Contraception and CKD

[MooseMom]

Bearing in mind the kerfuffle on a couple of "political threads", I am in two minds about asking this question, but it is a legitimate query and it is one that I myself had to grapple with.

When I was pregnant over 20 years ago, I was hospitalized for 6 weeks with pre-eclampsia and had to have a c-section when my kidney function started to deteriorate.  I did not know at the time that I had CKD.  I was intensive care for 4 days afterwards as my blood pressure went out of control.  I was lucky to escape with my life.  Six months later, I was biopsied, and that's when it was discovered I had fsgs.

I was referred to a neph who told me that I should not have another pregnancy.  He explained that the body of a pregnant woman actually manufactures more blood, so more blood means more blood to cleanse, and that means more work for the kidneys.  I was told that out of every organ system in the body, it is the kidneys that take the most strain during pregancy.

So, contraception became something of a necessity for me.  I toyed with the idea of tubal ligation because I knew that another pregnancy would never be a good idea, so a permanent solution might be wiser.  I spoke to my husband about it, and while he offered to have a vasectomy, I refused that option because since it was my body that needed to be protected, it was my responsibility.  I also felt that his chance to have another child should something happen to me shouldn't be denied him.

I decided that what must take priority was the child I already had.  I felt that he deserved a healthy mom, and for me to risk another pregnancy would be selfish of me.  I felt that my responsibility was not only to my son but also to my husband.  He deserved a healthy wife and a healthy mother for his child.  So, I chose tubal ligation and never looked back.

The topic of birth control can be an emotional one driven by religious faith; I know there are people who oppose the use of birth control, and of course, that is their right.  No one can force a husband or a wife to use it.  But those of us here who are of childbearing age and who have CKD have a special set of circumstances that must be considered.  It would be irresponsible to not give it a lot of thought because the consequences of pregnancy coupled with CKD can be dire.

So, after that wordy intro, what do you think a woman and her husband should do about contraception and CKD?  I ask this in the most respectful way possible.  I do not wish to fight, rather, I am interested in how you feel about this very real condundrum.  This is not a hypothetical question.

Thank you for your respectful replies.  For anyone who feels this is too personal a question, I agree it is VERY personal.  But it is also very important.

(edited to add:  I will not be offended by anyone who disagrees with my decision.  Dissent cannot change the past.  Besides, it was all so long ago, and that young woman doesn't even exist anymore.)

[KarenInWA]

Thank you for posting this, MM. I look at it this way. For those who are female w/CKD and who are lucky enough to be in a relationship - be it a marriage or a commited relationship, contraception is a reality that has to be faced. To play russian roulette with fate could be deadly - to both mother and baby. The only other solution to that would be to not engage in intimate relations, which then means that the disease wins. And that, to me, is wrong. My one mantra in this life with now ESRD is to NOT let it win. Be careful, yes. I certainly don't condone casual sex with strangers or anything. I'm talking in a commited, loving, faithful relationship.

I admit, I get really irritated, and sometimes scared, when I hear people talk about being against contraception. I get scared because there are some who are seeking to be in political power, or who are already in political power, who feel the same way. I don't want them to legislate their beliefs.

KarenInWA

[Lillupie]

HELP HELP HELP> ON this subject!! I WANT birthcontrol. I hate condoms. I am finallymarried and refurse to use them, especially not that i am not sinning. But no doctor will give me birth control. One of the reasons why I want birth control is to get rid of my chest and facial hair, and my severe acne. Well the one birth control that im on is NOT working! A blood test has shown that I have high testortone levels (sp?) I was hoping birth control would get rid of those effects. And its not doing anything.

So, I am not suspose to have any kids on dialysis, and now because of dialysis I cant have birth control that will even help with my hormone levels??? WT_? I was on birth control before dialysis. THey say lupus + dialysis = no birthcontrol.
 I am so angry over this. I take nothing but vitamins and stool softners. Havent seen a lupus doctor in almost 2 years, been in remission for 13. Not on any blood pressure meds for over 2 years. 
 My facial hair and acne are NOT going away. I was told that dial ysis does not get rid of all of the testortone (sp?) in the blood stream.

