{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:07:43Z","timestamp":1788566863343,"version":"build-2803163510"},"reference-count":72,"publisher":"American Spinal Injury Association","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>The World Health Organization (WHO) recommends that children be breastfed exclusively for the first 6 months of age. This recommendation may prove challenging for women with spinal cord injury (SCI) who face unique challenges and barriers to breastfeeding due to the impact of SCI on mobility and physiology. Tailored provision of care from health care professionals (HCPs) is important in helping women navigate these potential barriers. Yet, HCPs often lack the confidence and SCI-specific knowledge to meet the needs of mothers with SCI. An international panel of clinicians, researchers, consultants, and women with lived experience was formed to create an accessible resource that can address this gap. A comprehensive survey on breastfeeding complications, challenges, resources, and quality of life of mothers with SCI was conducted, along with an environmental scan to evaluate existing postpartum guidelines and assess their relevance and usability as recommendations for breastfeeding after SCI. Building on this work, this article provides evidence-based recommendations for HCPs, including but not limited to general practitioners, obstetricians, pediatricians, physiatrists, lactation consultants, nurses, midwives, occupational therapists, and physiotherapists who work with prospective and current mothers with SCI.<\/jats:p>","DOI":"10.46292\/sci23-00079","type":"journal-article","created":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T00:53:32Z","timestamp":1716512012000},"page":"9-36","source":"Crossref","is-referenced-by-count":4,"title":["Motherhood after Spinal Cord Injury: Breastfeeding, Autonomic Dysreflexia, and Psychosocial Health: Clinical Practice Guidelines"],"prefix":"10.46292","volume":"30","author":[{"given":"Andrei","family":"Krassioukov","sequence":"first","affiliation":[{"name":"International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada"},{"name":"Department of Medicine, University of British Columbia, Vancouver, BC, Canada"},{"name":"Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, Canada"},{"name":"GF Strong Rehabilitation Centre, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacy","family":"Elliott","sequence":"additional","affiliation":[{"name":"International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada"},{"name":"Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada"},{"name":"Sexual Health Rehabilitation Service, GF Strong Rehabilitation Centre, and Sperm Retrieval Clinic, Blusson Spinal Cord Centre, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shea","family":"Hocaloski","sequence":"additional","affiliation":[{"name":"Sexual Health Rehabilitation Service, GF Strong Rehabilitation Centre, and Sperm Retrieval Clinic, Blusson Spinal Cord Centre, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Krassioukova-Enns","sequence":"additional","affiliation":[{"name":"Axioms of Inclusion, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Hodge","sequence":"additional","affiliation":[{"name":"Adaptability Counselling and Consultation, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Gillespie","sequence":"additional","affiliation":[{"name":"BC Women's Hospital, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherry","family":"Caves","sequence":"additional","affiliation":[{"name":"Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teri","family":"Thorson","sequence":"additional","affiliation":[{"name":"Spinal Cord Injury BC, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Alford","sequence":"additional","affiliation":[{"name":"GF Strong Rehabilitation Centre, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Basso","sequence":"additional","affiliation":[{"name":"BC Women's Hospital, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"McCracken","sequence":"additional","affiliation":[{"name":"International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Lee","sequence":"additional","affiliation":[{"name":"International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, and Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Andretta","sequence":"additional","affiliation":[{"name":"Highly Specialized Rehabilitation Hospital, Motta di Livenza, Treviso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harvinder Singh","family":"Chhabra","sequence":"additional","affiliation":[{"name":"Indian Spinal Injuries Centre, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claes","family":"Hultling","sequence":"additional","affiliation":[{"name":"Karolinska