Study reveals how spinal cord injury disrupts breastfeeding

Spinal cord injury can disrupt breastfeeding by affecting milk let-down and triggering dangerous blood pressure spikes, research suggests.

In Canada, exclusive breastfeeding is recommended for the first six months of a baby’s life, with continued breastfeeding encouraged into the toddler years.

For women with spinal cord injury, or SCI, this can present distinct physiological and clinical challenges.

For decades, reproductive health in the SCI community has been understudied.

While more women with SCI are growing their families, gaps in research and clinical guidance persist and can create challenges soon after giving birth.

One patient partner at the International Collaboration on Repair Discoveries described how her newborn fed well from one breast but struggled with the other.

Although her injury affected one side of her body more than the other, neither she nor her care team were certain this was the main cause.

That helped prompt an international research effort led by clinician-scientist Dr Andrei Krassioukov of Vancouver Coastal Health Research Institute.

Krassioukov found that breastfeeding rates among women with SCI vary widely, ranging from 11 to 100 per cent.

Women with high-level injuries, meaning damage higher up the spinal cord and closer to the head, were less likely to breastfeed and tended to do so for shorter periods.

These differences are rooted in physiology. Breastfeeding depends on the “let-down reflex”, where signals from the nipple travel through the spinal cord to the brain, triggering the release of oxytocin and allowing milk to flow.

Injuries at or above the thoracic spinal cord, the part running through the upper and middle back, can disrupt this pathway.

“If injury is above this level, women may have difficulty breastfeeding or be unable to eject milk, even if it is being produced,” Krassioukov said.

Breastfeeding can also trigger autonomic dysreflexia, or AD, a sudden and potentially life-threatening rise in blood pressure caused by stimuli below the point of injury on the spinal cord.

Other causes include bladder and bowel problems such as infections or constipation, as well as tight clothing or skin irritation.

Because people with SCI may have reduced sensation, AD can be hard to detect until it becomes an emergency.

“AD can cause blood pressure to rise so high that a person can have a stroke,” Krassioukov warned.

Research suggests AD is common in women with injuries at or above the T6 level, in the middle part of the thoracic spinal cord, yet awareness of these risks remains low among both families and health care providers.

The research team conducted an international survey involving more than 100 women with SCI.

Their findings highlighted not only physiological barriers, but also significant gaps in care.

“Many women told us they did not receive the support they needed during what should be a cherished time,” Krassioukov said.

Some participants described pressure to breastfeed despite complications, while others said they felt ashamed when it was not possible for medical reasons.

These experiences reflect a broader issue, with many health care providers lacking SCI-specific knowledge, especially in maternal care.

In a national survey of Canadians with SCI, many respondents reported gaps in provider knowledge.

For breastfeeding specifically, clinicians may have limited training in how injury level affects milk production, positioning, safety risks and overall care.

To address these limitations, Krassioukov and his team, with support from the Craig H. Neilsen Foundation, developed two complementary resources: clinical practice guidelines for health care providers and a consumer guide for mothers.

The clinical guidelines provide evidence-based recommendations across disciplines, including obstetrics, physiatry, nursing and rehabilitation, with a focus on individualised, team-based care.

The consumer guide translates this information into accessible, practical advice to help women understand their options and communicate their needs with care teams.

The research also emphasises that some breastfeeding outcomes cannot be predicted from injury level alone. Instead, clinicians are encouraged to empower mothers to set individualised, realistic goals.

“If you are a care provider who does not have experience with spinal cord injury, ask for help,” Krassioukov said.

“And listen to your patients.”