Lisa

[monrein]

I believe that all babies and therefore all children ought to be wanted, welcomed and cared for in the world.  That's an ideal and one that will never happen but I still believe in it as a goal.  I started D at 26 and eventually made a decision NOT to have children since I didn't know if I'd be around to be a healthy mother and that was a tough decision since I love kids and think I'd have been a good Mum.  I also feel lucky to have (despite ESRD and D) a strong sexual identity, a sensual nature, no personal experience whatsoever with selfish, hurtful or icky sex and have been living with the same man for 41 years now.  The idea that anyone could/would/should have any bearing on our decision around contraception is ludicrous in the extreme.  Actually, my husband was very concerned about me taking the pill as he worried about the potential harm from it and insisted that he'd prefer we work with condoms...a rather unselfish and unusual stance back in 1971.
By the same token, if someone is religiously motivated to NOT use contraception I'd never dream of saying they should do so although if a whole bunch of kids resulted from that decision and were being neglected or whatever I'd certainly think they should lay off the sex or find alternative ways of getting their physical needs met.

I really think that our world is far too complicated and our individual situations even more so, for absolutes in areas that don't impact others.  Judging is easy, struggling with life's obstacles isn't and I think we each have enough on our own plates.  MM, I would have done the same as you and never looked back. 

[cattlekid]

We went the vasectomy route.  I never wanted children of my own, long before I knew I had CKD.  DH does not want children for various other personal reasons.  Since we agreed that biological children were not going to be part of our lives and I could not go on hormonal birth control, we decided that the vasectomy would be the best route.  It took a lot of fast talking to convince the doctor that this is what we wanted, since DH was just barely 30 at the time, but we have not looked back with regret.

[Desert Dancer]

Why politics should have any place in such a private matter is ludicrous and completely beyond me. It's simple, really: if you don't believe in contraception, DON'T USE IT! How hard is that?

Both of us hate condoms and I can't use hormonal birth control; the one time I tried it I was weepy and dangerously suicidal within a week, and I was on a low dose. Lack of really reliable birth control was ruining our sex life because both of us were terrified of pregnancy and so we ended up abstaining more often than not. Finally I said, "Screw this" and went to Planned Parenthood to have an (non-hormonal) IUD placed. It felt like a giant weight had been lifted off our shoulders. I really wish I'd had a tubal ligation last time I gave birth but it was too chaotic a scene for anyone to even think of it. Getting the IUD was the next best thing and the responsible thing to do. I'd do it again in a heartbeat.

[MooseMom]

It's simple, really: if you don't believe in contraception, DON'T USE IT! How hard is that?

It's not hard at all for some of us, but it might be hard for others who feel that the use of contraception is morally wrong.  But women who believe this way can and do get CKD, and for them, they have a choice to make.  Is it a difficult choice or not?  What if you decide that in this circumstance, it's ok to use contraception because it really can be a matter of life or death, but your husband does not agree and stills sees birth control as wrong?  Or has that just never, ever happened?

[lmunchkin]

Whoa MM you did not put this question to me the way you just did.  You asked how I felt about taking BC for medically necessary situations.  I stated of course, its okay in medical situations. But to use deliberately,for avoidance of pregnancy only, is what I did not believe is right! It was more a principle reason.. Nothing was said about politics on my behalf.  But on the behalf of SGK that I felt that there was some political ponderance there!

I had a child by my first husband.  I did not use BC at all.  We used the ole "take your temp" method.  I do not remember exactly how that worked, but it did with us. Anyrate, I have never been a sexually active individual.  When I got divorced the 1st time, I was a single parent for 16yrs. So the want or need for sex's was not my top priority due to having to raise my child & working alot of hours.

But I have certainly been a healthy person most of my life and just did not want BC in it. If I had engaged in sex then the man would use a condom. 

