm birth, such as bladder infection (strong, low).
- 3Clinicians should teach patients who cannot feel contractions, such as those with spinal cord injuries, how to identify signs of labour (strong, low).
- 4Clinicians 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).
- 5Consultation 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).
- 6Clinicians 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).
- 7Clinicians 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).
- 8Clinicians should treat autonomic dysreflexia in people with spinal cord injury by recognizing and addressing the underlying cause, which may require expediting delivery (strong, low).
- 9Care 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).
- 10Patients 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).
- 11Clinicians 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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 21, 2021
No. 416, June 2021Footnotes
This document reflects emerging clinical and scientific advances as of the publication date and is subject to change. The information is not meant to dictate an exclusive course of treatment or procedure. Institutions are free to amend the recommendations. The SOGC suggests, however, that they adequately document any such amendments.
Informed consent: Everyone has the right and responsibility to make informed decisions about their care together with their health care providers. In order to facilitate this, the SOGC recommends that health care providers provide patients with information and support that is evidence-based, culturally appropriate, and personalized.
Language and inclusivity: While the SOGC as a rule uses gendered language, in respect for our mission to advance women's health, there are contexts in which it is important to use gender neutral language, and to be fully inclusive. This guideline speaks to the needs of people are often marginalized or “unseen”. For this reason, except where citing the words of others, the SOGC has chosen to use gender neutral language in this guideline. The SOGC recognizes and respects the rights of all people for whom the information in this document may apply, including but not limited to transgender, non-binary, and intersex people. The SOGC encourages health care providers to engage in respectful conversation with their patients about their gender identity and preferred gender pronouns and to apply these guidelines in a way that is sensitive to each person's needs.
Identification
Copyright
© 2021 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
