Information provided by: Cherie C. Binns RN BS MSCN
By: MSF
Staff and reviewed by the MSF Medical Advisory Board
The
Decision
The decision to
start a family is a life-changing one. For any couple, it is difficult to
speculate how their relationship, employment and financial status might change
over the years. Speculation is a gamble and there are no guarantees. For those
couples that must factor in the additional uncertainties of MS, both
speculation and decision-making grow more complex. Nevertheless, there are
steps that you and your partner can take that will enable you to make
intelligent and realistic decisions.
Ideally, the
decision to start a family should be a team effort. Parenting is a lifetime
commitment and thoughtful consideration must be given to the various challenges
that could arise as a result of MS. Worsening disability could change your
financial status. Fatigue could be troublesome, particularly when caring for a
baby or toddler.
With a little
flexibility and a creative, proactive approach on the part of both parents,
solutions to these and similar problems are within reach. For example, if you
were not well for a period of time, would your partner be willing to take over
household chores and parenting responsibilities as needed? Do you have caring
friends or family members nearby to offer support and assistance throughout
your labor, delivery, and postpartum period? Having a support system in place
can make a tremendous difference.
Attend a local
MS support group meeting. Talk and listen to others who are successfully
parenting with MS. What are their challenges? How are they handling them? What
have they learned?
Together with
your partner, visit your neurologist and discuss current disease activity and
possible progression. Ask questions. In her book, Multiple Sclerosis: The Questions
You Have – The Answers You Need, Rosalind Kalb, Ph.D.
writes, “Historically (and occasionally even now), couples have found that
some members of the medical profession discourage pregnancy, and even parenting
for a woman who has MS. We now know that there is no medical reason for women
with MS to avoid pregnancy.” If you decide to start a family and your
neurologist is not supportive, find another one. A supportive obstetrician is
also important. As a team, these professionals can provide the care and
encouragement that you and your baby deserve.
Will My
Baby Develop MS?
The risk of
your child developing MS, although higher than the general population, still
remains low. “While there is some increase in the risk to children with a
family history of the disease, the actual risk is small (95 percent chance that
MS will not occur). At the present time there is no way to diagnose MS or
assess the MS risk in a particular infant before or after birth,” asserts
Dr. Kalb.
Will MS
Affect My Pregnancy?
Statistics show
that only ten percent of women experience relapses during their nine months of
pregnancy. Research indicates that women with MS who give birth show no signs
of increased disability over their lifetime than women with MS who never become
pregnant. One study even suggests that women with MS who become pregnant may be
less likely to develop a progressive course of the disease when compared to
women with MS who choose to forego having children.
For reasons
still not entirely understood, pregnancy allows the body to enter a mildly
immunosuppressive state. This means that during pregnancy, a woman naturally
achieves the immunosuppressive state that is usually achieved artificially with
some medications. This could be the reason for reduced disease activity during
pregnancy. Many women with MS feel exceptionally well, especially during their
third trimester, when relapse rates are at an all-time low.
On the other
hand, fatigue, especially during the first three months, constipation, and
urinary tract infections may be bother-some for some women. Your obstetrician
may suggest using a stool softener to alleviate constipation or having regular
urine cultures to detect potential infections.
Can I
Take Medication?
Generally,
there are two categories of medication used to treat MS. There are those that
are used to treat symptoms, such as bladder infections. These medications are
often safe to continue during pregnancy, but always check with your doctor
first. Then there are the immunomodulating agents that actually reduce disease
activity. These include Avonex®, Betaseron®, Copaxone®, and Rebif®, commonly
called the ABCR drugs. The safety of these drugs during pregnancy, as well as
their affect on the unborn baby, has yet to be determined. Recent research
suggests that Copaxone may carry a reduced risk to the fetus in animals. More
research is needed, however, to determine the effects of these drugs on the
unborn human child. There is also some concern that these drugs could increase
the risk of miscarriage.
As soon as you
begin trying to conceive, talk with your doctor about your medications. Unless
you plan to breastfeed your baby, you may, with your doctor’s consent, resume
your medication immediately after delivery.
Will MS
Influence My Labor and Delivery?
MS does not
appear to influence the course of pregnancy, labor or delivery. In fact, there
is no reason to expect your labor to be significantly different from that of a
woman without MS. An injection of anesthetic into the lumbar area of the spine
(an epidural) to alleviate pain during labor is common and usually safe.
General anesthesia is also considered safe. Many couples enroll in prenatal
classes, or practice the Lamaze technique. This breathing and relaxation method
has been widely practiced since the early 1950s. Meet with your doctor or
anesthesiologist to explore your options.
