New Canadian guidelines for managing labour and delivery in persons with a physical disability

Toronto - The Society of Obstetricians and Gynecologists of Canada (SOGC) has released new guidelines about managing labour, delivery and postpartum care for people with physical disabilities. It is the first set of recommendations from the SOGC for this patient population. “People with physical disabilities are interested in pregnancy,” said Dr. Anne Berndl, lead author of the guidelines and a maternal-fetal medicine specialist at Sunnybrook Health Sciences Centre and assistant professor at the University of Toronto. “For many people it is a safe thing to do, but it is helpful if they have appropriate support and interdisciplinary care.” Dr. Brendl is the founder and director of the accessible care pregnancy clinic, the first clinic of its kind in North America. READ: 2021 Canadian guidelines now available for management of asthma Dr. Brendl said she hopes that the guidelines will give physicians more confidence in managing a pregnancy in a person with a physical disability, which in turn will make the experience more positive for the parent. A key recommendation of the guidelines is to form an interdisciplinary team. Family physicians should be part of this team, because they are the healthcare professional most knowledgeable about the pregnant person’s health and medical history. “Their knowledge of the person is going to be really important for that person throughout that pregnancy in having a caring and knowledgeable individual as part of that team,” Dr. Berndl said. The guidelines recommend a consult with a maternal-fetal medicine specialist prior to conception or early in the pregnancy to plan for the birth and to take into account the pregnant person’s wishes and preferences. One recommendation in the SOGC guidelines centres on the risk of autonomic dysreflexia in people with spinal cord lesions. Physicians are urged to learn how to differentiate between symptoms of preeclampsia and autonomic dysreflexia. Early analgesia or anesthesia during labour is advised for people at high risk of autonomic dysreflexia. Recommendations also include screening for the risk of preterm birth in persons with a physical disability and teaching patients who cannot feel contractions to identify signs of labour. Breastfeeding is encouraged, although doctors should discuss how medications may affect breastfeeding and the risk of autonomic dysreflexia. Another recommendation centres on the need to use respectful language, both in discussions and in charting. Dr. Brendl said that in many cases, using offending language It is not done intentially, but done because of a lack of knowledge. “People need to feel welcome. They need to feel respected and supported,” she said. “There are words that are used when discussing people with disabilities that are correct, that are empowering, that are not disrespectful,” she said. The guidelines suggest using people-first language, where the person is emphasized over the disability. Language that victimizes or stigmatizes should be avoided. For example, using the term “person who uses a wheelchair” is more respectful than “confined to a wheelchair.” “I’m really hoping that these guidelines will provide a positive attitude towards people who have disabilities having a pregnancy,” Dr. Berndl said. People who have physical disabilities have historically encountered prejudice when announcing a pregnancy. “They’ve had negative comments made to them both by healthcare providers and people who are not healthcare providers,” she said. This is very different experience than that of people without physical disabilities, Dr. Brendl noted. A study presented at the SOGC’s annual clinical and scientific conference in June shows that Ontarians with disabilities who receive care from a physician with expertise in disability had positive birthing experiences. Others reported negative birthing experiences with healthcare professionals who had limited training in disability-related care. The study’s abstract is published in the Journal of Obstetrics and Gynecology Canada (JOGC). While the new guidelines focus on labour and delivery, Dr. Berndl said that a pre-conception counselling guidelines and anti-partum care guidelines for this patient population would be helpful. Guidelines specific to different types of physical disabilities would be also be useful to clinicians. The management of a pregnancy in a patient with a spinal cord injury is different than in a patient with cerebral palsy. “Although there are many overlapping themes of concerns that those individuals will have, I think that people with physical disabilities will be best served when they have individualized care,” she said. She said that physicians would also have more confidence in managing a pregnancy when there is more specific direction for the pregnant person’s type of disability. Dr. Berndl also served as chair of the women’s health guidelines for the U.S. Spina Bifida Association, which includes a section on pregnancy and childbirth. There are also guidelines from the American Society of Obstetricians and Gynecologists about spinal cord injury in pregnancy. The SOGC guidelines are published in the June issue of the JOGC.

New Canadian guidelines for managing labour and delivery in persons with a physical disability

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