Can dialysis patients give birth?

[Beth35]

I know that it is highly unlikely for someone on dialysis to become pregnant but if they do is it safe?  Can it be done?  Has anyone here ever done it?

[Fox_nc]

I had the same question ... I talked to my neph about it since I've never been able to have children - I actually thought that when I went on dialysis would be a good time to try since my kidney was all the way shot at that point    He advised against it because of my paticular situation, but he did say that if it was my long-term goal we could work on it together. I would say it depends on your situation and it's different for everyone. Have you talked to your neph yet? I believe there is a member on here who's wife had a baby while on dialysis maybe he can provide some good info.

Also ...  when I did research I found that some studies found there is a 50% fetal mortality rate in pregnancys on dialysis. Now that may be older research (I last looked it up 4 years ago) and like everything, it may be different now.

[kevno]

yes! On our unit in manchester a woman gave birth to twins while on dialysis. The last two months she did dialysis every day. It was very hard going. But last i herd the twins are doing fine.

[cariad]

Also ...  when I did research I found that some studies found there is a 50% fetal mortality rate in pregnancys on dialysis. Now that may be older research (I last looked it up 4 years ago) and like everything, it may be different now.

I would bet this is still true. Keep in mind, they would be gathering data from a really small sample. My nephrologist back in 2001 told me that renal failure in women of childbearing age is quite rare. (Isn't that great, ladies? We're rare!) He said only .5% of female dialysis patients can even conceive, and then the rate of miscarriage and other complications is high. A few successes does not make it a good idea, but I believe if it's important enough to you, then you need to pursue your dreams like everyone else. You're taking an important first step by gathering information and personal experiences. How would you feel about having to be inactive on the list for so long?

I wish you luck in whatever you decide to do.

[Zach]

You should contact IHD member Zog.
His wife is on hemodailysis and gave birth several years ago.

http://ihatedialysis.com/forum/index.php?topic=17950.msg312112#msg312112

[RightSide]

Yes, it can be done, though the odds of success are lower than for women without ESRD.  But it requires awareness of how changes to the mother's body during pregnancy have to be taken into account during the usual dialysis process:

http://www.aakp.org/aakp-library/Pregnancy/index.cfm

[Beth35]

Thank you for your responses.  I am getting up there in age which I know does not help.  I'm 36 now and I have adopted two children who I love SO super much!  I have always dreamed of being pregnant and having a baby in my belly.  It just seems like such a miracle.  I pretty much figured that would never happen.  The reason I'm asking now is that I am starting to date again and I am talking to someone online at the moment.  One of the questions he had for me is if I am open to having more children.  It got me thinking about the possiblity of pregnancy again and if it's possible.

Since this guy is new I have yet to inform him about my kidney disease.  I won't keep it a secret for too long.  Don't even know if things will work out there, but I thought I would get some info. together as it sounds like kids are important to him.

Zack, thanks I will try to contact Zog.   

[natnnnat]

I think it might be easier if you're on haemo than on PD?

[natnnnat]

Here are some discussions about pregnancy on dialysis.
Haven't read them, but I note a few are from Zog and his wife JDHartzog who had a baby while she was on haemo

Pregnant and on dialysis  http://ihatedialysis.com/forum/index.php?topic=6004.0

Re: Having a baby while on dialysis      http://ihatedialysis.com/forum/index.php?topic=16882.msg306198#msg306198
this post has a long description of their experiences written by Zog

Re: kidney disease and periods   http://ihatedialysis.com/forum/index.php?topic=16730.msg291331;topicseen#msg291331
this post is an article entitled "Pregnancy and contraception in renal disease"

Kids  http://ihatedialysis.com/forum/index.php?topic=15189.msg268474;topicseen#msg268474

Have you had children whilst on dialysis? (Question for the ladies only)  http://ihatedialysis.com/forum/index.php?topic=2805.0
Warning:  this one got heated for a page, then gets back on track on the last page.   It's a topic that gets people going.

xx
n

[Beth35]

Thanks for the links. I don't think having a baby is something I want to risk.  Makes me sad to accept that but it is what it is.  Life isn't always fair right?

