Ask The Expert – Pregnancy in Autism – Carrie Dickson
Choosing to become a parent can be one of the most amazing and challenging things in anyone’s life. It can be even more challenging if you have particular needs or concerns surrounding the process, obtaining health care, or managing life transitions. If you have autism, all of these things can be challenges. Here are some things to consider if you have autism and are planning to give birth.
Finding your care team
Start with the care provider
Whether obstetrician, midwife, or family doctor, you need a care provider who you can spend time with and build a trust and rapport. Ask how long their prenatal visits are. Typically obstetricians have the shortest visits (5-10 minutes) with family practice doctors and hospital midwives a little longer (15-20 minutes). Birth center and home birth midwives usually have the longest amount of time to get to know you and your family (30-60 minutes). These times are generalizations, so if you talk to your care provider, they can spend more time with you.
Consider a doula!
A doula is a person trained to support the pregnant family through pregnancy, labor, and birth. She does not provide medical care but supports the pregnant woman/couple emotionally (and in labor often physically!) She does not replace your significant partner but can help the partner find ways to support you in labor. Doulas have been shown to shorten labors, decrease the need for interventions, promote family bonding, and decrease rates of post-partum depression.
Consider where you want to birth
Some autistic families feel most comfortable in a hospital setting, but not all hospitals are the same. You may want to visit the hospitals you are considering and ask questions; especially about those things that concern you the most. See where you feel most comfortable. Ask your doula and birth partner to accompany you.
Other autistic families find they prefer out-of-hospital birth settings and there is data supporting safety with trained midwives. Many of the hospital norms or routines (like hospital gowns, monitor sounds, and a lack of privacy) can be very distressing for those with varying sensory needs. While you can speak to your hospital care provider about the importance of managing these issues, they can be easier to control in a birth center or home. According to Jennifer Zimmerman, an autistic mom: “Giving birth in the hospital was a sensory nightmare, and I was not allowed to have any control over the environment even though this is what I was promised beforehand. For my second and third child, I opted to give birth at home where I could control every aspect of the environment, including who I allowed into it, and I had much better experiences.“
Minnesota is lucky to have a vibrant out-of-hospital birth community, including many homebirth midwives and 5 freestanding birth centers in the Twin Cities alone. For a directory of midwives, by homebirth, birth center, and hospital, go to http://www.mfmidwifery.org/#!midwives/cfvg
Several of the birth centers offer the opportunity to plan a hospital or birth center birth. Couples find it helpful to have the opportunity to get to know the midwives and ask questions over the course of the pregnancy instead of having to decide right away.
Remember, the most important thing is that you find where you will feel safe and most comfortable. Regardless of your choice of birth location, you should not have to sacrifice safety for comfort or vice versa. The “right” place to birth is the one that is best for you.
Make a plan for prenatal visits, birth, and postpartum
What are the most important things to you when you think about your prenatal care, birth, and post-partum care? Take the time to discuss your needs, wants and fears with your support person, so you can talk with your care team about them. Your doula can be a significant help in this process, prompting you to think about various scenarios and what your needs may be. Share your wishes with your care provider in writing. Remember that sensory needs or aversions may change with pregnancy. Make your team aware when your needs change.
There is an online tool that is helpful in putting in writing your healthcare needs. It’s called the Autism Healthcare Accommodations Tool and can be found at http://bit.ly/autismHAT. Once completed online, you will have a printable document you can give to any healthcare provider. While this won’t be specific to pregnancy-related care, it is a good starting point and can be helpful for any healthcare interaction.
Centering Pregnancy or group prenatal care
A number of prenatal care providers in Minnesota offer prenatal care in a group setting. There, women/couples sit together in a group with their midwife, sharing experiences and concerns with each other. Some may find this environment disconcerting, but others may feel more comfortable in a setting where they are able to just listen and soak in questions posed by others. If you feel this format may benefit you, I encourage you to seek a practice that provides group prenatal care, sometimes called Centering Pregnancy.
Other things to consider
Discuss pain scales in advance with your care provider to find one that works for you. If you are familiar with the 5 point scale, you may want to adapt that for pain. Colors may be another effective method.
For some, a big event and life transition like this can trigger underlying depression and/or anxiety. Discuss this early in pregnancy if this is a concern for you, and don’t be afraid to seek out a mental health professional.
There are so many benefits of breastfeeding for mom and baby I can do a whole blog post on that! What’s important again, though, is that you do what is best for you and your baby. Talk to your doula or health care provider, and seek the support of a lactation consultant if needed.
Last but maybe the most important
You should expect nothing but the best possible care from your health care providers. Talk to them if that’s not what you’re getting, and if they’re not willing to support you then find someone else. Each baby only gets one birth, and every mother should feel valued and supported.
Resources
AASPIRE Healthcare Toolkit for Patients and Supporters http://autismandhealth.org/?a=pt&p=main&theme=ltlc&size=small
Autism Healthcare Accommodation Tool http://bit.ly/autismHAT
Autistic and Pregnant, Parenting or Planning Facebook community https://www.facebook.com/Autisticandpregnant/
Childbirth Collective http://www.childbirthcollective.org/
Minnesota Families for Midwifery http://www.mfmidwifery.org/#!midwives/cfvg
About the Author
Carrie Dickson is a Certified Nurse-Midwife with 20+ years in women’s health care. She teaches full-time in the Normandale nursing program. She works part-time as a Registered Nurse at the Minnesota Birth Center and is also a student in the Doctorate of Nursing Practice program at Minnesota State University, Mankato. She has 1 incredible husband and 3 amazing boys of 9, 7, and 5, the youngest of whom is on the spectrum. In what remains of her spare time, she likes to blog at Nursing the Issue [http://carriedickson.wordpress.com/]. She can be reached at [email protected].
Article reprinted by permission of the Autism Society of Minnesota.
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