Scoliosis, pregnancy and baby care

Sinead Murphy, a mother with scoliosis, from County Cork, Ireland, and co-founder of the Scoliosis Support Association of Ireland (SSAI) talks about the difference between her two pregnancies and how she wants to dispel myths about pregnancy and scoliosis.

I was diagnosed with juvenile idiopathic scoliosis aged seven and unsuccessful surgery left me with a fused but uncorrected curve of 120 degrees. When I became pregnant, aged 30, I opted for private treatment and chose the most experienced consultant I could find as I expected major problems.

Two contrasting pregnancies

I had a problem-free pregnancy with my first child but developed pre-eclampsia and needed an emergency caesarean section under general anaesthesia. I really had no need of any extra support or monitoring and the scoliosis had little effect on the pregnancy.

The second pregnancy, two years later, was a different story. I became very breathless in the last trimester and was treated for high blood pressure with aldomet (methyldopa). At 37 weeks I picked up a cold from my daughter which very quickly developed into a lower respiratory tract infection.

Thankfully, my doctor and consultant were aware of the potential for trouble and informed me that a patient ‘in my situation’ had been lost to compromised respiratory function. The plan was to deliver my baby by caesarean section and aggressively treat what had now become pneumonia. To administer a general anaesthetic to someone with an active chest infection and compromised lung function was a major gamble which they were forced to take after several attempts to administer an epidural had failed.

Within 48 hours of the delivery I went into respiratory failure as a result of pulmonary and needed aggressive therapy with ventolin (salbutamol) nebulisers, intravenous steroids, oral steroids and antibiotics. The obstetric physiotherapist was wonderful and spent many hours manually keeping my airways clear and thankfully I recovered fully. However, all the antibiotic therapy left me with clostridium difficile colitis.

I now know that I had only 52% lung capacity as a result of my scoliosis compressing my lung, and I also had severe uncontrolled asthma. Most women who have had successful surgery for adolescent idiopathic scoliosis don't have to worry about compromised lung function, but those with early onset scoliosis should be aware that this can happen.

Ideally, had the medical profession been more aware of this, someone like me would have been under the care of a consultant respiratory physician for the duration of the pregnancy.

Early baby care

My husband is a health and safety consultant so he made sure I minimised the amount of lifting and bending required for early baby care. We set the changing unit to waist level and when lifting the baby, I always kept my back straight and bent my knees to avoid strain. The cot had a sliding rail which dropped to avoid leaning into the cot in order to pick up the baby. These are common ergonomic adaptations that don't cost extra and by taking a common-sense approach to purchasing baby equipment, I avoided placing unnecessary strain on my few remaining unfused discs.

My husband did about 70% of the feeding and changing anyway. The only thing I found really hard was feeding as the weight of supporting the baby on one arm and holding the bottle in the raised position with the other led to a lot of neck pain. Even using a cushion did little to help.

My advice for other women

I would advise other women who have scoliosis and are considering pregnancy to plan their pregnancy, if possible, and take folic acid for four months before becoming pregnant. Inform all your care providers that you have scoliosis. If you have early onset scoliosis or a large magnitude curve, ask your doctor to refer you to a consultant respiratory specialist for pulmonary function testing prior to becoming pregnant.

Keep a copy of your most recent X-rays and show them to the anaesthetist. An experienced anaesthetist can often successfully administer an epidural if s/he sees evidence of the levels of fusion. Be prepared to educate your care providers about your condition.

Ask to see an obstetric physiotherapist if your hospital has one, as they can offer helpful advice about exercise during pregnancy. Don't necessarily assume that you will have back pain during pregnancy because you have scoliosis. My consultant assured me that he has seen people with small curves with severe backache and others like me with severe spinal curvature who experience little pain. It's impossible to predict.

If you've been shown to have low lung capacity you can ask your doctor about breathing machines such as the Bilevel Positive Airway Pressure (BiPAP) device. This assists with breathing at night by keeping the airways open and reducing carbon dioxide build up during sleep, which can help reduce the risk of pulmonary compromise. Always remember to wash hands regularly in late pregnancy to avoid picking up coughs and colds.

I would advise any woman to cherish and enjoy the special feeling of a first time pregnancy. Accept all the help that you are given from friends and family and protect the discs beneath the fusion (if you've had surgery) if possible.

Dispelling the myths

I met another Irish mother on a message board, who had exactly the same degree of curvature as me, who also had respiratory failure following the delivery of her daughter. We went through our pregnancies in ignorance of the risks or even unaware of how very possible it was to have a successful pregnancy. It's astonishing how many women we meet who believe that they cannot have children because they have scoliosis. We wanted to dispel the myths surrounding pregnancy and scoliosis.

As a result of our lack of effective treatment as children, we also wanted to create a resource for people to exchange experiences of scoliosis treatments, to ask questions and have a support network for both families and patients.

We met a UK-based web developer who has scoliosis and had developed an international online message board (www.scoliosis-support.org). With over 1,600 members, it offers an anonymous forum to ask questions, seek reassurance and learn about other people's experiences. Together we registered the Scoliosis Support Association of Ireland (SSAI) as a charity. We are pleased to have a close association with the forum and, in April, SSAI and the forum will celebrate our fifth anniversary of collaboration.

Editor's note: Ultrasound has been used to aid the positioning of an epidural in women whose scoliosis has been corrected with rods, thus avoiding general anaesthesia. (Yeo ST and French R. 1999. Combined spinal-epidural in the obstetric patient with Harrington rods assisted by ultrasonography, British Journal of Anaesthesia 83(4): 670–2.)

For more information on pregnancy and birth for women with scoliosis please see DPPI journal, issue 57.

First published in DPPI Journal, Issue 64, Winter 2008/2009.

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