This is part of a series of posts taken from a research paper I wrote for my certification to become a breastfeeding educator.
Though myelomeningocele and other forms of spina bifida are relatively common, information on breastfeeding infants with these defects is limited. In their 2007 study, Hurtekant and Spatz state, “At present, no research has examined the unique breastfeeding needs of a mother and her infant with spina bifida.” Though a few babies with very severe hydrocephalus which frequently accompanies spina bifida may not be able to breastfeed because of neurological impairments, the vast majority of babies with spina bifida can breastfeed (Riordan, 561). Breastfeeding will be just one of many normal activities that will simply require some initial adaptations for the baby with spina bifida. Parents should be encouraged to keep in mind that despite their baby’s condition, breastfeeding is still normal and very beneficial.
SPINA BIFIDA FORMS AND COMPLICATIONS
Spina bifida encompasses a class of neural tube defects characterized by an opening in the spine. This occurs when the posterior neural tube fails to completely close- usually around the 28th day of pregnancy. There are four different types of spina bifida: Occulta, closed neural tube defects, meningocele and myelomeningocele.
Spina bifida occulta is the mildest form and is relatively common, occurring in approximately 10 to 20 percent of the population. Spina bifida occulta is usually asymptomatic as the skin covers the defect. This form of spina bifida may cause some degree of disability, however such an occurrence is very rare.
Closed neural tube defects are characterized by malformations of fat, bone, or meninges. Closed neural tube defects may have few or no symptoms or may sometimes cause incomplete paralysis with urinary and bowel dysfunction. A dimple, tuft of hair or birthmark may be present at the skin covering the site of the malformation.
Spina bifida meningocele consists of defects in which spinal fluid and the layers of protective tissue surrounding the spinal cord called meninges protrude through an abnormal vertebral opening. These malformations contain no neural elements like nerves and may or may not be covered by a layer of skin. Spina bifida meningocele may cause few or no symptoms or it may result in complete paralysis and bladder and bowel dysfunction.
Spina bifida myelomeningocele is the most severe form of spina bifida and results in an open neural tube defect where the spinal column or neural elements protrude through the opening in the spine. Individuals with this form of spina bifida generally have some form of complete or partial paralysis in the lower body as well as bladder and bowel dysfunction. This form of spina bifida is usually accompanied by a brainstem malformation called Chiari II malformation in which the brainstem protrudes down into the neck or spinal column area. This often causes a buildup of excessive spinal fluid in the skull, a condition called hydrocephalus. Many individuals with spina bifida utilize clean intermittent catheterization to empty their bladders and prevent renal failure (National Institutes of Neurological Disorders and Stroke).
Spina bifida- especially myelomeningocele- is a relatively common disabling birth defect affecting approximately 1 in every 2,858 births. (Centers for Disease Control). The cause of spina bifida is not fully understood at this point, though neural tube closure seems to be governed by both environmental and genetic factors. Genes, such as Pax3, sonic hedgehog, and openbrain, are essential for the formation of the mammalian neural tube, but dietary factors, such as cholesterol and folate intake play an important role. It has been estimated that 50% of human neural tube defects could be prevented by a pregnant woman taking supplemental folic acid. To this end, the U.S. Public Health Service recommends that all women of childbearing age take 0.4 mg of folate daily to reduce the risk of neural tube defects during pregnancy (Gilbert). However, other factors have been linked to spina bifida such as gestational diabetes, obesity, elevated body temperature during the early weeks of pregnancy and certain anti-seizure medications (Mayo Clinic).