[Zog]

How did I miss this topic this morning?

Beth,

You could still have a child if you are still fertile.  However, I don't know if it something you should actively pursue while on dialysis unless you are otherwise healthy and have a willingness to learn all you can about this and take charge of your dialysis treatments.

I don't know if it would be fair to your adopted kids to risk your life in such an endeavor.  We didn't choose to have our baby so much as she chose to happen at just the right moment (in between birth control methods (we stopped YAZ, that stuff is bad)).  We believed in giving her a chance after being warned by several doctors to abort.  If you have a transplant down the road and get the right guy and are still young enough, then go for it.  I love Jenn for more than her ability to have children.  I sort of had faith we would have a child when I met her on dialysis (she was only 22).  I just thought it would be with her transplant. 

The biggest problem with being pregnant on dialysis is too much fluid which in my opinion leads to polyhydramnios (too much amniotic fluid), high blood pressure (too much fluid), and Preeclampsia (too much fluid).  My theory was this fluid problem is caused by high intradialytic fluid gains that aren't correlated well with changing dry weight.  The second biggest problem is low hemoglobin and the third is whatever caused you to go on dialysis in the first place.  The forth is high BUN levels, high other levels which could lead to birth defects, premature babies.  Anyway, here is my cookbook method for having a baby on dialysis which is more faith/experience than science.

Do dialysis for 4 hours x 7 times per week at a high blood flow rate 450-500 ml/min.  Dialysis at the beginning of pregnancy is just as important as towards the end.  It just gets harder to manage.  Preferably do home hemodialysis with a very good access with a gentle machine like the NxStage.  Fast molecule clearance may not be what you are looking for.  The less shock to your system the better.  The goal is to trick your body into behaving like you still have kidneys that function 24/7.  There have been successful PD babies, but I don't know anything about that.  I imagine they did more/constant exchanges.  I would recommend nocturnal hemo, but near the end of term I doubt you would want to put the machine on autopilot while asleep.  You want to be checking blood pressure and the fetal monitor.  Keep UFR below 1.0 L/hr.  Drink at least 1.0 L/day.  Get weekly ultrasounds to verify there is not too much or too little amniotic fluid.  Get weekly labs to make sure your treatment is doing what it is supposed to which is keep your pre BUN below 50 and your post BUN in the normal range for a normal person.  Do labs to make sure you are eating enough protein and have enough hemoglobin.  You need to be able to do your own Epo shots at home every other day in your rear end.  You may need as many as 80,000 units/week.  However, don't get your hemoglobin above 13 or you do have a risk of clotting and you will clot your filter up and have less effective dialysis.  Heparin is okay for pregnancy and may actually help.  Make sure you do the other things to make red blood cells (B12 and Iron).  You may be able to go off most of your dialysis related medications with frequent long dialysis sessions.

Fluid is fluid.  When you do UF, drink water, etc, you are changing the amniotic fluid level slightly.  This is very important, plot your dry weight changes in relation to the suggested IOM weight gain guidelines for pregnant women that factor in for BMI.  Make sure you don't go too far off this path with your dry weight.  Your dry weight is going to change every week.  Eat whatever you want, but not too much, you don't want to mess up your steady dry weight gain.  You can't afford to pig out like some pregnant women.  Just eat like you weren't on dialysis.  The fetus needs phosphorus and potassium, protein, etc.  Learn to monitor your blood pressure and correlate it with your changing fluid level.  If it is high you may be able to do more UF.  If it is low, then maybe you should up your dry weight.  If you can master your fluid level and we did, you may actually feel better than a pregnant woman who is not on dialysis.  Remember that their kidneys are struggling and yours is plugged into the wall and can take the extra load.  Jenn never really had swollen feet or high blood pressure. 

