Pregnancy and parenting are challenging experiences, but for individuals with Acquired Brain Injury (ABI), these challenges are magnified, writes Natalie Mackenzie Director of BIS Services.
ABI, encompassing both Traumatic Brain Injury (TBI) from external trauma and non-traumatic injuries from internal factors such as a stroke, introduces unique demands into the family dynamic.
Pregnancy is a period of substantial change and increased vulnerability, particularly for those with ABI. Cognitive impairments can significantly affect a woman’s ability to care for herself and her unborn child.
The common experience of “baby brain” in pregnancy, characterised by short-term memory issues, is often intensified in women with ABI, leading to greater difficulties in daily functioning.
Pregnancy brings a range of psychological, cognitive, and physical changes.
For neurotypical women, these may include decreased verbal learning and memory capabilities during gestation (Buckwalter et al., 2001).
Psychological challenges such as ambivalence, fatigue, and anxiety are common, and some women may experience tokophobia (a fear of childbirth), which can lead to increased stress and impact foetal health (Hofberg & Brockington, 2000); (Staneva et al., 2015).
Women with ABI often face additional challenges, such as lower self-esteem, higher rates of depression, sudden hormonal changes, and various functional disabilities (Howes et al., 2005; SNR, 2024).
Cognitive and behavioural deficits—such as impaired information-processing speed, language difficulties, and increased fatigue and anxiety—may be exacerbated by pregnancy (Goldman et al., 2022; Headway, 2024).
Ensuring robust support systems is crucial to manage these symptoms and reduce stress (Staneva et al., 2015).
Cognitive impairments can include decision making and problem solving, during pregnancy extra support may need to be provided to individuals with ABIs in order to ensure they can complete activities surrounding the baby and themselves.
Pregnant women more often than not experience fatigue and tiredness, partially due to hormonal changes (NHS, 2020).
Many hormonal changes have a greater impact upon pregnant women with TBIs.
For example, it is common for progesterone levels to be higher than usual during pregnancy which may impact upon physiological states for the baby and mother.
Drops in progesterone caused by some ABIs in pregnant females could raise the possibility of having a miscarriage or premature labour (Blaya et al., 2022).
Increased fatigue during pregnancy can cause certain risks to become higher for instance, preterm labour and extended labour lengths (Effati-Daryani et al., 2021). Due to individuals with ABIs struggling with fatigue, the increase in this during pregnancy can contribute to a number of increased needs for the mother.
Emotional regulation has been found to be impacted in those living with ABIs (McDonald & Genova, 2021).
When looking at the hippocampus and brain injury, it has been established that, whilst not being injured directly, it is impacted by atrophy in the months following the injury (Atkins, 2011). Therefore, emotional regulation is often effected after brain injury, and may be amplified in pregnant women due to the increase in hormones (Pięta et al., 2014).
Impact on Parenting
The diverse responsibilities of parenting necessitate robust cognitive abilities.
ABI can significantly impact cognitive functions essential for parenting, including memory, planning, judgement, and language skills. These impairments may lead to challenges in remembering critical details, organising daily tasks, and managing emotions.
Specific impacts may include memory impairments which may result in parents forgetting important aspects of their child’s life and struggle with daily organisational tasks.
Executive dysfunction deficits can hinder planning, organisation, risk assessment, and safety management, often requiring an increased support and therapy input for strategy implementation and education.
Emotional regulation challenges which can impact Temper management and irritability may make it difficult for parents to manage their emotions and their children’s behaviour effectively, placing strain on a whole family unit and dynamic.
Additionally, some acquired literacy challenges can affect a parent’s ability to support their children’s educational needs.
Parenting with ABI can be extremely difficult for both the individual and their family. The needs of the family often shift towards supporting the member with ABI, potentially impacting the caregiver role (Elbaum, 2019).
This can be problematic for their children by shifting the caregiver role on to them or leading to confusion in younger children (Goody, 2024).
In a comparison between families with and without a caregiver with ABI, results inferred that caregivers with ABI are less likely to set goals, promote discipline, nurture and be actively involved with their children. (Uysal, 1998).
Any injury which impacts emotional regulation, complicates the stress management associated with parenting. Mood swings, impulsivity, and the development of mental health conditions such as post-natal depression are common (Harris and Prvu Bettger, 2018).
