Supporting Women with Spinal Cord Injuries and their Unique Challenges: Fertility, Childbirth, Sexuality are Regularly Addressed

When Jessica Espinoza, a 37-year-old woman who uses a wheelchair, realized she was pregnant, she and her husband celebrated their joy — and then Espinoza quickly reached out to Jennifer M. Chui, M.D., her physical medicine and rehabilitation physician at JFK Johnson Rehabilitation Institute.

Dr. Chui and Espinoza had already discussed fertility and childbirth as well as other aspects of life with spinal cord injury. “I regularly talk with my patients about all the changes that can come with a spinal cord injury, and for my female patients that may mean issues such as childbirth,” Dr. Chui said.

Dr. Chui told Espinoza that women with spinal cord injury can become pregnant and successfully carry and deliver a baby. There is no evidence to suggest a higher chance of adverse pregnancy outcomes. However, there are circumstances unique to pregnant women with paraplegia that should be addressed.

Some medications often given to people with paraplegia, for instance, are contraindicated with pregnancy and should be changed. Issues revolving around high blood pressure should be carefully monitored. Dr. Chui said wheelchair users can deliver vaginally.

“I was happy Dr. Chui knew about pregnancy and childbirth for people who use wheelchairs,” Espinoza said. “It gave me confidence.” In a recent visit with Dr. Chui, Espinoza held Ayden, her happy and healthy five-month-old baby boy. Dr. Chui supports Espinoza’s medical management as well as occupational and physical therapy to support her independence and new role as a mother.

Dr. Chui is a primary author of Rehabilitation Considerations for Women with Spinal Cord Injury, a review of the medical literature that explores a range of issues facing women with paraplegia. It is part of a special issue of Physical Medicine and Rehabilitation Clinic devoted the rehabilitation care for women. The goal is to help health care providers recognize and address the specific care points for women, who account for about 20 percent of Americans with spinal cord injury. Because men make up 80 percent of people with spinal cord injury, much of the research and guidance revolves around male patients.

For Espinoza, of Rochelle Park, the support and expertise of JFK Johnson have made a difference in her life. Pregnancy, an uncomfortable time for many women, can be especially challenging for people with mobility impairments. The JFK Johnson physical therapists helped her find a way to sit comfortably in a wheelchair during her pregnancy. JFK Johnson is now working with her to replace her wheelchair with a newer and better model.

Espinoza has used a wheelchair for much of her life. She was 12 years old when she woke up one morning and fell to the floor after getting out of bed. “I could not walk. My sister ran to tell my mother,” she recalls, “No one knew what happened.” Eventually she was diagnosed with transverse myelitis, a rare neurological disorder characterized by inflammation of the spinal cord.

Today Espinoza cares for her baby, deftly maneuvers her wheelchair, and lives her life with support from her family and her JFK Johnson team.

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