If you can get past week 12 or 15 then the chance of a having a baby goes way up.  If you get past week 30 then you could go ahead and have the baby.  Don't feel pressured to induce the baby early if everything is going well.  Stay out of the hospital unless you are having an issue that would send a normal woman to the hospital.  You don't need to be there just because you are on dialysis and pregnant unless you have given up trying to manage your pregnancy.  The last trimester you want to get a home fetal monitor from someone like Matria.  During the second trimester you will want to go in to a high risk OBGYN (based out of a hospital) and have an NST every other week.  This is good training for using the home fetal monitor.  It is very comforting to have a home dialysis machine you control running with all the pressures right and a home fetal monitor showing baby's heart beating normally.  That may sound scary to someone who hasn't done it for themselves, but believe me, you aren't going to get a dialysis tech who does NST's or a OBGYN nurse that does dialysis.  The one time Jenn went in to the hospital for dialysis during the pregnancy to receive blood units, because her hemoglobin level was down to 8.  She had to argue over her dry weight, etc and had to skip Sunday because they don't run that day.

Jenn and our baby almost died from an infection that came from a catheter exchange at the hospital.  There are definitely risks beyond all the risks a normal pregnancy has.

Back to you, take it slow with this guy.  You don't need to be in a hurry to do this.  It isn't exactly something Jenn and I want to do again, even though we would love for our daughter to have a sibling.  Honestly your guy maybe better off with someone else if this is a very big deal to him, however if he really loves you, this shouldn't keep him away.  Of course it might make him feel bad, but he can't blame you for it.  It was his decision to have a relationship with you.  Think of your adopted children first.

Feel free to send me a message sometime.  If you decide to have a baby or get pregnant by accident, I'll be waiting for your message.  You can always put the ball in his court and sign up to get a paired transplant from this guy if he is really serious.  I haven't even been crazy enough to jump on the paired donation option, but it is nice to know it is an option, should we need it someday.

Kevin

[Beth35]

Thank you so much Zog for taking the time to reply to my thread.  First I just want to say that I'm so glad things worked out for you.  That is awesome!

Honestly I just wasn't sure if things have changed where technology made it easier for people to have children on dialysis.  I really don't want to risk my life or the life of a child in trying to accomplish this.  The children I have now are the light of my life.  I don't want that to be mistaken.  In fact, if a magic genie came into my life saying that I could go back in time and have bio children instead of adopting, I would never want to do that.

I always knew I wanted to adopt.  Even before my kidneys failed.  My mom was a foster parent and I simply LOVE children.  I was babysitting from the time I was eleven and went to school to be a teacher.  I just thought I would have bio kids first and then adopt.  But I guess life had other plans for me.

I blame it on my ex.  It may not be the mature thing to do but I do anyway.  He ended things after eight years because of my weight gain after my transplant.  After that, it took me time to recover and get over him.  It was not easy.  I just couldn't find anyone that I really liked after that so I decided to adopt my son.  A year later, I got the call for his bio sister and they have been the joy of my life.

But I never got to feel a baby kicking in my stomach.  I never got the well wishers asking me how I am and rubbing my stomach.  I never got the baby shower or any of that.  I never got to look into a child's eyes and see a part of myself or create a child with someone I truly love.  Does that make me sad?  Yeah, it does.  I think it's okay though.  I think it's normal and I should get to grieve not getting to experience those things.

There are a lot of things that just are not fair in this world, and this is one of them.  But I am so grateful for the two wonderful children that I have in my life.  They bring me so much joy.  But when people say how beautiful they are, I know deep inside that it's not because of me.

Thanks for sharing your story with me.

[carson]

I've never wanted kids, so I can't appreciate the desire that most women have...however....in my group of nocturnal home hemo patients, there have been a whole bunch who've had kids in the past 3 yrs!!! All VERY healthy and happy.
PD, I wouldn't. Hemo, maybe. Nocturnal home hemo, I'd definitely go for it! At 36 there can be complications anyway, nevermind dialysis.

[Beth35]

Many folks are having babies in their mid to early forties now.  Not really so uncommon anymore.  I think many women are getting their careers in order before giving birth now a days. 

