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Women's health

Physical disabilities and long term conditions

A physical disability, or physical impairment, which may have a substantial and/or long-term adverse effect on a person’s ability to carry out normal day-to-day activities, is considered below. This may include long term conditions, which may have an impact on daily living, as well as physical challenges faced by some individuals. Again, the key message here is about individuality, and not assuming that any condition affects everyone in the same way.

When considering how to approach this for pregnant and childbearing women, the focus here is on long term conditions, such as cardiac or respiratory conditions, often with a medical basis requiring medical intervention and support over a long period of time. We have also included chromosomal/genetic condition, cancer and musculoskeletal conditions. These conditions can be managed using medication, and/or devices which can improve their daily living.

Women with a long-term condition who become pregnant may face particular challenges, however the emphasis is that they will know more about their condition, and how it affects them, and so the specific support required from healthcare professionals is sensitivity, listening and enabling a positive experience for that individual.

The mother/and her partner may also be concerned about any risk to the fetus of a similar disorder, and may wish to focus initially on prenatal screening to enable them to make the best decision for their family, or may indeed be concerned about the reaction of healthcare professionals. Further information on Prenatal/Antenatal Screening can be found at:

National Screening programme for:

Long-term condition support (2020) contains tools and resources designed primarily to enable primary care teams to continue to effectively manage patients with long-term conditions.

See: MBRRACE-UK. Saving Lives, Improving Mothers' Care 2020: Lessons to inform maternity care from the UK and Ireland Confidential Enquiries in Maternal Death and Morbidity 2016-18

Cancer is when abnormal cells divide in an uncontrolled way, which can eventually spread into other tissues.

There are more than 200 different types of cancer, and it can be a devastating diagnosis for anyone and their family. Some women who are pregnant will be in recovery and living with a condition, whist others may be newly diagnosed and challenged with deciding on treatment options, whist some women will be diagnosed during pregnancy. 

The role of the midwife will be different depending on the woman’s circumstances, and the overriding message, as always, is support for the woman, her partner and family as required. The following resources may help with that support.

One example of care may be supporting a woman who has stoma, either short or long term, again this will be about tailoring care to meet her needs - she knows how her stoma functions and understands the need to change it, however she may struggle as pregnancy advances, or afterwards when feeding her baby.

Further resources

Cardiac disease remains a leading cause of maternal death in pregnancy and psotnatally. The conditions include myocardial infarction, ischaemic heart disease, aortic dissection, peripartum cardiomyopathy, rheumatic heart disease, aortic dissection and congenital heart disease The Royal College of Obstetrics and Gynaecology's (RCOG) Good Practice Guide provides further details on these conditions.

Further resources

Pre Eclampsia, gestational hypertension 

Pre Eclampsia and gestational hypertension (during pregnancy) affect around 8-10% of all pregnant women and may be associated with significant complications for both the woman and her baby/babies. Gestational hypertension is when blood pressure is higher than 140/90 mm Hg in a woman who had normal blood pressure before 20 weeks gestation and has no proteinuria (excess protein in the urine). Pre eclampsia is classically considered when that high blood pressure is accompanied by proteinuria.

Genetic disorders is a collective team for all conditions caused by a genetic or chromosomal abnormality. They can be inherited conditions, but may not be. When women with genetic disorders become pregnant, they will have lived with this condition, and will be familiar with the needs they may have, however the professional help will be with adapting to pregnancy and childbirth. The pregnant woman and her partner may also be concerned about the risk to the fetus of a genetic disorder, requiring support around fetal anomaly assessments. 

Further resources

Downs Syndrome

Prenatal/Antenatal Screening:

The endocrine system is made up of glands that produce and release hormones, whose main function is to control body functions. A disorder in one of the glands may cause overproduction or underproduction of the relevant hormones.

Diabetes 

Cells in the pancreas control the release of the hormones insulin and glucagon, which can lead to diabetes if disordered. Diabetes is a long term condition, that causes a high blood sugar level. There are two main types:

  • Type 1 diabetes – where the immune system destroys the cells that produce insulin
  • Type 2 diabetes – where the body produces insufficient insulin, or the body cannot react to the insulin being produced

Gestational diabetes is a condition specific to pregnancy, where there is a high blood glucose level. This usually disappears after the postnatal period, although some women will continue to suffer from diabetes after this.

