The Pregnant Woman with Physical and Mental Challenges

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For so many years, women with disabilities were discouraged from getting pregnant because their condition may complicate the pregnancy. However, with the advent of technology, women who are physically and mentally challenged are given more ease during pregnancy and childbirth. Also with the guidance of their healthcare providers, they are now able to plan pregnancies and childbirth and their special concerns are now addressed in any healthcare facility across the country.

The Pregnant Woman who is Physically or Mentally Challenged

A physically or mentally challenged woman who wants to get pregnant is advised to engage in careful planning of her pregnancy so everything would be tailored to exactly what she needs.

  • On the first prenatal visit, explore the nature of the woman’s disability to identify the alterations needed for a successful pregnancy.
  • A woman who is house bound during pregnancy must be compliant in taking a vitamin D supplement because she might not be getting adequate sun exposure.
  • Assess the woman’s ability to reach her emergency contacts for pregnancy-related emergencies.
  • Assess the woman’s ability to come for a prenatal visit or if she can drive alone.
  • Encourage a woman who uses a wheelchair to press with their hands against the armrests and lift their buttocks off the wheelchair seat for five seconds every hour to prevent pressure ulcers as the fetus is getting heavier.
  • Encourage the woman to increase fluid intake to prevent urinary tract infections and to void frequently even though mobility is an effort.
  • Physical examinations may need to be modified to accommodate the woman with disability.
  • Women who are cognitively challenged may not know how they became pregnant, so if she was abused sexually, give ample time to talk to her regarding a pelvic examination.
  • For a visually challenged woman, a trained guide dog may be brought during prenatal visits but since the guide dog’s main function is to offer directions, it still has protective instincts and might be threatened whenever people may pet it.
  • Use demonstration aids when teaching a visually impaired woman, to allow her to feel or touch the aids.
  • A cognitively challenged woman may need instructions limited to those few items related to safety.
  • A visually challenged woman could not read pregnancy pamphlets, so either her support person would read the pamphlet to her or she can have a tape recorder with information recorded about pregnancy or any topic you want her to remember.
  • Nutrition counseling needs to center on foods that can be prepared without cooking.
  • For activity and exercise, if mobility Is an issue, let the woman understand that walking around her home is just like walking around the block as exercise.
  • Encourage the woman to attend childbirth preparation classes if possible, especially those who are not working outside their home so they can practice breathing exercises.
  • For a hearing impaired woman, show her printed words when teaching so she can see what your lip motions represents.
  • If the woman has an interpreter for sign language, be certain that you are facing the woman while talking and not the interpreter.
  • For a woman with spinal cord injury, instruct her to palpate her abdomen for uterine contractions so she can be aware that she is in labor.
  • Cesarean and forceps birth may be necessary for women with muscle spasticity or spinal cord injury.
  • A woman who cannot assume a lithotomy position could be positioned in a dorsal recumbent or Sims’ position during vaginal delivery.

The Pregnant Woman who is Substance Dependent

One of the major problems among pregnant women today is the use of illegal drugs. A person is substance dependent if she has withdrawal symptoms after discontinuing the use of illegal drugs. Assessment of the pregnant woman during the prenatal visit is necessary for the possibility of substance abuse.

  • A woman with substance abuse problem may come in late for her prenatal care because she is afraid that her drug use would be discovered and reported to the authorities.
  • She may also have difficulty in following instructions for proper nutrition as she may lack sufficient money to buy nutritious foods and drugs, as well as supplemental vitamins.
  • Illicit drugs can cross the placenta, so the fetus of a substance dependent woman has a drug concentration of about 50% that of the mother.
  • Drug abuse accounts for preterm birth and fetal abnormalities, and also the risk for hepatitis and HIV increases if the woman uses injected drugs.
  • Cocaine is the most frequently abused drug during pregnancy and it causes extreme vasoconstriction that can compromise placental circulation leading to premature separation of the placenta and ultimately, preterm labor or fetal death.
  • Infants of cocaine-dependent women may suffer from immediate effects of intracranial hemorrhage and withdrawal syndrome.
  • Newborns born to women who use amphetamines show jitteriness, poor feeding at birth, and growth restriction.
  • A woman who uses marijuana or hashish would not be able to breastfeed because of reduced milk production and the risk to the newborn from excretion of the drug in the milk.
  • Narcotic agonists such as heroin would have effects on the pregnant woman such as fetal opiate dependence and severe withdrawal symptoms in the infant after birth.
  • Women who are opiate dependent can enroll in a methadone maintenance program during pregnancy, but the infant would still not escape the withdrawal symptoms at birth, and methadone withdrawal has more severe reactions than heroin.
  • However, the fetus would still be ensured of better nutrition, better prenatal care and less exposure to pathogens since methadone is given to her legally during the program.
  • The woman may also be treated with buprenorphine if methadone programs are not available.