Also, if I had CKD, I would not chance bringing a child in to this world. I believe Monrien said it best.  But I assure you, politics has no room in my personal life and beliefs.  Im not stating anything but my personal heartfelt beliefs.  And I most certainly am not forcing them on those who believe otherwise, just merely trying to answer the question put before me in an honest and sincere way!

I do believe in BC for all medically necessary situations, and would personally use them for that if I needed them.  But for strictly to avoid pregnancy, I would not use them myself!  Maybe I sounded pompus in my answer to you MM, but that was not intentional. It is my true belief.  Even if I was not a Christian, I would still feel the same way.

I would love to have had more children than one, but it was never meant to be.  In 1992, I had early signs of Endometriosis and had to have an Ablasion.  Thus no more children. Would I like to have more, Heck yea, but it was not meant for me.

Im sorry guys, if I come across strong at times. God sent this site to us and Iam Blessed because of it!  There is so much wisdom & knowledge with this family, I certainly want to remain a part and maintain my convictions.

Again, I apologize for maybe coming across as "pushy".  I really couldnt Push anyone to do anything! 
God Bless,
lmunchkin
 

[MooseMom]

lmunchkin, rereading my original post, it does admittedly appear that I was injecting politics into this discussion when I referenced the now-infamous political threads, but what I was actually referencing was the high emotion that such topics create.  I didn't want this discussion to become as emotional as those other discussions despite the fact that this IS an emotional topic for many.  So, my apologies for not being clearer.

No, you were not being pushy at all...not in the least!  You were gracious and forthcoming as always, and it is much appreciated.   I understand your reasoning and would never want you to make choices or have opinions with which you could not live comfortably.

I, too, would have liked to have had another squishy punkin.  Here 20 years later, it still makes me very sad.  I'm sorry you couldn't have more, either.

Again, apologies for not being clearer in my original question.  Thank you for once again being so honest and introspective.

[Jean]

My CKD was caused by high blood pressure. Had it been caused by one of the other inheritable types, I certainly would have used BC. As that would be an endangerment to both mother and child. You did the right thing MM and something I too would have done. Yes, you take your chances. If God forbid, your only living child passes away then you are left with none, but, that is God's will, whether you were meant to be a good Mom or not.

[lmunchkin]

Thanks MM for your acknowledgement. That other thread was definately "heated", but I know those individuals are Passionate in what they believe. You & I are not so very different either.  I do find you to have always been fair & open. We may not agree on some things, but the respect has always been there! 

You are loved by all here, Moosey, and you neednt apologize.  That thread was definately getting "HOT". But I totally understand why they are Hot topics!!!!  Oooooch.....

lmunchkin
 

[bette1]

I think that a woman with CKD should use birth control because a pregnancy in a person with this disease could cause risk the life of the mother and the child.  I was fortunate to have a daughter, but the pregnancy caused preeclamsia and she was born prematurely.  I was advised not to become pregnant again. 

I did not want to get my tubes tied, and I didn't want my hubby to get a vasectomy in case something happened to me.  We have used a diaphragm.   I don't have a problem with using the pill, but I was told that it wasn't good for someone with my health issues.

Why do some people have a problem with the pill vs a barrier method of birth control?  The pill does not kill a fetus, it fools the body into thinking you are pregnant so that conception can not take place.  Is there a moral difference for some.  If so please explain, I don't want to debate, I just want to understand.

[billybags]

You mean your lot still have sex. Lucky people.

[Lillupie]

Why do some people have a problem with the pill vs a barrier method of birth control?  The pill does not kill a fetus, it fools the body into thinking you are pregnant so that conception can not take place.  Is there a moral difference for some.  If so please explain, I don't want to debate, I just want to understand.

