My wife is pregnant with our first child. And I’m not sure how we got here, but we’ve made it this far. We’ve gone through a ton of emotions including joy, excitement, anxiety, and wondering how this ‘unfathomable love’ everyone speaks of will hit us once we set our eyes on our little bundle of joy. And no matter how much advice you get or books you read, when it comes to the challenges of pregnancy, can anyone truly prepare you for all the obstacles and pitfalls? What about expectant mothers who are amputees? As if new mommy worries aren’t enough, you’re contending with life as an “amputee mommy”.

So let’s do this. Let’s work out how to manage life as an amputee and expectant mother.

Courtesy Christa Couture. Photography by Jen Squires.

New Amputee Mom: First Trimester

The first trimester is a douzy. Some of you may be hiding the pregnancy for the first few months, and others may be preparing to share the good news as soon as you’ve confirmed there’s a bun in the oven. No matter your choice, most women will begin experiencing those first trimester ‘Changes to [Her] Entire Being’, as my loving wife puts it.

She’s not an amputee mommy, and she doesn’t hide any of the things she’s feeling as her body changes thanks to the miracle of pregnancy. As my wife has reminded almost on the daily, ‘Oh I’m not doing anything big here, just building a placenta from scratch and creating human life.’ She’s modest and I love her for it.

In the first trimester, you’re contending with finding the right Obstetrician, exhaustion, morning sickness, sore breasts, and if you’re lucky like my wife, adult acne among other things.

So let’s talk about exhaustion. If you thought you knew what tired was before you got pregnant, let my wife tell you, “it’s nothing compared to this.” That’s because you and your body are doing a TON of work and you’re going to feel it. And that’s okay. The one thing that kept my wife going through it all was remaining active. As many articles and experts advise, remaining active during pregnancy typically translates to easier labor. It’s suggested that healthy women exercise at least 150 minutes a week doing moderate-intensity aerobic activity spread throughout the week. Now 150 minutes seems like a lot, but you can break that down to two walks a day, 5 days a week. It can be as easy as 2 15-minute walks with your dog. Or perhaps instead of sitting down and having coffee with a friend, take that coffee on a walk around downtown and enjoy the scenery while on the move. As for continuing with your regular exercise routine or starting a new one, always check with your doctor to make sure things are on the up and up.

My wife was obsessed with indoor spinning and continued to spin 4-5 times a week until her second trimester. But she was constantly concerned about keeping her heart rate at a recommended 140 bpm. Her doctor was the voice of reason and said she may continue any routine she did pre-pregnancy and just focus on not exerting herself for long durations. The Mayo Clinic writes that today, heart rate limits aren’t typically imposed during pregnancy.  

The good news is even at rest, amputees experience an increased heart rate. And while you’re pregnant, your heart is pumping a whopping 40 to 50 percent more blood than it did pre-pregnancy. It’s also beating 10-20 more times per minute than before. And that’s all to fuel the umbilical cord and placenta – and prep for the main event: baby’s birth. Now it makes more sense why you’re more tired than you were pre-bump, doesn’t it.

Pregnancy and Your Prosthetic Leg

It’s important to tell your Prosthetist the good news so you can start discussing options as your body changes. Creating a Prosthetic Roadmap is important for managing these changes as a new amputee mom. If insurance allows, it may be a good time to begin the authorization process for a new prosthetic socket with your insurance carrier. However, if a prosthetic socket change is not an option, you and your Prosthetist can look at all the other potential options to manage limb volume changes during pregnancy.  

Your Residual Limb

Body aches are a very common complaint during pregnancy. From leg cramps to pelvic pains to residual limb aches, the discomfort is usually just a sign your body is preparing for childbirth. All those boney structures and ligaments are changing and becoming more lax, preparing to bring your baby into the world. If you experience residual limb aching or worse cramping, massage may be helpful. Cramping may also be related to your prosthetic socket becoming tight due to swelling of your residual limb. At times, this can be caused by salt intake or swelling side-effect common in pregnancy. Either way, wearing a fresh prosthetic shrinker at night may help alleviate some of the swelling.

Quick First Trimester checklist 

Weeks 1-10 * 

• Find an OB/GYN
• Schedule prenatal checkup
• Research insurance — how does it deal with pregnancy and children? Prosthetic coverage?
  • Is your preferred OB/GYN in/out of network
    • What hospital do you prefer
    • What hospital will doctor deliver at
  • What tests will be covered under insurance
  • Will it allow for prosthetic socket change
  • Will it cover pre-natal vitamins
• Make sure partner has short and long term disability
• Figure out how pregnancy, baby and maternity leave will affect finances
  • Go to HR and see what your company allows for maternity leave
    • Will your company allow you to take time off BEFORE the baby arrives
    • How long are you allowed and at what coverage level AFTER the baby arrives
  • Figure out a budget
    • Do you want to take off more time with baby? How much time can you afford?
    • Remember to calculate out-of-pocket expenses for doctor check-ups, hospital stay, and tests
  • First prenatal checkup (right around week 8-10)

Weeks 8-12 

• Chorionic villus sampling
• Nuchal translucency screening (week 10-12)
• Chromosomal disorder screening (week 10-14)
• Doctor visit

*Pregnancy is counted from the last menstrual period and your due date is approximately 40 weeks after that. 