Women with
substantial lack of sensation or paralysis may be closely monitored during the
ninth month, just in case they are unable to recognize the onset of contractions
or need labor to be induced after dilation of the cervix begins. Should muscle
weakness or fatigue occur after several hours of pushing, the delivery may be
assisted with forceps, a suction cup on the baby’s head, or a Caesarian
section. If leg control or spasticity is a problem, an epidural can be
beneficial.
Inform your
obstetrician of any steroid use, particularly over the past 12 months. If you
have taken steroids on a regular basis during that time, you will need steroid
medication during labor.
What
About the Postpartum Period?
Careful
planning for the postpartum period can minimize stress, fatigue, and your risk
of having an exacerbation. Exhaustion is typical for new mothers, but a new
mother with MS must not ignore this fatigue. It is important to focus only on
caring for yourself, resting, and feeding your new baby. Other household tasks,
shopping, social events, and even some of the infant care should be delegated
to others.
During the
initial six months after delivery, 29 percent of women will experience a
relapse. Due to this heightened risk, you may choose to start or restart one of
the immunomodulating drugs right after your baby is born. If you are employed
outside the home, you may require a longer maternity leave than the average six
to eight week period that is customary in the U.S., because relapses occur most
frequently between the fourth and eighth week of the postpartum period.
In the book, Mother To Be: A Guide to Pregnancy
and Birth For Women with Disabilities, Judith Rogers and Molleen
Matsumura interviewed Margie, a 27 year-old woman with MS, to discover the
changes she experienced throughout her pregnancy, labor, delivery, and
postpartum period.
“Margie
had MS before she became pregnant. Her symptoms before pregnancy were weakness
in the arm and leg on one side, and occasional bladder problems. About her
first pregnancy Margie said, ‘I felt great while I was pregnant! I enjoyed
feeling so healthy, and I had a positive outlook on life’.”
The authors go
on to explain that, “After her first pregnancy, Margie’s MS worsened
slightly. Her main problem was blurred vision. After her second pregnancy, she
made sure she had extra help, and there was no exacerbation of MS.”
Should
I Breastfeed My Baby?
“Historically,
neurologists have discouraged women with MS from nursing, feeling that it posed
an additional physical burden to a woman already at increased risk for an
exacerbation,” writes Dr. Kalb. “However nursing is now widely
encouraged if you have adequate dexterity, strength, and stamina.”
Breast milk not
only provides optimal nutrition, but also eliminates the nuisance of bottle
preparation. If you do choose to breastfeed, be consistent with all feedings
during the first two weeks. This should generate a steady and sufficient milk
flow. After this initial period, you can pump and store your milk or use
formula so that your partner can handle the nighttime feedings. This is the
best way for you to get the sufficient, uninterrupted rest that is so crucial
for a new mother with MS. According to current medical information, there is no
elevated risk of exacerbation caused by breastfeeding.
It is important
to realize, though, that breastfeeding can be tiring. For women whose symptoms
are exacerbated by fatigue, this could be a deciding factor. On the other hand,
some women feel that breastfeeding is less demanding than bottle-feeding. Talk
it over with your partner, your obstetrician, your neurologist, or a lactation
consultant at your local hospital.
A Final
Word
Make sufficient
rest top priority from conception through the postpartum period. Proper
nutrition and some form of physical activity are also important. Strive to
communicate openly and honestly with your partner. Establish a support network
before the baby arrives. Be flexible in terms of parental and domestic
responsibilities. Things may not always be done exactly the way you would do
them yourself, but they will be done. Let that suffice. Your health and the
health of your child are far more important than any domestic chore.
Rather than
ignoring the existence of your disease, acknowledge it, in all its
unpredictability, and plan accordingly. Many of the things you plan for may
never come to pass. Nevertheless, preparedness now will reduce stress and
fatigue later, granting you and your partner ample time to delight in your new
baby.
RECOMMENDED
READING
Multiple
Sclerosis: The Questions You Have – The Answers You Need. Rosalind C. Kalb, Ph.D.
©2000 Demos Medical Publishing, Inc.
Multiple
Sclerosis and Having a Baby: Everything You Need to Know about Conception,
Pregnancy and Parenthood
Judy Graham ©1999 Inner Traditions Intl., Ltd.
Mother
To Be: A Guide to Pregnancy and Birth For Women with Disabilities
Judith Rogers and Molleen
Matsumura ©1991 Demos Publications
(Last reviewed
7/2009)
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