Institutet, Spinalis Foundation, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina-Anastasia","family":"Rapidi","sequence":"additional","affiliation":[{"name":"Physical & Rehabilitation Medicine Department General Hospital \u201cG. Gennimatas,\u201d Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fin-Biering","family":"S\u00f8rensen","sequence":"additional","affiliation":[{"name":"Clinic for Spinal Cord Injuries, Rigshospitalet, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ineta","family":"Zobina","sequence":"additional","affiliation":[{"name":"Welsh Spinal Cord Injury Rehabilitation Centre (WSCIRC), Cardiff, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francois","family":"Theron","sequence":"additional","affiliation":[{"name":"Muelmed Rehabilitation Centre and Department of Orthopedic Surgery, University of Pretoria, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Kessler","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine and Ren\u00e9e Crown Center for Spinal Cord Innovation, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederique","family":"Courtois","sequence":"additional","affiliation":[{"name":"Department of Sexology, Universit\u00e9 du Qu\u00e9bec \u00e0 Montr\u00e9al, Montreal, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Berri","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation at the University of Michigan Medical School, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"25425","reference":[{"key":"b1","series-title":"Top Spinal Cord Inj Rehabil","first-page":"265","article-title":"Spinal cord injury community survey: Understanding the needs of Canadians with SCI","volume":"20","author":"Noreau\n              L","year":"2014","unstructured":"Noreau\n              L\n            , NoonanVK, CobbJ, et al.\n          Spinal cord injury community survey: Understanding the needs of Canadians with SCI. Top Spinal Cord Inj Rehabil. 2014;20:265-276."},{"key":"b2","series-title":"Breastfeeding recommendations","author":"World Health Organization","year":"2021","unstructured":"World Health Organization\n          . Breastfeeding recommendations. 2021.Accessed December 25, 2023. https:\/\/www.who.int\/health-topics\/breastfeeding#tab=tab_2"},{"key":"b3","series-title":"Psychol Health","first-page":"1536","article-title":"Predicting intention and maintenance of breastfeeding up to 2-years after birth in primiparous and multiparous women","volume":"38","author":"Grano\n              C","year":"2023","unstructured":"Grano\n              C\n            , FernandesM, ConnerM. Predicting intention and maintenance of breastfeeding up to 2-years after birth in primiparous and multiparous women. Psychol Health. 2023;38:1536-1552."},{"key":"b4","series-title":"Birth","first-page":"122","article-title":"Breastfeeding rates and hospital breastfeeding practices in Canada: A national survey of women","volume":"36","author":"Chalmers\n              B","year":"2009","unstructured":"Chalmers\n              B\n            , LevittC, HeamanM, et al.\n          Breastfeeding rates and hospital breastfeeding practices in Canada: A national survey of women. Birth. 2009;36:122-132."},{"key":"b5","series-title":"Top Spinal Cord Rehabil","first-page":"114","article-title":"Motherhood after spinal cord injury: Lactation, breastfeeding and autonomic dysreflexia. Knowledge to practice","volume":"24","author":"Lee\n              AHX","year":"2018","unstructured":"Lee\n              AHX\n            , HocaloskiS, HodgeK, et al.\n          Motherhood after spinal cord injury: Lactation, breastfeeding and autonomic dysreflexia. Knowledge to practice. Top Spinal Cord Rehabil. 2018;24:114-115."},{"key":"b6","series-title":"Spinal Cord","first-page":"837","article-title":"The availability and quality of breastfeeding guidelines for women with spinal cord injury: A narrative review","volume":"60","author":"Rosetti\n              L","year":"2022","unstructured":"Rosetti\n              L\n            , ElliottS, LeeAHX, et al.\n          The availability and quality of breastfeeding guidelines for women with spinal cord injury: A narrative review. Spinal Cord. 2022;60:837-842."},{"key":"b7","series-title":"Acta Paediatr","first-page":"30","article-title":"Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: A systematic review and meta-analysis","volume":"104","author":"Horta\n              BL","year":"2015","unstructured":"Horta\n              BL\n            , Loret de MolaC, VictoraCG. Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: A systematic review and meta-analysis. Acta Paediatr. 2015;104:30-37."