Second Trimester

Before you know it, you’ll have graduated to the second trimester. This is where most women will regain their energy again (yeah!) and where if you haven’t begun showing, you will start to see a bit of a bump. You’ll also be hitting exciting milestones like feeling baby’s first kicks, saying goodbye to morning sickness, buying maternity clothes, and thinking about baby names to name a few.

The second trimester is where you’ll likely see a bit more weight gain, and if you’re like my wife and not used to having your center of gravity shift so quickly to the front, may I suggest you take this time to invest in little things that may make life easier? For instance, suction handrails can easily be added to the toilet area to help you get on and off the toilet more easily. If a raised toilet seat is your thing, by all means, this is a great time to implement this game changer. Now when it comes to sleeping, a ‘U’ shaped pregnancy body pillow will not only support your growing belly, it’s a great support for your residual limb while sleeping. One warning, this thing is HUGE. It’s like having an extra person in your bed, which poses its own challenges when kissing your significant other good night. But boy is the tradeoff worth it for a good night’s sleep!

And since you have more energy, let’s continue to stay active. Low intensity activities like swimming and walking can be done safely right up until delivery in most cases. Swimming is at the top of many expectant amputee mommy lists because being in water allows you to feel almost weightless, which is a welcome relief after carrying around an extra human all day long. Plus swimming can be done comfortably even when your prosthesis isn’t fitting well.

Stretching

Stretching seems to be a magical solution to many things that ail us. And pregnancy side-effects are no exception. Stretching while pregnant can keep you feeling your best. It can help prepare your body by lengthening muscles, which can help offset the growing stress on joints. Loose, flexible muscles also help make you more comfortable as you carry extra weight. Pregnant women should target upper and lower back muscles, leg muscles, and their chest and hips with stretches. Just remember to move slowly. Pregnancy relaxes your ligaments and joints and can affect your balance. Always listen to your body and stop stretching if you are in pain.  

Second Trimester and Your Prosthetic Leg

At this stage, you should be executing your Prosthetic Pregnancy Road Map you designed with your Prosthetist.  Because your current socket may start feeling tight, this roadmap will often include a new socket. The simplest prosthetic socket option, regardless whether you wear an above or below-knee prosthetic leg, is one that includes a prosthetic cushion liner. You may already know most prosthetic brands make liners available in different thicknesses, 3mm, 6mm and 9mm thick. Insurance will typically cover two liners per year (however, check with your insurance for sure) so I suggest ordering two liners at the same time, a 3mm and 9mm liner. 

As your baby and body grow, it will become more difficult to put your leg on. The reason why I suggest a cushion liner is that your Prosthetist can glue a ratchet lock to the outside of the liner. This ratchet lock can then snake out on the outside of your prosthetic socket and engage with the ski boot binding type of lock. When the lock is on the outside, it's easier to find and unlock.  I’d avoid pin systems right now because being swollen and rocking a bigger belly, they can be hard to engage and there's a chance of getting your socks lodged in the lock. As that belly grows, it becomes increasingly difficult to see what you're doing-- and getting stuck inside your prosthesis is no fun.

As your adorable bump sprouts into full-on baby belly, applying your gel liner will become increasingly difficult. Using Prosthetic Liquid Powder will allow you to slide your liner onto your residual limb with ease. It takes just one minute for the liquid powder to dry before you can begin walking. A secondary benefit of liquid powder is that the powder will absorb perspiration and keep you drier. And if you’re lucky enough to be pregnant through the hottest summer months, this is especially comforting.  

Now for prosthetic liner thickness, start with the thicker 9mm liner with a 5-ply sock fit and adjust accordingly. As your residual limb swells thanks to warmer weather and pregnancy, you can easily manage your sock ply and change to a thinner liner.

