Motherhood after Spinal Cord Injury: Breastfeeding, Autonomic Dysreflexia, and Psychosocial Health: Clinical Practice Guidelines

This article provides evidence-based recommendations for healthcare professionals (HCPs) who work with prospective and current mothers with spinal cord injury (SCI). It addresses key questions about improving breastfeeding outcomes, enhancing support services, and assisting HCPs in making informed clinical decisions about breastfeeding facilitation and complications associated with SCI. The guidelines aim to improve awareness and mental health support for mothers with SCI, who are at heightened risk of postpartum distress, depression, and anxiety. They also focus on promoting the use of healthcare resources and community supports to facilitate optimal breastfeeding and independent living for mothers with SCI. The development process involved a pilot survey, a larger-scale study, and an environmental scan of existing postpartum guidelines to assess their relevance and usability for breastfeeding after SCI. An expert panel systematically interpreted findings and discussed applications to maternal care and lactation practice.

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  Mothers with SCI, particularly those with injuries at or above T5, may experience impaired milk production and let-down reflex due to disrupted breast innervation.
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  Autonomic dysreflexia (AD) can be triggered by breastfeeding, clogged ducts/mastitis, or orthostatic hypotension (OH) from prolonged sitting, especially in mothers with SCI at or above T6.
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  Early identification of breastfeeding difficulties, such as issues with latching and suckling, is crucial for reducing distress in both mother and child. Techniques like skin-to-skin contact and hand expression can enhance breastfeeding effectiveness.