Practice Quiz: The Pregnant Woman with Physical and Mental Challenges


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Questions


1. A pregnant woman tells you that she takes amphetamines almost daily. A fetus of a drug-addicted mother receives approximately what percentage of the mother’s drug concentration?

A. 20%
B. 50%
C. 70%
D. 100%

2. Your client has a T2 spinal cord injury and is 6 months pregnant. Which of the following information should be included in pregnancy counseling for her?

A. She needs to feel her abdomen often during the last months to detect tightening of labor.
B. She should adjust the footrests on her wheelchair so that she maintains her legs with a sharp bend at the knee to relieve the pressure on her abdomen.
C. Pregnancy will decrease her risk for urinary tract infections since serum corticosteroid levels are increased during pregnancy.
D. The enlarged uterus will assist her in urinating, so she will not need to use a catheter to be sure that she empties her bladder.

3. Joan is in her fourth month of pregnancy and confides to the nurse that she is addicted to heroin and uses prostitution to afford her habit. Which response by the nurse would be most appropriate?

A. Plan to include tests for sexually transmitted diseases in Joan’s future prenatal visits.
B. Record on Joan’s chart the need to monitor her baby for hyperbilirubinemia.
C. Tell Joan her baby is in no danger because fetal exposure to narcotics actually strengthens the liver and the lungs.
D. Prepare Joan for the high possibility that her baby will be born dead because she has taken heroin.

4. Ana is a pregnant cocaine user. Which of the following, if undertaken by Ana, would indicate that a teaching plan for her had been effective?

A. Ana stated she will use crack instead of cocaine while she is pregnant.
B. Ana voiced plans to seek assistance to help her stop using cocaine.
C. Ana plans to restrict her cocaine use to smoking a pipe during the last months of her pregnancy.
D. Ana decreases cocaine use once she has completed her pregnancy.

5. Which information would be most important to provide to a pregnant woman who is drug dependent?

A. Marijuana can be used to decrease withdrawal symptoms without fetal harm.
B. Regular cocaine would not cross the placental barrier but crack cocaine will.
C. Pregnancy will temporarily take away her desire for drugs and alcohol.
D. Her fetus might be born drug dependent and have withdrawal symptoms.

Answers and Rationale


1. Answer: B. 50%

  • B: 50% of the drug concentration of the mother is being transferred to the fetus.

2. Answer: A. She needs to feel her abdomen often during the last months to detect tightening of labor.

  • A: Women with spinal cord injury would not be able to feel uterine contractions.
  • B: Women should decrease the sharp bend at their knees to promote venous return and prevent varicosities and thrombi formation.
  • C: To decrease risk for urinary tract infections, the woman should increase her fluid intake and void frequently.
  • D: Women with a spinal cord injury would need to use a catheter to make sure that they empty their bladder.

3. Answer: A. Plan to include tests for sexually transmitted diseases in Joan’s future prenatal visits.

  • A: Pregnancy complications related to heroin abuse include sexually transmitted diseases due to shared needles.
  • B: The fetal liver is forced to mature faster than normal so the newborn is better at coping with bilirubin.
  • C: The fetus is still in danger because of the many complications that heroin abuse could bring.
  • D: Fetal death is probable but not highly possible for a fetus with a heroin-dependent mother.

4. Answer: B. Ana voiced plans to seek assistance to help her stop using cocaine.

  • B: Stopping cocaine use through programs such as the methadone maintenance program shows that the teaching plan has been effective.
  • A: Alkaloidal cocaine or crack produces an even more rapid and intense “high” when inhaled.
  • C: Cocaine use should be stopped entirely for the whole pregnancy and even afterward.
  • D: Cocaine use should be continuously stopped even though the pregnancy is complete especially for breastfeeding mothers.

5. Answer: D. Her fetus might be born drug dependent and have withdrawal symptoms.

  • D: The fetus might be born drug dependent and have withdrawal symptoms of tremulousness, irritability, and muscle rigidity.
  • A: Marijuana cannot decrease withdrawal symptoms and could cause fetal harm.
  • B: Crack cocaine could not cross the placental barrier as well as regular cocaine.
  • C: The desire for drugs and alcohol would stay in a pregnant woman if proper counseling is not initiated.

Women who have challenges during pregnancy need to be guided by their healthcare providers throughout their journey. They need all the facts that they can get so they can slowly modify their lifestyle to fit the present situation. Safety and education should be a healthcare provider’s priority especially for pregnant women with special needs.

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