If I didn't have kidney disease, I wouldn't double think it.  But it's the dialysis or kidney function/high blood pressure that scare me.

[Des]

A lady at our unit was pregnant and had a baby girl some years ago. It was VERY controlled. She was nearly under 24hour surveillance.
This was not a planned pregnancy at all.
It can be done but it is extremely dangerous.

[Riki]

Zog, thanks for the info.  I think it's pretty cool that you and your wife now have a beautiful child, even if the pregnancy was a heck of a lot more work than it would be for a woman without kidney disease.

Me and a few friends run a small message board, and every day, we have a question of the day, which are mostly just "what if" questions. It's kind of fun, and we get some neat responses.  A few days ago, I posed a question for this, asking, if you could be anything else, what would you be?  My mom answered, saying that she would like to be a grandma.  I felt like absolute crap when I read it, because I know that, unless something drastic happens, she never will be.  Both me and my brother's girlfriend have health issues, that make it hard or impossible to carry a baby to term.  She already has 2 kids, so I don't think she worries about it as much as I do.

I feel like the worst daughter in the world because I can't do this one thing for my mom.  It's not like I don't want kids, I've always wanted to be a mom, well, actually, I wanted to be a grammie, but I would have to be a mom first. *L*  I don't think she realized when she said it how much it would hurt me, or she probably wouldn't have said it at all.

[Beth35]

Riki, just wanted to put out there that you still can be a mom, even though you may not be able to give birth.  I adopted both of my children at birth so they were in my arms at two weeks of age.  I could feel that they were mine from day one.  My feelings are so strong for them that I really couldn't ask for anything more.  I don't think I could love a child more than I love my kids. 

Do I wish I could experience the miracle of childbirth?  Yes.  But I truly have the best kids and my parents adore them as well as everyone else in the family.  Just food for thought!

[Riki]

I know I can adopt, and that's probably the route I'll take if I'm ever ready to do it. I just worry about when I'm actually healthy enough to care for a child, and have the financial ability to care for one, if my other disabilities will make it harder to care for a child. I'm legally blind as well as all the kidney crap

[*kana*]

Hi,
My husband I weren't able to have our own children and looked into adoption.  Not to be the one to bring you down, but I found several places that wouldn't let use adopt either until 10 years after a transplant. 
It was a hard knock for me to have kidney disease, have mult miscarriages and then be told I couldnt even adopt.  Look into it before you have to do D. 

[romanyscarlett]

There was a pregnant lady at my dialysis yesterday. She had a transplant a while ago and is now 30 weeks pregnant and requires dialysis again. She had her first session on Tuesday and was having another one yesterday afternoon. While we were in the waiting room she said she had been feeling fine until the previous evening after dialysis and since then she had been vomiting and not been able to keep anything down. Within 20 minutes of being connected to the machine she was being sick and continued to do so for the whole 4 hours.

Hopefully since she is 30 weeks pregnant already her baby will be ok but the whole process was obviously very distressing for her.

[Riki]

Hi,
My husband I weren't able to have our own children and looked into adoption.  Not to be the one to bring you down, but I found several places that wouldn't let use adopt either until 10 years after a transplant. 
It was a hard knock for me to have kidney disease, have mult miscarriages and then be told I couldnt even adopt.  Look into it before you have to do D.

I'm already on dialysis.. have been now for six years... and I've never had a kidney last 10 years.. so that doesn't give me a whole lot of hope

[Beth35]

I was able to adopt five years after having my transplant.  I adopted two newborn babies through the state foster care system and I didn't even have to pay a fee.  I also only waited four days from the time I was licensed to the time I got the call for my son.  So it is possible. 

[Zog]

I thought about starting a new thread, but then I figured I'd just stick this on this one.

This is a chart of dry weight changes I made and used to predict dry weight with Jenn's pregnancy two years ago.  It worked pretty well.

http://www.scribd.com/doc/36176909/Dry-Weight-Prediction-5