462
CHAPTER 28
orgastic sensations may be aroused in complete lesions below T5/6 by tactile stimuli,
especially in the erogenic zone of the breast, with erection of the nipples.
Pregnancy with labour
With the increasing number of marriages of paraplegic women in recent years, the
problem of motherhood has become more acute. In the past, reports on pregnancy and
labour in paraplegic women were very scanty (Gerstmann, 1926; Ware, 1934) but have
increased in recent years (Jung & Schmidt, 1962; Hutchinson & Vasicka, 1962; Gutt-
mann, 1963; Robertson, 1963; Jackson, 1964; Guttmann
et al.,
1965; Hardy & Warrell,
1965; Comarr, 1966; Rossier
et
a/., 1969; Goller & Paeslack, 1970). Experience has shown
that women with complete transverse lesions, even including tetraplegics, can become
pregnant and deliver normal babies vaginally, and Caesarean section is indicated very
rarely. The following case is an example: a woman of 21, while in the Army, sustained
a fracture-dislocation resulting in a complete paraplegia below the 5th dorsal segment.
Her bladder was treated by immediate suprapubic cystostomy. At a military hospital,
she was found to be pregnant. Paraplegia as such was at that time considered to be an
indication for terminating pregnancy, and this was carried out in her case at 16 weeks
by abdominal hysterotomy. She was admitted to Stoke Mandeville in 1945, where
she made an excellent rehabilitation and became one of the best sportswomen. After
the war, she married a man with a traumatic cauda equina lesion. Twelve years after the
injury, at the age of 33, she became pregnant and had 3 blood transfusions during that
time because of anaemia with fainting attacks. Having regard to the permanent supra-
pubic drainage, which could not be discontinued because of her highly contracted bladder
and chronic urinary infection, a classical Caesarean section was performed (Mr Struan
Robertson) and a healthy boy was delivered, who is now 18 years old. One could hardly
find happier and more grateful parents, and one could perhaps forgive them for imposing
upon the poor boy the Christian names of the two medical attendants—Ludwig and
Struan! The mother has continued her sportive activities in archery and took part in
both national and international Stoke Mandeville Games including those in Rome and
Tokyo.
In 1963, I reported on 27 babies—17 boys and 10 girls—born to 19 women with
spinal cord lesions, three of them polios and 16 transverse lesions of the cord, amongst
the latter 9 complete lesions at levels ranging from C7 to Li following fracture-disloca
tions of the spine. Five of the paraplegics, amongst them 4 traumatic, had two children
each after becoming paraplegics. No disturbances of the lactation, i.e. (a) the synthesis
of milk secretion, (b) milk ejection, were recorded, but this problem needs further and
more detailed studies in complete lesions below and above Th5, in particular in tetraplegic
women. Three also had children before their paraplegia.
Two of the 27 babies were stillborn. One died in utero in a patient with a traumatic
paraplegia below T5. This woman became pregnant again two years later and had a
spontaneous premature delivery of a healthy girl. This courageous mother tragically
died i£ years later of an inoperable cancer of the bladder. The other stillborn baby was
a breech birth at home to a woman of 20 with a complete transverse lesion below Ti2,