To answer your question, I really dont know I personally want the pill because of my severe acne and to help balance out my hormones that would not be a problem if it werent for dialysis.
 Im guessing that some strange people see that a form of birth control is a form of abortion?? I personally wouldnt want my tubes tied becuase after a transplant I want one more child. And I dont like condoms. I personally would not be against an IUD if I didnt have high male testorone levels. I just want to get rid of the facial hair and the acne. If I cant have estrogen or have kids on dialysis, why not the birth control? THat is just me

[MooseMom]

Bette, I don't understand the "moral" argument against birth control.  It seems to be the personally responsible thing to do if a pregnancy would harm either the mother or the child.  In such situations, the use of birth control is "pro-family", in my view.

Sean Hannity had some discussion group assembled to talk about contraception and the "war on religion", and I couldn't help but notice that every single participant was male.  I would really have liked to hear a woman's perspective, particularly a woman who did believe that the use of contraception is against her religious beliefs.  I'd hate to think that we are entering into yet another fight between men and women on this issue.  If an insurance policy must cover Viagra, then it just makes sense to cover birth control...and cheaper, too.  But perhaps I am missing something here.

Lillipue, I am very curious about your situation.  Do none of your doctors have a solution for you?  What is it about lupus that makes using hormones to treat acne so ill-advised?  Sorry I don't know more about the disease.

[Hemodoc]

Bette, I don't understand the "moral" argument against birth control.  It seems to be the personally responsible thing to do if a pregnancy would harm either the mother or the child.  In such situations, the use of birth control is "pro-family", in my view.

Sean Hannity had some discussion group assembled to talk about contraception and the "war on religion", and I couldn't help but notice that every single participant was male.

Lillipue, I am very curious about your situation.  Do none of your doctors have a solution for you?  What is it about lupus that makes using hormones to treat acne so ill-advised?  Sorry I don't know more about the disease.

There are severe stroke and heart attack risk for patients with Lupus.

[MooseMom]

There are severe stroke and heart attack risk for patients with Lupus.

Oh, thanks for that.  I know nothing about lupus...could you tell me more what it is specifically about lupus that results in these increased risks?  Does lupus cause high blood lipid levels or something like that?  Thanks!

[Lillupie]

Bette, I don't understand the "moral" argument against birth control.  It seems to be the personally responsible thing to do if a pregnancy would harm either the mother or the child.  In such situations, the use of birth control is "pro-family", in my view.

Sean Hannity had some discussion group assembled to talk about contraception and the "war on religion", and I couldn't help but notice that every single participant was male.

Lillipue, I am very curious about your situation.  Do none of your doctors have a solution for you?  What is it about lupus that makes using hormones to treat acne so ill-advised?  Sorry I don't know more about the disease.

There are severe stroke and heart attack risk for patients with Lupus.

Surprisingly, my OB/GYN is willing to take the risk. He called me the other night and was wiling to put me on actual birth control pills. I dont have high blood pressure nor am I on any bp meds, and have been in lupus remission for 13 years.

[kristina]

When my kidneys first failed I was only 17½ years old and when I asked questions,
the Professor quietly informed me that in his experience a pregnancy in females with damaged kidneys
would damage the mother and/or child or both.

This came as a great shock because I do adore children and I always get on extremely well with them.

I then decided not to have any children because I now knew how dangerous a pregnancy would be for me
and if I would have gone ahead and would have given birth to a sick or disabled child,
I would have felt as if I would have knowingly inflicted bodily harm to a child
and I don’t think I would have been able to survive that.

I possibly would not have survived a pregnancy anyway because, as I found out later,
my mother died shortly after my birth, she suffered from the same Lupus/SLE/MCTD as I do.

[Hemodoc]

Renal disease by itself is not a contraindication to pregnancy as several mothers who have done daily dialysis can attest. That aside, SLE, MCT and other rheumatologic diseases carry separate risks above and beyond that of renal disease alone. As in all issues, it is a risk benefit analysis between patient and their health care team in each individual case.

http://www.dailymail.co.uk/health/article-2073994/Woman-kidney-failure-defies-doctors-baby-despite-risk-life.html

[KarenInWA]

All I can say is I am so 100% pissed off at what is happening in the USA right now in regards to contraception. I have been reading way too many articles and comments about it, and ignorant people are painting women as "sluts" who dare use a frickin' BC pill! WTF??? Yeah, I was so totally a slut when I was using the pill to regulate my frequent periods and not having sex! Give me a f*&#kin' break, people!!!