},{"key":"b8","series-title":"J Hum Lact","first-page":"556","article-title":"The influence of spinal cord injury on breastfeeding ability and behavior","volume":"34","author":"Holmgren\n              T","year":"2018","unstructured":"Holmgren\n              T\n            , LeeAHX, HocaloskiS, et al.\n          The influence of spinal cord injury on breastfeeding ability and behavior. J Hum Lact. 2018;34:556-565."},{"key":"b9","series-title":"CMAJ","first-page":"E839","article-title":"AGREE II: Advancing guideline development, reporting and evaluation in health care","volume":"182","author":"Brouwers\n              MC","year":"2010","unstructured":"Brouwers\n              MC\n            , KhoME, BrowmanGP, et al.\n          AGREE II: Advancing guideline development, reporting and evaluation in health care. CMAJ. 2010;182:E839-E842."},{"key":"b10","series-title":"Spinal Cord","first-page":"815","article-title":"The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)-What's new?","volume":"57","author":"ASIA and ISCoS International Standards Committee","year":"2019","unstructured":"ASIA and ISCoS International Standards Committee\n          . The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)-What's new?Spinal Cord. 2019;57:815-817."},{"key":"b11","series-title":"Respir Physiol Neurobiol","first-page":"157","article-title":"Autonomic function following cervical spinal cord injury","volume":"169","author":"Krassioukov\n              A","year":"2009","unstructured":"Krassioukov\n              A\n            \n          . Autonomic function following cervical spinal cord injury. Respir Physiol Neurobiol. 2009;169:157-164."},{"key":"b12","series-title":"Top Spinal Cord Inj Rehabil","first-page":"225","article-title":"Evaluation and management of autonomic dysreflexia and other autonomic dysfunctions: Preventing the highs and lows: Management of blood pressure, sweating, and temperature dysfunction","volume":"27","author":"Krassioukov\n              A","year":"2021","unstructured":"Krassioukov\n              A\n            , LinsenmeyerTA, BeckLA, et al.\n          Evaluation and management of autonomic dysreflexia and other autonomic dysfunctions: Preventing the highs and lows: Management of blood pressure, sweating, and temperature dysfunction. Top Spinal Cord Inj Rehabil. 2021;27:225-290."},{"key":"b13","series-title":"J Chiropr Med","first-page":"170","article-title":"Ultrasound as a treatment of mammary blocked duct among 25 postpartum lactating women: a retrospective case series","volume":"11","author":"Lavigne\n              V","year":"2012","unstructured":"Lavigne\n              V\n            , GleberzonBJ. Ultrasound as a treatment of mammary blocked duct among 25 postpartum lactating women: a retrospective case series. J Chiropr Med. 2012;11:170-178."},{"key":"b14","series-title":"Breastfeeding: A Guide for the Medical Profession","author":"Lawrence\n              RA","year":"2021","unstructured":"Lawrence\n              RA\n            , LawrenceRM. 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J Spinal Cord Med. 2021;44:247-252."},{"key":"b35","series-title":"Can J Public Health","first-page":"244","article-title":"Symptoms of postpartum anxiety and depression among women in Canada: Findings from a national cross-sectional survey","volume":"112","author":"Gheorghe\n              M","year":"2021","unstructured":"Gheorghe\n              M\n            , VarinM, WongSL, et al.\n          Symptoms of postpartum anxiety and depression among women in Canada: Findings from a national cross-sectional survey. Can J Public Health. 2021;112:244-252."},{"key":"b36","series-title":"Matern Child Health J","first-page":"362","article-title":"Prevalence and risk factors for postpartum depression symptoms among women with disabilities","volume":"19","author":"Mitra\n              M","year":"2015","unstructured":"Mitra\n              M\n            , IezzoniLI, ZhangJ, et al.\n          Prevalence and risk factors for postpartum depression symptoms among women with disabilities. Matern Child Health J. 2015;19:362-372."},{"key":"b1","series-title":"Top Spinal Cord Inj Rehabil","first-page":"265","article-title":"Spinal cord injury community survey: Understanding the needs of Canadians with SCI","volume":"20","author":"Noreau\n              L","year":"2014","unstructured":"Noreau\n              L\n            , NoonanVK, CobbJ, et al.\n          Spinal cord injury community survey: Understanding the needs of Canadians with SCI. Top Spinal Cord Inj Rehabil. 2014;20:265-276."},{"key":"b2","series-title":"Breastfeeding recommendations","author":"World Health Organization","year":"2021","unstructured":"World Health Organization\n          . Breastfeeding recommendations. 