Thursday, December 2, 2010

Moms with IBD - Part 2!

Here we go - part 2!  Part 1 is about medications, and what's safe or not safe during pregnancy or breastfeeding.  This section is not as specific, I'll try to go after it in a Q and A.

Disclaimer: I'm not a doctor.  I'm a mommy with UC who likes to write stuff and put it on the internet.  Please don't take my advice over the advice of someone who has a medical degree and does this for a living!  Talk to your doctor before you do anything dumb.

I have UC/Crohn's.  Can I have a baby?
Yes.  Lots and lots of women with IBD have kids, and have healthy, happy pregnancies.  You need to take extra-special care of yourself during pregnancy and post-partum.


Does UC/Crohn's affect fertility?
Yes and no.  If the disease is under control, then there should be no change in your ability to get pregnant.  Active disease can affect fertility - mostly due to fever, anemia, inflammation, and general malaise.  If you're flaring, try to get healthy before you try to have a baby.

What should I consider before trying to conceive?
Evaluate your health with your GI doctor.  Does he/she believe you are healthy enough to handle the physical and emotional stress?  Discuss any drugs you may be on right now, and get off any of the nasty meds if you can.

Will I flare during pregnancy?
Maybe, maybe not.  About 25% of IBD mamas will flare during their pregnancy - 75% will stay totally healthy.  If you do flare, it is most likely to happen in the middle to end of your second trimester, when your hormone levels peak.  Keep an eye on your symptoms and address a possible flare early.  Many treatments work for a mild flare but major flares are harder to control.

Do I have to see a high-risk OB?
Not unless you have high-risk symptoms.  Having IBD does not make you high risk.  If your pregnancy is progressing in a healthy way (even if your disease isn't!), you can see whoever you are comfortable seeing.  Despite being in the midst of a rough flare, I was lucky enough to be cared for by a wonderful midwife.

Do I have to have a c-section?
No.  If you have had surgery on your intestines, you may be given the option for a c-section, but remember - it's major surgery.  Many GI and obstetrics professionals recommend vaginal birth, because it is easier on your system.  

If you are flaring severely, there is a slight risk of fissures while pushing.  The solution to this is not a c-section!  The solution is mother-directed pushing; that is, rather than being told when to push and counting to 10, you push when you are comfortable doing so.  Your body will tell you when you push, don't worry - and it will also tell you when not to push, which is very important.  If you decide to have an epidural or other pain medication, ask that it be turned down or off before you start to push.  That way, you can feel your body's reaction and control it.

I know a few moms with IBD who have even had home births.  Don't let your disease rob you of a beautiful birth experience.

I have to have a colonoscopy or endoscopy while pregnant.  Is this safe?
Colonoscopies, sigmoidoscopies and endoscopies should only be performed during pregnancy if medically necessary, and then, they should be performed after the middle of the second trimester.  I had an unmedicated colonoscopy at 21 weeks, and I do not suggest it.  Because my disease was in full swing, it hurt more than unmedicated childbirth!  If you'd like to learn more about sedation options, click here.  I wish I'd researched them before instead of after.

I'm used to the pain that comes with UC/Crohn's.  How is labor different?  Will I know I'm in labor?
I can't answer the first question personally (my first sign of labor was my water breaking!) but other moms say to look for regularity of contractions.  You'll feel your entire belly get hard, and contractions are timeable.  I found that the pain of natural childbirth was really not very bad at all, compared to my worst UC pain.  Pitocin contractions were a different story....

I'm flaring.  Is my baby in danger?
Probably not.  If you are past the halfway point in your pregnancy, your body will usually choose to take care of the baby before it takes care of you.  In your first trimester, a severe flare does carry a higher risk of miscarriage, because of malnutrition.  If you are losing weight in pregnancy, this is a concern and you should talk to your GI doc about getting your flare under control.

I'm scared to take medicine.  I won't even take Advil or have a beer! 
Me too.  BUT, we're in a tough spot.  It's about balancing risk.  Your baby needs a healthy mom - before and after birth.  Putting your own health at risk does not help the baby.  Work with your doctor to find a solution.  Do not hide from this disease.  It will not go away on its own - you have to do something, if it's diet adjustment, supplements, or medicine.

Can I breastfeed my baby?
Yes, unless the medications you need are unsafe for breastfeeding.  Malnutrition can cause supply problems, so do the best you can to stay healthy while you are breastfeeding.  If you end up on the nasty meds post-partum, you can look into milk donation.  There's a great group on Facebook called "Eats on Feets" that can put you in touch with local donors.

Will I pass IBD on to my children?
I don't know.  Nobody does.  There is clearly some genetic component to IBD, but it's not cut and dry.  Breastfeeding cuts down on the risk of your baby getting IBD; so does healthy eating during childhood.  Most people with IBD have a close relative with the disease, but it's not a straight corrolation.  There is currently no genetic testing for IBD.

Any other advice?
Be careful right after you have the baby.  Most of the IBD moms I know flared, not during pregnancy, but right after - in the 6 weeks post-partum.  Your hormones crash, you're not getting enough sleep, you're stressed and anxious, and you eat pizza 4 nights a week.  Not a good combo!

You are most vulnerable after you have your little one in your arms.  Every new mother needs lots of support; you need even more.  The advice to "sleep when the baby sleeps" is especially important to you.  Don't live on take-out; eat healthy and carefully -  make your friends and family cook for you.  Take care of yourself.  On the boards below, you'll hear story after story of IBD moms hospitalized when their babies were weeks old...including me!  Take care of yourself.


How can I connect with other moms with UC and Crohns?
Healing Well's support group has a lot of great moms and other resources.
UC and Crohn's Mommies on BabyCenter
Facebook - Moms with Crohn's and UC

Good luck!  Post comments!  More than anything, be well and enjoy your baby.  Don't let IBD diminish the beauty of pregnancy and birth for you.  This is a wonderful, precious time.  Love it.

1 comment:

  1. Hi there, I am a trainee breastfeeding counsellor and your story of breastfeeding struggles grips my attention. I wondered whether you would make contact - spiritual_skater@hotmail.com as I found a snippet of info which may be useful to you and other sufferers... Would you mind??? In the meantime, my own struggles made BBC news if you're interested :-) http://news.bbc.co.uk/1/hi/health/6613229.stm
    Great info on the medications. The BfN have a great 'drugs in breastmilk' helpline too, but this is super to see written down like this. X

    ReplyDelete