According to some who think they should be the be all that ends all, if you are a woman who should not get pregnant, then you should abstain. Even if you are married. OMFG, get me the F out of this country! If these people win the election AND get their beliefs put in as law, I want to get the H out!!!!

KarenInWA

[KarenInWA]

Renal disease by itself is not a contraindication to pregnancy as several mothers who have done daily dialysis can attest. That aside, SLE, MCT and other rheumatologic diseases carry separate risks above and beyond that of renal disease alone. As in all issues, it is a risk benefit analysis between patient and their health care team in each individual case.

http://www.dailymail.co.uk/health/article-2073994/Woman-kidney-failure-defies-doctors-baby-despite-risk-life.html

Hemodoc, that may be true of women who are in Stage 5 and are on dialysis, but I challenge that truth when it comes to a woman in Stage 3 or 4. Not everyone fits into the same mold. I am sure that I would have been an excellent candidate for pre-eclampsia when I was in those stages, especially since I was on a BP pill. Now I am a recent post-tx, not on a BP pill, but on many other meds as you know. If I were married, I would need to have access to a birth control option, be it temporary like the pill, or permanent like sterilization. I am thankful, however, that I do not work for a Catholic hospital or University. The local Catholic hospital network here in my area is taking over a secular network of hospitals, and I find that scary beyond belief.

KarenInWA

[MooseMom]

LOL@Karen.  You should run for office!  I'd vote for you!

[Hemodoc]

Renal disease by itself is not a contraindication to pregnancy as several mothers who have done daily dialysis can attest. That aside, SLE, MCT and other rheumatologic diseases carry separate risks above and beyond that of renal disease alone. As in all issues, it is a risk benefit analysis between patient and their health care team in each individual case.

http://www.dailymail.co.uk/health/article-2073994/Woman-kidney-failure-defies-doctors-baby-despite-risk-life.html

Hemodoc, that may be true of women who are in Stage 5 and are on dialysis, but I challenge that truth when it comes to a woman in Stage 3 or 4. Not everyone fits into the same mold. I am sure that I would have been an excellent candidate for pre-eclampsia when I was in those stages, especially since I was on a BP pill. Now I am a recent post-tx, not on a BP pill, but on many other meds as you know. If I were married, I would need to have access to a birth control option, be it temporary like the pill, or permanent like sterilization. I am thankful, however, that I do not work for a Catholic hospital or University. The local Catholic hospital network here in my area is taking over a secular network of hospitals, and I find that scary beyond belief.

KarenInWA

Depending on the underlying disease, most women in stage 3 CKD will be able to carry a pregnancy to term, but they are certainly high risk for fetal and maternal complications. Stage 4 CKD prior to the initiation of dialysis is a rather ominous state to begin a pregnancy.

http://sin-italy.org/Formazione_e_Ricerca/gruppi_di_studio/Rene_e_Gravidanza/docs/Pregnancy_in_CKD-AJKD.pdf

On the other hand, stage 5 with renal replacement therapy is not a contraindication to pregancy despite the many doctors that would state it is. There have been many successful pregnancies without maternal or fetal complications utilizing daily dialysis.

[Hemodoc]

All I can say is I am so 100% pissed off at what is happening in the USA right now in regards to contraception. I have been reading way too many articles and comments about it, and ignorant people are painting women as "sluts" who dare use a frickin' BC pill! WTF??? Yeah, I was so totally a slut when I was using the pill to regulate my frequent periods and not having sex! Give me a f*&#kin' break, people!!!

According to some who think they should be the be all that ends all, if you are a woman who should not get pregnant, then you should abstain. Even if you are married. OMFG, get me the F out of this country! If these people win the election AND get their beliefs put in as law, I want to get the H out!!!!

KarenInWA

Funny, that's how I feel is Obama is reelected and begins social engineering of religious institutions.