These emotional challenges can strain parent-child relationships, particularly when navigating conflicts becomes difficult.
The lack of resources and education available to families can influence their understanding and management of ABI (Hart et al., 2018).
Tailored interventions and extensive neurorehabilitation have proven successful in improving functional independence and productivity for individuals with ABI (Holleman et al., 2018) and support from social networks is essential, as many individuals with ABI report that parenthood would not be feasible without it (Headway, 2024).
ABI often affects emotional regulation, complicating stress management associated with parenting. Mood swings, impulsivity, and the development of mental health conditions like depression are common (Harris and Prvu Bettger, 2018).
These emotional challenges can strain parent-child relationships, particularly when navigating conflicts becomes difficult.
ABI can also result in physical challenges, including motor function impairments, fatigue, and sensory deficits, making daily activities more difficult.
These physical limitations can affect independence and alter the individual’s sense of self (Harris and Prvu Bettger, 2018), as well has having practical implications of caring for a child.
Impact on Parent-Child Relationships
ABI can significantly affect parent-child relationships. Research indicates that 92 per cent of children with an ABI-affected parent showed negative emotional and behavioural changes over time (Pessar, Coad et al., 1993).
Research suggests that a child’s wellbeing may be neglected and at risk if their parent has an ABI (Tiar & Dumas, 2015) with a further of different case studies on the matter deemed these children a “high risk group” when looking at emotional and behavioural problems (Urbach & Culbert, 1991).
One study examining parenting skills and the effects of parental TBI on children found that parents with a TBI were less involved with their children and both parents were less strict with their disciplines (Uysal et al., 1998).
The coping competence model by Tiar and Dumas (2015) suggests understanding how families adjust to these changes through prosocial, antisocial, and asocial coping strategies encouraging open communication to adapt caregiving roles, fostering stronger bonds as well as the implementation of adaptive parenting techniques and seeking assistance from healthcare professionals.
Being able to join parenting classes that have been adapted for those affected with ABIs mean that the strategies taught would be adapted in an accessible way.
Meeting other parents in similar situations and forming connections within the community can help parents affected feel seen and not alone in their struggles.
Online forums and parenting classes can also be a more accessible way to get this support and be available at any time.
It is vital that these parenting support services promote accessibility and inclusivity to make it a welcoming environment where people have the space to learn and grow without judgment.
However, the availability of such programmes and classes with a focus on brain injury are scant at best, and often delivery is via individual rehabilitation teams.
Rehabilitation and Support
Community rehabilitation, encompassing cognitive rehabilitation and skill-building exercises, is crucial for individuals with ABI.
Rehabilitation should focus on skill enhancement in areas such as organisational and time management skills, while emotional regulation training can provide insights into managing mood swings and stress triggers (Ponsford, Harrington et al., 2006; Foster, Armstrong et al., 2012).
Strategies for community engagement include ensuring there are accessible support networks and community resources to aid in rehabilitation and where possible participation in adapted parenting classes and online forums to foster community connections and support.
Managing an Acquired Brain Injury adds complexity to the already challenging experience of parenthood. Understanding the impact of ABI on pregnancy and parenting is essential for neurorehabilitation professionals designing effective rehabilitation programmes tailored to the unique needs of these parents.
By providing targeted support and resources, professionals can help individuals with ABI navigate the complexities of parenthood, ensuring a supportive and sustainable family environment.
Many studies examining the effects of the family dynamic involved with ABI or the strain on an individual with ABI throughout pregnancy all highlight the importance of unique, personalised interventions to help improve outcomes for families (Morriss et al., 2013).
For patients with ABI, tailored intensive neuro-rehabilitation has been successful in improving functional independence and productivity for many years following injury (Holleman et al., 2018).
By fostering a comprehensive understanding of ABI’s impact on parenting, we can contribute to better rehabilitation outcomes and improved family dynamics.
This article was compiled by Natalie Mackenzie Director of BIS Services, bringing together research undertaken by 3 of our 2023/24 Placement students whom credit is also given: Lauren Taberner, Lauren Casewell and Roma Mitra.
We wish them the best of luck as they return to their studies.