Pregnancy: Your Questions and Concerns
Your ability to get pregnant does not seem to be affected by MS, so that's the good news. Women with MS conceive at the same rate as other women who do not have MS. Additionally, research has shown that pregnancy and childbirth don't have any long-term negative effects on most women with MS. It's uncommon for expectant mothers to experience a worsening of symptoms while they're pregnant. In fact, for many women with MS, pregnancy seems to offer some protection from exacerbations. Here are some other things to keep in mind:
Labor for a woman with MS is usually handled in the same way as it is for other women. In general, moms with MS deliver their babies like everyone else.
Expectant women with MS are more susceptible to other health problems, such as fatigue, urinary tract infections, and constipation. An obstetrician may suggest certain precautions, such as using a stool softener to counter constipation, having regular urine cultures to detect possible infections, or changing MS medications.
Research shows no elevated risk of exacerbations caused by breastfeeding. Certain medications may be off limits, and some mothers may be too tired to breastfeed. It's a personal choice that you should explore with your MS specialist.
The risk that your baby will someday develop MS is about 1 to 5 percent. Although MS is not a directly inherited disorder, genetic factors are thought to increase the risk of developing MS in some individuals.
Women with MS can have healthy, full-term babies. Research shows that there is no increased risk for miscarriages.
People are often surprised to find that pregnancy is a viable option for women with MS and that there appear to be few — if any — physical implications beyond an increased risk of relapse following childbirth. The challenge comes from thinking things through — putting the what-ifs into play and problem-solving potential issues such as disease progression or physical limitation.
Essential
Since you can't be sure how you'll be feeling two or three years down the road, it's often difficult to think ahead, so a good rule of thumb is to imagine what you'd do in certain situations, such as losing or leaving a job or having problems with mobility or fatigue. Problem solving before problems arise is a good stress-management strategy.
The Planning Process
Deciding to start a family is a big decision for any couple, but for those living with MS, there are a number of considerations to take into account. Practical issues such as financial security and employment come into play, as well as long-term considerations such as how many children you'd like to have and how MS may affect your parenting ability. While the statistics are in your favor, it's important to be cognizant that you may be the exception and have a relapse following pregnancy. The truth is, in order to make a well-informed decision you have to hope for the best and plan for the worst. You have to troubleshoot any potential problems and figure out now how you'd handle them.
Alert
In the postpartum stage, research indicates that exacerbations increase in nearly 30 percent of cases, so your chances of having a relapse after giving birth are somewhat greater. You're most at risk in the first three to six months after you've given birth. Further, women who are experiencing active MS before their pregnancy may be more at risk for having a relapse following pregnancy.
There are a few things that need serious consideration before starting a family:
Your financial status. Diapers and nursery school are only the tip of the iceberg. Financial security also includes college planning, health and life insurance, and job security. Before deciding to start a family, you should take a good look at your finances and troubleshoot any potential problems, such as a partner who might decide to leave the work force early or the possibility that you'll change careers. A financial planner can help you get your financial house in order.
Timing. The disease-modifying therapies are not approved for use during pregnancy or breastfeeding, so you'll have to stop the medication two to three months before you become pregnant. If you decide to breastfeed, you won't be able to resume the DMTs until you're through nursing your baby.
The numbers. You may have once imagined that you'd have a house full of kids, but it's time to reconsider the number. Five children will be five times the demand on your time and energy and you don't want to spread yourself too thinly.
Support. Take a good look at your support network and see if that helps you in the decision-making process. People who have oodles of relatives on hand may feel If you think you could use a bit more support, be proactive in developing a network. Parenting groups give you opportunities to meet other parents. Neighbors and friends are a good source of support, too. You may want to look into hiring some help as well, such as a babysitter who can give you a few hours' break on a Saturday afternoon.
Alert
If you were recently diagnosed, your doctor may want you to consider postponing pregnancy for a year or two until you've gotten a handle on things and you've given your DMT a chance to kick in. Your MS specialist will have valuable insight, so make an appointment to talk to him during the baby-planning process. The timing of having a family is a deeply personal issue, but one you need to carefully explore.
The First Year
The first year of a baby's life is exhausting for parents and you'll be hard pressed to find anyone to tell you any differently! Good planning and realistic expectations can help you over the humps, though.
Researchers aren't exactly sure why women are at increased risk of experiencing a relapse after giving birth, but they theorize it may have something to do with postpartum hormonal fluctuations. When you add in a lack of sleep and a whole host of new tasks and chores, it's easy to see how new parents can feel drained.
Be sure to call in the troops after you've given birth. Having a family member to support you those first few weeks is invaluable, especially if it's someone who has experience with newborns. Being able to take a hot shower or a short nap is not only wonderful, but important to your health and well-being.
Have your friends or neighbors pledge their support before the baby is born. In other words, schedule rest and relaxation for yourself before you need it. Beyond your support network, you may want to limit guests for the first few weeks to give yourself a chance to recuperate.
If you're planning on going back to work, take as much maternity leave as possible. Remember, you'll be doing double duty when you leave your job each day to juggle the responsibility of home and children. You'll want to use your break from work as a time to connect with your child, but also to establish a good health regimen. Your goal will also be to regain your strength.
Enlist the support of your spouse or someone else you trust to help you with daily tasks, including nighttime feedings. If you're breastfeeding, learning to use a breast pump will add some flexibility to your schedule.
Good planning and strategizing will go a long way in helping you to manage the challenges of starting a family.