Second Trimester Mommy Checklist

• Start buying maternity clothes– my wife put this off for as long as she could and once she got her first pair of maternity jeans, she was in heaven.
• Knit-Rite not only knits prosthetic socks, but they also make belly bands for sale at preggers.com. My wife began using the Bellaband and eventually moved onto using belly band from Preggers because ‘Bellaband is like a gateway band. These from Preggers are the real deal.’ My wife is succinct.  
• Start using your U-shaped pillow to help with sleeping 
• Use a shower chair  
• Install suction handrails in the bathroom for getting on/off the toilet and in the shower stall. 
• Stay hydrated, but avoid drinking too much water before bedtime. Nighttime bathroom breaks will become more difficult and take away from your much needed sleep. Difficulty comes in the form of putting your prosthetic leg on when pregnant or using crutches to get to the bathroom. Carrying a growing belly, worrying about a prosthesis or crutches, and making it to the toilet in a timely manner is no easy chore in the middle of the night. Coordinate a plan with your significant other.    

Third Trimester and Your Prosthetic Leg

This is it. Major milestones in the next few months include finding and taking a Childbirth Class, preparing for maternity leave, and decorating your nursery. And one more important thing, keep moving! As long as your doctor says it’s okay and you follow a few fitness safety precautions, you can continue to swim, walk or continue whatever your exercise of choice is right up to your due date.

Prosthetic Pregnancy Road Map

At this point, you’re likely wearing the thinnest gel liner, the 3mm with the appropriate amount of socks. If you’re experiencing chafing, consider a sheath. If you have an above knee amputation, the A/K Brim Sheath is a great choice. The third trimester will see even more changes in your body. Make sure you continue to see your Prosthetist to make needed adjustments to your prosthetic socket to increase your comfort. It is common to experience lower back pain during the third trimester, so your Prosthetist can monitor your alignment and leg length height.

 Another tip for putting on your prosthetic leg during your third trimester is simply to begin showering at night before bedtime. You’re least swollen first thing in the morning, so applying your prosthesis is easier. Showering in the AM means your limb is out of your prosthesis, allowing it to swell and increase the chance of it being too tight to apply correctly. This may also exacerbate any low back pain you’re already experiencing.

Third Trimester Amputee Mommy Check-List

• Write out your Birth Plan. Having a solid birth plan that you can discuss with your OB and partner prior to going into labor will be helpful.
• Take a hospital tour. If you haven’t already, month 7 is a great time to  take a tour of the hospital or birthing center where you plan to give birth.
• Choose a pediatrician.  Interview a few candidates with a list of questions around week 32 and pick your favorite.Not sure where to start? Ask your OB for recommendations.
• Buy baby gear.  Make sure you have the baby gear essentials — especially a car seat (which you’ll need to bring your baby home from the hospital), crib, stroller, changing table and baby monitor. On that note, take your car seat in to be professionally installed.And if you’re a two-car family, consider getting two bases, so you can put the baby car seat in either car without having to unstrap and restrap, level, and constantly make adjustments to the all-important base.
• Pack your hospital bag
  • The main basics to remember for the hospital bag are, as my wife puts it ‘things to keep [her] feeling human’. Besides the big items like copies of your birth plan (if you have one), a picture ID, health insurance information, and hospital registration forms, she recommends remembering little things like a smartphone and charger, reading material or knitting (whatever you can do to pass the time), a robe and nightgown, cash and change, flip flops, toiletries, snacks, homecoming outfit for you and your baby, nursing bra, washable nursing bra pads, disposable underwear, and an extra bag for the goodies from the hospital and your well wishers. Oh, and if you want a good pic of you and baby right after birth, she recommends bringing your OWN hospital type gown. She was gifted this by a mom at work, telling her ‘you don’t want your first picture with baby to be in a hospital given gown.’ We didn’t know this is a thing either, but now she’s the proud owner of a teal gown with red roses, and it’s packed and loaded in her bag.

• See more here: Packing List

It's Time

As the baby’s due date approaches for the amputee mother, it’s important to consider whether or not you’ll wear your prosthetic during delivery. Delivery Room nurses frequently recommend walking during the early stages of labor to hasten cervical dilation, among other benefits. The old days of lying down on the hospital bed as soon as you arrive until the baby is born are almost gone. Now they want you up and moving, and some nurses even recommend squatting or semi-reclining positions to allow gravity to assist the baby’s movement, so wearing a prosthesis as long as possible can be helpful.

Labor

Don’t get married to your dream delivery even if you’ve written out it out on your Birth Plan (BTW, bravo prepared mama-to-be). Even if you’re hoping for a vaginal birth, there’s a 1 in 3 chance you may have a C-section. But not to worry, it won’t be the end of the world.

If you wear an above knee prosthesis, discuss with your doctor BEFORE labor to have the incision made a little higher if possible.  This may help avoid prosthetic socket brim fitting issues—skin irritation— after labor. 

There are so many considerations when bringing baby into the world; many more than I’m able to cover in just one article. Your journey as an amputee mommy is unique, and I hope this helps you a bit. I wish you a happy pregnancy, easy labor, and healthy baby.

Please let me know if you have additional thoughts or questions. Comments are welcome below!