Parenthood
Pregnancy and parenthood for people with cerebral palsy
Thinking of having a baby?
This factsheet has been put together to provide answers to some of the questions that you may have about cp, pregnancy and birth.
Does cp affect fertility?
There is currently no evidence to suggest that cp affects fertility. Research suggests cp is inherited in only a very small percentage of cases and there are normally other additional social or cultural factors. The risk of a mother or father with cp having a child with cp is generally not significantly different from that of any other person. Generally, there is no medical reason why a woman with cp should not have a baby, with no greater risk of miscarriage or premature birth. Pregnancy should have no lasting adverse affect on your cp. However, individual concerns should be discussed with your doctor (GP) or other health professionals.
Planning a pregnancy
Getting fit before you get pregnant is especially important if you are disabled. It is also a very good idea for both partners to stop smoking and drinking alcohol before trying for a baby as these can affect fertility in both men and women. Having a baby may change your lifestyle considerably, financially, practically, physically and socially, so many things need to be taken into account. It is wise for any couple considering raising a child together to talk in advance about their expectations, concerns and anxieties about how they will parent and have some agreement in advance of how tasks will be divided between them.
For lesbian, gay and bisexual parents-to-be, Pink Parents UK is a good source of information.
Medication in pregnancy
Medication taken for your condition should be checked with your GP to ensure that it does not adversely affect your baby or yourself during pregnancy. Your spasms may increase while you are pregnant requiring medication to help control them. Should you decide to breastfeed, the effects of any medication should be discussed with your GP.
CP and pregnancy
Make sure all health professionals are aware how your cp as well as other conditions (for example epilepsy) may affect your pregnancy. Some conditions you experienced before becoming pregnant (for example swollen ankles) may also be related to pregnancy. You need to inform your midwife or GP about any such concerns. Not every woman with cp will have the same experience. We hope you will have a trouble-free pregnancy, but be prepared to accept that pregnancy may make the effects of cp worse.
One lady reported the following:
"My spasms and ability to stand got worse (temporarily) and I had badly swollen feet."
Whilst another said:
"I found that my spasms got much less and I didn't seem to need as much physiotherapy as I normally would."
During pregnancy
During the early and later months of pregnancy many women experience tiredness so you will need to rest as much as you can. You may need help with carrying out your usual activities.
Two other symptoms of pregnancy are morning sickness, which can occur at any time of the day, and constipation. Some mothers find complementary therapies helpful in relieving such symptoms. Urinary tract infections are also common so bowel and bladder care is necessary to avoid infections.
Good eating habits are important, as gaining additional weight may cause extra mobility problems. Exercise during pregnancy is also important, especially if you use a wheelchair. Exercise will improve circulation and help you prepare for the delivery. It can also help with spasms; reduce constipation and increase strength and flexibility. An obstetric physiotherapist may be able to advise on suitable exercises. If you are a wheelchair user, extra care will need to be taken to avoid pressure sores.
Emotional changes
As well as physical changes during pregnancy, you may experience emotional changes, due to hormonal changes in your body. Frustration may also arise due to restricted activity and movement during pregnancy. It may help to talk to other people about your feelings:
"Emotionally people didn't know how to react to the news, some assuming it wasn't planned and that upset me."
During your pregnancy, reliable emotional and practical support from partners, carers, friends and family or other mothers with cp is invaluable. Not everyone may greet your pregnancy as good news. Becoming pregnant as a disabled person can arouse varied reactions from others so be prepared for some negative as well as positive reactions.
Ante-natal care and classes
Attending all your ante-natal appointments is important, as both you and the baby need to be monitored throughout your pregnancy. Clinics may be held at your GP's surgery or at a hospital, but your community midwife should be able to visit you at home if this is easier.
During your pregnancy you will be examined regularly and have pelvic examinations and you will probably have an ultrasound scan at 12 and 20 weeks. There may be various other tests that you may be able to have to screen the baby for certain conditions, but it is your choice as to whether you have these or not. It is not possible to detect cerebral palsy from ante-natal tests.
Your impairment may affect how these examinations can be carried out comfortably. You may need to discuss appropriate positions, methods and equipment to enable you to transfer to and from the examining table.
"Because I found it difficult to get up onto the high examination beds at the doctor's I asked whether they had a height-adjustable one which could be lowered for me. They did and whenever I made an appointment, that room was kept free for me!"
Your midwife or other health professionals may never have cared for an expectant mother with cp. The Disabled Parents Network may be able to put you in touch with professionals who have. The Royal College of Midwives has also produced a paper on maternity care for disabled women. The National Service Framework for Young People and Maternity Services (NSF) (Autumn 04) highlights the need for services to be equitable and accessible to all.
Attending ante-natal classes is very useful, as it means you can prepare yourself for the birth, learn relaxation methods, breathing techniques and meet other parents. Involve your partner, or the person supporting you, as much as possible in ante-natal preparations, planning and classes. Meet up with the trainer before the classes begin to discuss your personal concerns.
