Having a baby while on dialysis

[Melissa]

No, I am not having a baby!

But recently I have heard comments about not being able to have a baby while on dialysis, and I wanted to see if that is really true.  I know Dr.s do not recommend it, and that it is very high risk, but I have read some news articles about it happening, and most recently when I was in the hospital a woman came in to show off her brand new, healthy baby.  She was a long term dialysis patient who dialyzed 6 days per week in order to carry the baby.  I think it is not common, but there are centers who will let women do this now.  I am too old and have some other issues so I could not do it, but for some of you younger ones out there it might be something to look into!!
If anyone has more information I would love to learn more!

[bette1]

I know that it is possible,  and I have a woman at my center who had a baby while on dialysis. 

As you said, it is difficult since many dialysis patients don't have periods, or are in too poor health to carry a baby.  I was counciled to get a transplant and then get pregnant because the outcomes are much better for women with transplants who get pregnant.

[cariad]

I definitely wouldn't do it. And I have a ridiculously high risk tolerance for most medical matters. It is rarely successful, and the majority of the risk is with the baby's health.

[okarol]

Here's one news story http://ihatedialysis.com/forum/index.php?topic=13716.0

One of our members had a baby on dialysis but she has not posted for awhile. I will see if I can find her story.

[Zog]

Yes you can I have a baby on dialysis.

Here is a picture of our baby, my wife, her nurses in 2008.





It's rough I tried to explain everything we had to do to Miz Flow a girl with lupus on home hemodialysis.

Here's what I wrote back then.

We had a baby while on home hemodialysis. My wife had 3 failed kidney transplants and has been on and off dialysis since she was 12. She is 26 now. Her childhood doctors, like yours, told her that she would probably not have any children. We had a baby girl in April at 36 weeks gestation and she is fine. She has a 50% chance of having an genetic issue with her bladder that may or may not lead to VUR which caused my wife's kidney loss.

If you ever are pregnant and on dialysis, your first problem will be finding out you are pregnant, because morning sickness and a bad dialysis day feel the same. If you are still doing your own dialysis set your own dry weight. Keep a daily weight gain chart and graph a trendline using Excel. You should have a pretty linear gain after 14 weeks. Your blood pressure may indicate if your weight is too low or high.

Monitor your fluids and keep your ultrafiltration rate below 0.8 L/hr. Do dialysis 7 days a week for around 3-4 hours each day for about 24 hours a week or at least until your PRE-BUN is less than 50 and your post BUN is normal. We found skip days to be scary and reckless after the 1st trimester and decided to go 7 days/week. You have so much weight to pull off after a skip day and that makes the dry weight calculation hard and the ultrafiltration rate high, not to mention your BUN is too high. If we had to do it again, we would push for nocturnal home hemo every night.

Don't worry about Heparin and pregnancy. They give Heparin to some women to stop miscarriages.

You will need massive amounts of Epogen. We did 40,000 units twice a week. Do blood labs weekly to check your BUN and hemoglobin. I don't know if there is a lupus related blood number you should keep an eye on, but you should figure that out with your doctor.

Don't worry about phosphorus and potassium and binders. Eat healthy things needed to make a baby. Babies have bones. They need calcium and phosphorus. Doing dialysis for over 20 hours a week is about as close to having a kidney as you can get. Blood test reference ranges for pregnant women are not very well known or established. Don't be alarmed if some lab number is out of range and it is supposed to be that way for "normal" pregnancies.

Stay out of the hospital as long as possible if you feel comfortable doing so and go full term or at least 34 weeks. If they "force" you into a hospital, make sure you have some input into your dry weight. Don't let them induce you unless there are some pretty good reasons and it is past 34 or 35 weeks. Some doctors will brag about some baby they saved at 28 weeks, that's great, but you don't want to risk that if you don't have too.

A few hundred extra or less milliliters can stress your baby's placenta. Fluid is fluid and it will go into and out of the placenta. You will need weekly ultrasounds in your third trimester to make sure there is not too much or too little fluid in the placenta.

The relationship between this fluid and how well you manage your dry weight hasn't really been studied. Some doctors are trying to use some one size fits all weight gain chart. Go by the new IOM guidelines that are based on your BMI.

You will need several NST's (non stress tests) to monitor the baby's heartbeat and your contractions. My wife had to have a c-section after she had a catheter exchange that got infected. The biggest clue that the baby needed to come out NOW was the NST. The baby was in distress. We had a home NST machine too. I highly recommend getting one as you may have to rely on it to decide when to go to the hospital. Most dialysis mothers don't have the luxury of waiting to go into labor to have the baby. It will probably be a medical decision based on the NST readout.

Read as many medical journal articles as you can. You would be amazed at how little experience is out there. What you will find is a direct correlation between hours per week on dialysis and the length of the pregnancy.

Sorry if this is long. I probably should have my own blog! Good luck with whatever you do. We thought about adopting children before we married. I always had faith we could make a baby, and we did.

[Malibu]

For discussions sake, aren't you guys concerned that you will pass on your kidney ailment to your offspring?  That would be of a very big concern to me.

[Zog]

We thought about it.  Several doctors tried to talk us into abortion.  Abortion terminates about 20% of dialysis pregnancies.  Jenn had VUR.  Her dad had VUR.  Her 3 brothers had VUR.  Our niece has had VUR.  Jenn and her Dad are the only ones who have lost their kidneys.  Jenn's great grandfather is the only one who may have died from it.  VUR is very treatable if found soon enough.  Jenn's brothers had their ureters reimplanted.  Our niece who is a toddler had something implanted.  Our daughter has no signs of VUR and her ureters appear normal on ultrasound and during a VCUG.  Some say the condition is passed by the father.  I think our daughter may be a carrier but not a sufferer.

[Malibu]

What is VUR?  That is good news that it can be treated if found early.  I can imagine your calendar!  :O) 

I think I would be living on pins and needles but probably when my daughter giggled and smiled at me all those worried feelings would go away.

[Zog]

VUR is vesicoureteral reflux.  A condition where urine doesn't empty into the bladder properly or flows from the bladder back to the kidney.  It results in enlarged ureters (the tube that connects the bladder to the kidney).  This leads to hydronephrosis which damages the kidney.

Here's a link http://www.urologychannel.com/pediatric/vur.shtml

Jenn had congenital VUR.  Jenn had several UTI's and it was discovered her youngest brother and her father had this condition before Jenn lost her kidneys at age 12 .  Why the alarms didn't go off that they should check Jenn and her other brothers until after her kidneys were beyond repair is a tragic mystery to me.  Her pediatrician should have know better.  I would ask her and her parents more questions about this, but I don't want to reopen any old wounds.  I just know it is very important that we always monitor our daughter and that she knows to check her children and grandchildren, etc, etc.