Motherhood after spinal cord injury : lactation, breastfeeding, autonomic dysreflexia and postpartum considerations

Lactation dysfunction following spinal cord injury has been previously documented. However, the extent of lactation dysfunction and influence of spinal cord injury on breastfeeding ability and behaviour is not well understood. The research aim was to identify major barriers to lactation and breastfeeding related to spinal cord injury, specifically comparing injuries above and below the T6 spinal cord segment. A retrospective survey design was used to evaluate breastfeeding barriers in an international cohort of women who gave birth following their spinal cord injury. In the pilot study, 52 women participated in two online questionnaires. The follow-up study evaluated 102 participants with one questionnaire. An expert panel of clinicians and mothers with spinal cord injury systematically developed and reviewed all questionnaires. Exclusive breastfeeding duration significantly differed between women with spinal cord injury above versus below T6. Women with cervical spinal cord injury were less likely to breastfeed for at least 6 months (as recommended by the World Health Organization). Breastfeeding difficulties rated most severe were insufficient milk production and impaired milk ejection. Breastfeeding barriers also included autonomic dysreflexia (particularly with cervical and upper thoracic injuries), impaired access to the infant and balancing breastfeeding with personal care and tasks of daily living. A considerable proportion of women did not receive education specific to breastfeeding with spinal cord injury. Postpartum depression and anxiety were self-reported by this population at a higher incidence than is reported in the general population. The prevalence of self-reported postpartum depression was greater than prevalence of clinical diagnosis, indicating a greater need for early screening and postpartum mental health support. This research provides novel insight into the breastfeeding barriers presented by spinal cord injury, which differ based on level of injury. Multidisciplinary care is recommended to address these barriers, which range from physiological (i.e. impaired milk production and autonomic dysreflexia) to psychological (i.e. postpartum depression) to fundamental functioning (i.e. functional independence and personal care) in order to improve the chance of successful breastfeeding. These findings provide the impetus for further research into motherhood after spinal cord injury to improve breastfeeding outcomes and quality of life for this population.Medicine, Faculty ofExperimental Medicine, Division ofMedicine, Department ofGraduat