Assistive Devices, Technology or Positioning Information

A major consequence for people with SCI is mobility impairment, which can make positioning and cradling a baby while breastfeeding challenging. In high-level SCI, weakness in the upper arms may necessitate the use of a wrap, harness, support cushion, partner, family member or care aide to help with holding the baby. Although upper arm motor function is preserved in individuals with low-level SCI, impaired trunk stability may contribute to difficulties with breastfeeding. Specific supports that can help with breastfeeding may include setting up the mother’s chair to care for her baby, as well as training family members to assist with positioning and latching the baby (Cowley, 2007; Gragg, 2015).

Discussion

Past studies consistently report only that there may be a potential need for assistive devices. An occupational therapist (OT) is likely in the best position to help create or adapt assistive devices through:

• Transfers (e.g., slide board, temporary hoists, and car transfer techniques)
• Pressure relief (e.g., Review existing cushion/mattress or pressure-lifting techniques; consider weight gain and extra weight from the baby)
• Mobility (e.g., determines the need for assisted mobility, assist with the trial and selection of a power wheelchair)
• Selection of Baby Equipment (e.g., assist with the trial and selection of a child’s car seat, a sling to assist lifting baby off the floor, and the ease of belt application, slide-down cot sides, height-adjustable highchairs, suitable slings and supports, and prams that are easy to fold and push with one hand) (Hunter & Coventry, 2003).

One qualitative study reported that 7 women had difficulties with wheelchair fit, maneuverability or stability (Iezzoni et al. 2015b). These problems affected the women by reducing their mobility; increasing their risks of wheelchair tipping and causing falls or other injuries; causing difficulties transferring from one surface to another; and causing problems with skin shear and/or pressure ulcers (PU) at vulnerable pressure points. Some women became so afraid of falling during pregnancy that they changed their behaviors, such as starting to routinely use transfer boards or limiting their activities. Pre-conception planning and in-depth discussions during early pregnancy are recommended to anticipate and address future mobility difficulties. Breastfeeding plans should include considerations for balancing personal care, night feeds, and mobility challenges. Although it is recommended that health care professionals consider mobility issues and alternative breastfeeding positions, it is unknown how mothers with SCI perceive this barrier to be in comparison to other challenges (Carty et al. 1990).

Conclusion

Larger studies with more participants and studies specifically testing the efficacy of assistive devices are needed to further explore the knowledge on breastfeeding after SCI. To educate medical professionals on the appropriate supports for positioning during breastfeeding, more information is required to identify specific mobility-related challenges and appropriate solutions.