Preparing for the birth
Ideally before the birth of your baby, you will need to consider how your impairment may affect how you are able to care for your child. Look at what support is available to you, decide what extra help you may need, and arrange this in good time. If you have a partner decide the childcare roles and responsibilities you and your partner will have when the baby is born. These should be realistic, flexible and open to negotiation.
Many organisations are able to provide information and advice about equipment. Contact your Occupational Therapist (OT) or Scope Response for further details. The Disabled Living Foundation provides free, impartial advice about all types of disability products and disabled equipment for disabled people, their carers and families.
Delivery
Nearly all women have someone with them during labour. Most women find their birth partner's presence positive and encouraging but, if you prefer, you can have a close relative or friend. If possible, involve your birth partner in preparations and decide what role (if any) they are going to have during the birth.
Discuss the decision over place of delivery with your midwife and/or obstetrician. One advantage of a hospital delivery is the availability of equipment and expertise in case difficulties arise. If you have a choice of hospital, choose one that has an obstetrician who has a speciality in cp/disability. If not, ensure that the obstetrician confers with your OT/physiotherapist.
Your individual situation needs to be considered when decisions are being made about vaginal delivery or caesarean section. Possible reasons for having a caesarean include involuntary spasms (which may interfere with delivery), pelvic impairments or if the baby is in breech position. A caesarean may also be performed if there are signs that the baby is in distress during delivery.
If you are having a vaginal delivery (with advice from your midwife or health visitor), try out some delivery positions in advance. Side-lying or reclining positions may be an option if you cannot use stirrups or have difficulty in keeping your legs wide apart.
Your cp will not affect your contractions or dilation of the cervix, but you may find that contractions increase your spasms. Epidurals are not advised for women who have severe and uncontrollable spasms due to the increased risk of accidental dural tap and headache, and the risk of pulling the epidural catheter out during labour. Frequent changes of positions, massaging or braces may help with spasms. You should discuss methods of pain reduction in advance of the delivery. Be prepared to change these if the pain level isn't what you expected.
"Prepare a birth plan in advance, outlining your wishes and needs in as many eventualities as possible."
Looking after baby
It is generally recognised that breastfeeding is better for baby and easier than sterilising bottles and making up feeds. However, this is entirely your decision. If you have difficulty holding your baby in your arms you will need to find a comfortable position for feeding. Changing and dressing your baby are important concerns. Disposable nappies are the easiest choice. Clothes that are easy care and have Velcro fastening can also save time and effort.
Having a young baby to care for is daunting for any new parents. Most new mothers have anxieties about being able to cope and need help of some sort, so don't be reluctant to ask for it. Your health visitor is there to assist you with all aspects of parenthood or childcare. Social workers may be able to arrange practical support or help obtain specialised equipment for you or your baby. You may also find it helpful to speak to other women with cp who have had children. ParentAbility can put you in contact with other disabled mothers. They may also be able to advise you about any benefit entitlements you may now have in your role as a parent.
There may also be a number of other local voluntary organisations which may be able to assist you in your role as a parent so it is always worth checking with your local voluntary services council or other local disability information service.
Books and magazines can also be a useful source of information, both before and after the birth. One good journal is ‘Disability, Pregnancy and Parenthood International' (DPPI) which covers topics directly related to disability. It aims to share information and experience on all aspects of parenting with a disability in the UK and overseas. DPPI also has an information service for disabled parents. (The DPPI UK Information Service does not offer specific medical advice).
For further information
Disability Pregnancy and Parenthood International
Tel: 020 7628 2811 Fax: 020 7628 2833
Tel: 0800 018 4730 (Helpline)
Text Phone: 0800 018 9949
Email: info@dppi.org.uk
Website: www.dppi.org.uk
Royal College of Midwives
Tel: 020 7312 3535
Email: info@rcm.org.uk
Website: www.rcm.org.uk
Disabled Parents' Network
Tel: 0870 241 0450 (Helpline and Admin)
Email: information@DisabledParentsNetwork.com
Website: www.disabledparentsnetwork.org.uk
Pink Parents UK, The D'Arcy Lainey Foundation
Website: www.pinkparents.org.uk
Disabled Living Foundation
Tel: 0845 130 9177
Email: advice@dlf.org.uk
Website: www.dlf.org.uk
This factsheet is for information only
For more information about cerebral palsy and Scope services
Contact Scope Response for information, advice and support. Copies of all Scope's information sheets can be downloaded from the website or obtained from Scope Response.
Scope Response hours are:
Monday - Friday 9 am to 5 pm. Closed weekends and Bank Holidays.
Scope Response
PO Box 833
Milton Keynes
MK12 5NY
Tel: 0808 800 3333
Fax: 01908 321051
Email: response@scope.org.uk
Scope acknowledges the help and support of everyone who has been involved in the production of this information.
This information can be made available in other formats if required eg. large print or tape. We have information about Scope and cerebral palsy available in different languages on CD-ROM. We also offer a telephone interpreting service to people whose preferred language is not English.
Please contact Scope Response for more details of these services.
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