Further resources

Thyroid disorders

Disease of the thyroid can cause issues with conception and problems in pregnancy. The British Thyroid Foundation (BTF 2018) provides further details about the impact of diseases of the thyroid.

Further resources

Pituitary and adrenal gland disorders

The pituitary gland is situated at the base of the brain, and is responsible for controlling many other hormones. Disruption of normal functioning can affect bone growth, menstrual cycles, and breast milk release.

Haematological disorders is the collective term for disorders of the blood, and those that most impact on women during pregnancy, labour or postnatally may include Haemoglobinopathies, Coagulation disorders (Haemophilia) and/or Anaemia.

Haemoglobinopathies

Haemoglobinopathies are a complex group of red blood cell disorders, also referred to as autosomal recessive inherited disorders of haemoglobin synthesis (thalassaemia) or structure (sickle cell) that are responsible for significant complications both for mothers and their infants. 

Coagulation disorders (Haemophilia)

Anaemia

There are a wide range of infectious diseases, which pregnant women may have or be diagnosed with. Winson (2018) provides a good overview of those that midwives need to be familiar with, whilst HM Governments 2016 publication, provides an overview of risks to pregnant women from infections: current screening, vaccination, treatment and prevention programmes.

Further resources

Tuberculosis

HIV

Parasitic diseases

Malaria

Helminths

Toxoplasmosis

Congenital Cytomegalovirus Infection (CMV)

Inflammatory diseases is a collective team for any condition mainly characterised by inflammation. This may include: allergy, asthma, autoimmune diseases, coeliac disease, systemic lupus, erythematosus, hepatitis or inflammatory bowel disease.

Further resources

Lupus / SLE (Systemic lupus erythematosus)

Inflammatory bowel disease

The integumentary system comprises the skin and its appendages acting to protect the body from various kinds of damage, such as loss of water or damages from outside. Disorders of the integumentary system include psoriasis, acne, pressure ulcers, sunburn and skin cancer.

Further resources

Psoriasis 

Any disorder of a body system can impact on the pregnancy, and this will depend on the severity of the disease from mild through to more complex cases of women being on dialysis or following transplants.

Obstetric cholestasis

is a disorder that affects the liver during pregnancy, causing abnormal liver function tests and/or raised bile acids occur and both resolve after delivery. The main symptom is itching of the skin. In the UK, it affects less than 1% of pregnant women - about 7 in 1000. It is more common among women of Indian- Asian or Pakistani-Asian origin, with about 1.5% (15 in 1000) affected.

See:
RCOG (2011) Obstetric Cholestasis Green–top Guideline No. 43
Obstetric Cholestasis Patient Information Leaflet

Further resources

Conditions that affect the Musculo-skeletal system’ can have a profound affect on fertility, being pregnant, labour and supporting women to look after their new born.  

Further resources

Rheumatoid arthritis

Wheelchair users

Osteoporosis

Symphysis Pubis dysfunction / pelvic girdle pain

Neurological disorders affect the central and peripheral nervous system, which includes the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots, autonomic nervous system, neuromuscular junction, and muscles. These include cerebral palsy, multiple sclerosis, epilepsy and motor neurone disease. 

Further resources

Cerebral Palsy

Motor neurone disease

Epilepsy

Muscular dystrophies

Multiple Sclerosis

Any condition that affects the respiratory system has the potential to impact on pregnancy. Respiratory conditions may be infectious and chronic. 

Further resources

Asthma

Cystic fibrosis

General resources

ACED (2020) Pregnancy in women with disabilities 

Byrnes L., Hickey M. (2016) Perinatal Care for Women With Disabilities: Clinical Considerations. Journal for Nurse Practitioners, 12(8):503-509 

Disability Rights UK. Disability Rights UK is run by and for people with lived experience of disability or health conditions

King’s Fund (2020) Long-term conditions and multi-morbidity 

Mackay-Moffat S. (2007) Disability in childbirth  London: Churchill Livingstone

NICE (2019) Intrapartum care for women with existing medical conditions or obstetric complications and their babies (NG21) 

Page last updated - 10/05/2022