Over the course of my career in maternal-fetal medicine, I’ve seen many complex pregnancies. In 2017, I got the opportunity to care for Latonya Menefee, a pharmacist who, at age 41, learned that she was pregnant – with a baby boy who is due 20 years to the day that a tragic accident left her paralyzed from the waist down.
Latonya’s is a complicated pregnancy, no doubt about it. In order to provide the unique care she needs, we’ve worked with Latonya and our UT Southwestern colleagues to modify some of our traditional prenatal tests and measurements.
Four challenges in Latonya’s care
1. Getting weighedGetting weighed is a routine part of pregnancy care, but it’s complicated when the patient is in a wheelchair. Transferring the patient from the chair to the scale and back again can be time-consuming and inaccurate if the patient is being supported by a nurse or doctor.
To get around this, we weigh Latonya on a scale in our wound care clinic at Clements University Hospital. Latonya visits the wound care clinic on the third floor before or after her Ob/Gyn appointment on the fifth floor. It’s still not simple. The wheelchair has to be positioned just so for the weight to accurately register, and there are times when she has to be lifted from the chair so the chair can be weighed by itself.
2. Length of appointments
One of Latonya’s UT Southwestern maternal-fetal medicine doctors, Patricia Santiago-Munoz, M.D., and Emily Rainier, RN, realized after a few visits that transferring Latonya from her wheelchair to the exam table and back was eating up a lot of time in the clinic schedule. We began to block two appointment times for her in order to address her needs and questions and care for subsequent patients in a timely manner.
We’ve also adapted to provide all of her care in one room. For example, instead of moving her to a different room for a sonogram, as we would with most patients, we do all of her visit in her first room to save an extra transfer.
3. Urine testsLatonya uses catheters to empty her bladder, so the typical instruction to “pee in a cup” and leave the specimen in our restrooms is much more cumbersome and time-consuming. To make it a little easier on Latonya and to keep our appointment schedule on track, we give Latonya clean, marked specimen cups so she can collect urine at home and bring it to the clinic for testing.
4. Fit of wheelchairAs Latonya’s body changes during pregnancy, the fit of her wheelchair will change as well. This could leave her susceptible to pressure sores, or sores that develop when the wheelchair presses into the skin too much in the same spot. Because she has no feeling in the lower half of her body, Latonya won’t feel when these sores develop. She has to physically inspect her skin regularly and keep an eye out for overall signs of infection, such as sweating, chills, and nausea.
Ideally, she would get a new wheelchair to use during pregnancy. However, there is a lot of red tape and expense that goes into getting mobility equipment. Because Latonya works and has insurance, she’s not eligible for government assistance that could cover a new chair before her allotted review time. She’s currently borrowing a chair from Numotion, a local mobility equipment company.
While we make adjustments to care for Latonya at the Ob/Gyn clinic, she is adapting to doing things differently at home and at work. She offered to share the first part of her pregnancy story and to follow up with us after her son is born.
Latonya’s story in her words: Overcoming the odds to become a mom
I was 21 and in my second semester of pharmacy school when I was involved in an accident that left me paralyzed from the waist down. The way I saw it then is the way I see it now: I could give up, or I could grow stronger. I chose the latter.
With hard work and support from my family and friends, I recovered from the accident and finished pharmacy school. Today, I’m a pharmacist in Dallas, I’m expecting a baby boy I thought I’d never have, and I couldn’t be happier.
I’ve always wanted children, but doctors told me for years that it would never be possible for me. My boyfriend, Leon Maryland, and I decided to try a fertility app to calculate my most fertile days and see if we could defy the odds. Lo and behold, we got pregnant naturally!
I came to UT Southwestern for my prenatal care because one of my sorority sisters, who is an Ob/Gyn, referred me here. I first got to see the maternal-fetal medicine specialists eight weeks into my pregnancy, and they’ve been caring for me ever since.
Adapting to my pregnancy at work and at homeFor the past two decades, I’ve gotten pretty good at taking care of myself. One of the toughest things about my pregnancy so far has been having to lean on Leon and my mother more than I’d like. I’m grateful for their help, of course, but getting out of breath doing little household things or transferring from my chair to bed is frustrating. I’m afraid that if I fall, my baby could get injured. My mother and Leon take shifts at home so someone is always with me in case something happens, and that makes me feel better.
I’ve had to make some adjustments at work, too, as my body changes during pregnancy. I work 12-hour days, and a pharmacy is a fast-paced work environment. My feet swell more than a typical woman’s might, so I’ve had to start wearing house shoes to work because my regular shoes don’t fit anymore. My swollen feet tend to slip off the footrests of my chair, and I have to be aware of where my feet are to avoid injuries that could lead to infections. About halfway through my pregnancy, I ended up needing emergency surgery for a leg infection and had to spend some time on bedrest because of it.
And I have to strategically plan out my restroom breaks. What used to take just a few minutes now takes 15 to 20 minutes because I have to work around my growing belly to use my catheters. I depend more now on protective garments to guard against accidents when we’re busy in the pharmacy.
Other than these modifications, my doctors say my pregnancy has been fairly normal. We’re planning for a vaginal delivery, and I’m excited but a little nervous for that. I can’t push, and I’m not sure if I’ll know when my water breaks or when contractions begin.
Leon and I have been keeping a journal of our experiences with my pregnancy so we can give hope to other people who have been told they would be unable to have a baby. Being paralyzed for 20 years has made me a natural problem-solver, and my medical background as a pharmacist has made me flexible enough to try new things when a plan doesn’t work. The way I see it, the only difference between me and an able-bodied woman is that I’m rolling! And I’ll keep rolling through this pregnancy, right into motherhood.
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