Intrapartum Care for Women with Multiple Sclerosis: A JBI-Guided Scoping Review and Evidence Synthesis of Clinical...

This scoping review aimed to map and synthesize current evidence on intrapartum care practices reported for women with MS, maternal and neonatal outcomes associated with childbirth among women with MS, and implications for midwifery and nursing care for women with multiple sclerosis (MS). Despite the increasing prevalence of MS among women of reproductive age, intrapartum management remains inconsistent and insufficiently synthesized, which may contribute to unnecessary interventions and variability in clinical decision-making.

This scoping review followed the methodology of the Joanna Briggs Institute and adhered to PRISMA-ScR guidelines. Searches were conducted in PubMed, MEDLINE, CINAHL, Scopus, and grey literature for studies published between January 2020 and January 2025. Two independent reviewers conducted study selection and data charting using the Population-Concept-Context framework. Methodological quality was assessed using an adapted Kmet checklist. Findings were synthesized narratively and organized using the PAGER framework.

Eleven studies met the inclusion criteria. Women with MS experienced higher rates of cesarean section compared with the general obstetric population, despite evidence that MS alone is not an indication for surgical birth. Neuraxial analgesia and anesthesia were consistently reported as safe and were not associated with postpartum relapse or disability progression. Maternal outcomes included increased fatigue, mobility limitations, and emotional concerns during labor. Postpartum relapse was primarily associated with pre-pregnancy disease activity. Neonatal outcomes were generally reassuring, with adverse outcomes mainly linked to disease activity and exposure to disease-modifying therapies. The PAGER synthesis identified patterns of conservative care, advances in analgesia safety, and gaps in fatigue management and interdisciplinary coordination.

Intrapartum care for women with MS remains conservative and inconsistently aligned with current evidence. Midwives and nurses play a key role in supporting evidence-based decision-making, managing fatigue and anxiety, and promoting woman-centered, interdisciplinary intrapartum care.