2021.Accessed December 25, 2023. https:\/\/www.who.int\/health-topics\/breastfeeding#tab=tab_2"},{"key":"b3","series-title":"Psychol Health","first-page":"1536","article-title":"Predicting intention and maintenance of breastfeeding up to 2-years after birth in primiparous and multiparous women","volume":"38","author":"Grano\n              C","year":"2023","unstructured":"Grano\n              C\n            , FernandesM, ConnerM. Predicting intention and maintenance of breastfeeding up to 2-years after birth in primiparous and multiparous women. Psychol Health. 2023;38:1536-1552."},{"key":"b4","series-title":"Birth","first-page":"122","article-title":"Breastfeeding rates and hospital breastfeeding practices in Canada: A national survey of women","volume":"36","author":"Chalmers\n              B","year":"2009","unstructured":"Chalmers\n              B\n            , LevittC, HeamanM, et al.\n          Breastfeeding rates and hospital breastfeeding practices in Canada: A national survey of women. Birth. 2009;36:122-132."},{"key":"b5","series-title":"Top Spinal Cord Rehabil","first-page":"114","article-title":"Motherhood after spinal cord injury: Lactation, breastfeeding and autonomic dysreflexia. Knowledge to practice","volume":"24","author":"Lee\n              AHX","year":"2018","unstructured":"Lee\n              AHX\n            , HocaloskiS, HodgeK, et al.\n          Motherhood after spinal cord injury: Lactation, breastfeeding and autonomic dysreflexia. Knowledge to practice. Top Spinal Cord Rehabil. 2018;24:114-115."},{"key":"b6","series-title":"Spinal Cord","first-page":"837","article-title":"The availability and quality of breastfeeding guidelines for women with spinal cord injury: A narrative review","volume":"60","author":"Rosetti\n              L","year":"2022","unstructured":"Rosetti\n              L\n            , ElliottS, LeeAHX, et al.\n          The availability and quality of breastfeeding guidelines for women with spinal cord injury: A narrative review. Spinal Cord. 2022;60:837-842."},{"key":"b7","series-title":"Acta Paediatr","first-page":"30","article-title":"Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: A systematic review and meta-analysis","volume":"104","author":"Horta\n              BL","year":"2015","unstructured":"Horta\n              BL\n            , Loret de MolaC, VictoraCG. Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: A systematic review and meta-analysis. Acta Paediatr. 2015;104:30-37."},{"key":"b8","series-title":"J Hum Lact","first-page":"556","article-title":"The influence of spinal cord injury on breastfeeding ability and behavior","volume":"34","author":"Holmgren\n              T","year":"2018","unstructured":"Holmgren\n              T\n            , LeeAHX, HocaloskiS, et al.\n          The influence of spinal cord injury on breastfeeding ability and behavior. J Hum Lact. 2018;34:556-565."},{"key":"b9","series-title":"CMAJ","first-page":"E839","article-title":"AGREE II: Advancing guideline development, reporting and evaluation in health care","volume":"182","author":"Brouwers\n              MC","year":"2010","unstructured":"Brouwers\n              MC\n            , KhoME, BrowmanGP, et al.\n          AGREE II: Advancing guideline development, reporting and evaluation in health care. CMAJ. 2010;182:E839-E842."},{"key":"b10","series-title":"Spinal Cord","first-page":"815","article-title":"The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)-What's new?","volume":"57","author":"ASIA and ISCoS International Standards Committee","year":"2019","unstructured":"ASIA and ISCoS International Standards Committee\n          . The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)-What's new?Spinal Cord. 2019;57:815-817."},{"key":"b11","series-title":"Respir Physiol Neurobiol","first-page":"157","article-title":"Autonomic function following cervical spinal cord injury","volume":"169","author":"Krassioukov\n              A","year":"2009","unstructured":"Krassioukov\n              A\n            \n          . Autonomic function following cervical spinal cord injury. Respir Physiol Neurobiol. 2009;169:157-164."},{"key":"b12","series-title":"Top Spinal Cord Inj Rehabil","first-page":"225","article-title":"Evaluation and management of autonomic dysreflexia and other autonomic dysfunctions: Preventing the highs and lows: Management of blood pressure, sweating, and temperature dysfunction","volume":"27","author":"Krassioukov\n              A","year":"2021","unstructured":"Krassioukov\n              A\n            , LinsenmeyerTA, BeckLA, et al.\n          Evaluation and management of autonomic dysreflexia and other autonomic dysfunctions: Preventing the highs and lows: Management of blood pressure, sweating, and temperature dysfunction. 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