Spina bifida is a type of neural tube defect that occurs very early in pregnancy. During the first month of gestation—often before a woman even realizes she is pregnant—the embryo forms a structure called the neural plate. This plate rolls up to form the neural tube, which eventually becomes the brain and the spinal cord.
When this tube fails to close completely along the back, a gap is left in the vertebrae. This structural failure usually happens between the 26th and 28th day after conception. While the exact cause involves a complex mix of genetic and environmental factors, a lack of adequate folic acid intake before and during early pregnancy is proven to increase the risk significantly. In Nigerian clinical practice, midwives frequently encounter cases where mothers had little or no access to periconceptional vitamin supplementation, making health education on nutrition a vital preventative duty.
Spina bifida presents in different forms, ranging from mild anatomical variations with no symptoms to severe conditions involving paralysis and hydrocephalus.
When a baby is born with an open neural tube defect, immediate and careful assessment is required. Midwives must examine the newborn methodically without damaging the delicate lesion.
Safeguarding an unruptured neural sac before surgical repair is a critical nursing priority. The exposed neural tissue is extremely fragile, and any trauma or drying out can worsen permanent nerve damage.
Positioning is the first line of defense. The newborn must never be laid flat on their back. Instead, nurse the baby in a prone position (lying on the stomach) or in a supported side-lying position to keep pressure entirely off the back lesion.
The sac must also be kept moist to prevent the delicate membranes from cracking or drying. Apply sterile, non-adherent dressings soaked in warm normal saline. Avoid wrapping the area tightly or using adhesive tape directly over the lesion. Diapers should be kept well away from the lower edge of the defect to prevent faecal or urinary contamination, often by leaving the lower half un-diapered and using absorbent pads underneath the baby's hips instead.
An open spinal defect acts as a direct pathway to the central nervous system, making meningitis and local wound infections major, life-threatening risks. Strict aseptic technique is mandatory during every interaction with the infant.
All dressing changes must be performed using sterile gloves and instruments. Midwives should inspect the sac frequently for any signs of leakage, redness, foul odor, or purulent discharge. Because newborn immunity is already immature, hand hygiene before and after touching the baby or the surrounding bedding cannot be overemphasized. In busy clinical wards, maintaining a clean environment and limiting the number of people handling the infant helps reduce cross-infection. Prophylactic antibiotics may be prescribed by the medical team, but they never replace rigorous physical hygiene and barrier protection.
Surgical repair is performed as soon as possible after birth—usually within the first 24 to 48 hours—to close the spinal defect, prevent infection, and protect remaining neural tissue.
Following surgery, the newborn returns to the ward for intensive monitoring. The surgical site must be kept clean, dry, and free from stool contamination. The midwife continues to nurse the infant in a prone or side-lying position until the surgical team confirms the wound has healed sufficiently.
Pain management, vital sign observation, and strict neurological checks are essential. Midwives must remain vigilant for signs of rising intracranial pressure, such as a bulging fontanelle, vomiting, irritability, or a rapidly increasing head circumference, which indicate that the infant has developed hydrocephalus requiring a shunt insertion.
The birth of a child with spina bifida impacts the entire family, requiring comprehensive, long-term care that extends far beyond the neonatal period. Because the condition affects multiple body systems, management involves a team of specialists including pediatricians, neurosurgeons, physiotherapists, orthotists, and urologists.
Long-term care addresses mobility challenges through physiotherapy and bracing, neurogenic bladder management through clean intermittent catheterization, and developmental monitoring. In many resource-limited settings, parents face emotional distress, social stigma, and financial strain. Midwives play a crucial counseling role by offering empathetic listening, connecting families to community support groups, and teaching parents home care techniques to promote their child's independence and dignity.