Pregnancy with another condition or disability
Some women had health problems of their own which could affect pregnancy and birth. In these cases, the staff giving them antenatal care needed to know about the condition and liaise with her GP or specialist. While most women would be keen to avoid medication in pregnancy in case it harmed the baby, women with conditions such as diabetes and epilepsy had to continue their drugs.
A woman with diabetes had had a series of problems in pregnancy, including several miscarriages, severe sickness, pre-eclampsia and a baby with heart defects. Her most recent pregnancy ended in a stillbirth at 36 weeks. She had never had formal pre-pregnancy counselling. She received excellent care once pregnant, but with hindsight she wondered if the baby died because of her diabetes (see also 'Stillbirth and neonatal death').
Managing blood sugar levels during pregnancy is important for people with diabetes. She never...
Was that your choice?
It wasn't a choice. It was just something that - I never really thought about it. I didn't think [sigh]. I suppose you don't actually think of what the consequences could be by not doing it. And because nothing, none of my previous problems have ever been put down to that fact that my levels were high when I started, when I became pregnant, I've never really thought about it.
So none of the miscarriages, nobody ever said that that's more common with people with diabetes or anything?
Well obviously it, every thing that happens to me [cough] is in some way put down to the diabetes. Children with heart defects are more prone to mothers with diabetes. Miscarriages are more prone to mothers with diabetes. Stillbirths are more prone to mothers with diabetes. So, and morning sickness again is probably more prone to people who have got diabetes.
She had excellent care during pregnancy, but with hindsight wonders if her baby was stillborn...
Looking back do you think it would have been good to have had some pre counselling?
Yes. Definitely. Although they haven't said that what happened to me was as a direct result of my diabetes, I think because there was no other reason that it probably was. Although I mean, they, they stressed that everything, I did everything humanly possible to make sure. Although I started, my level was high when I started, within weeks it was down to an acceptable level. And although they say that it probably had nothing to do with the diabetes I think somewhere deep in the back of my mind I think it probably was.
Will you ever get an answer to that?
No. No. We had a post mortem carried out and everything was absolutely with my son completely normal. The only thing - it, it came up as unexplained death. That's the official report. But we obviously went to see the obstetrician with the report and results, and one of the things that he said is that they just, from a professional opinion think that, that my son just grew. He was too big and my placenta just basically gave up. Couldn't feed him anymore, so. And that's what - although that's not the official result, that's what they think. So.
Because the extra growth is something that is associated with...?
With the diabetes, yeah.
Other women spent some time discussing their condition with their specialist before getting pregnant (see 'Getting pregnant'). One mother with epilepsy said the risks for the baby from taking her drugs were lower than the risks from having a seizure, which could affect the baby's oxygen supply. Even so, the drugs increased the risk of spina bifida, and talking to another mother using the same drug reassured her. Apart from one seizure early in pregnancy, her epilepsy has been better since becoming pregnant and having the baby, but possibly because of a less stressful lifestyle. (See also the Healthtalk site on epilepsy - 'Women and epilepsy').
She worried about the risks to the baby from taking epilepsy medication. It helped talking to...
Yes, and I had, before I got pregnant, I had all their epilepsy and pregnancy leaflet. They also, there's a chap called Betts at the University of Birmingham, who's written a lot about women with epilepsy getting pregnant, and the implications of that, and I read a couple of his papers. Which, they were both - I got one, I think, through Epilepsy Action, and one also through the Royal College of Midwifery in Wales, which I had picked up in some article, that they produced a, a paper on epilepsy in pregnancy, so I read those and things. And part of them is very reassuring, but also part of them is, scares the living daylights out of you. You know, because the statistics have to come from somewhere, and so you are slightly nervous. I had one girl in the epilepsy magazine, from Epilepsy Action, about nine months before I, we got pregnant. There was a girl - there's a sort of pen-pal thing - and she said she wanted to meet up with anyone taking Tegretol Retard, who was planning a family - who had had a, was pregnant. And I wrote to her and said, 'I take Tegretol Retard, and I'm planning on getting pregnant, so I'd be very interested in it if anyone comes back to you.'
And she wrote to me and it turned out that the ad had gone in very late, and she'd actually already had the baby, and - but she'd also lived in the same town I live in. And so she could tell me all about it. And so that was almost better - it was almost easier to not meet somebody but have a whole load of tips, and she talked about all the sorts of things she'd eaten beforehand to help her fertility, and nuts and grains. And a book that she recommended, the Food Bible, which I got. And I mean, whether that's epilepsy related, probably not so much. But it was nice to, you know, hear from somebody.
Apart from one seizure in early pregnancy, her epilepsy is now better than it has ever been.
The neighbour came in, and I was fine, but [husband] had actually - or my husband had actually thought I was cooking because there was this terrible clattering of plates and what have you, and actually I was just sitting on the sofa, and I fell on my supper plate, which I'd finished. But - so that meant we actually had to tell everybody, because my husband was with his mother and was going stir crazy, but couldn't get in the car and drive; it wouldn't have been much use. And my parents were trying to force God knows what down my throat - all these drugs - so we had to come out, as it were, then, which was a bit of a shame, and I didn't want the pregnancy to feel like for ever, and when people know at eight weeks, it sort of drags on a bit. But, so my drugs were upped at that point, my epilepsy drugs, because what they concluded was that because there's so much more blood in your body, when you're pregnant, that the drugs had been diluted. Therefore they weren't working.
Right. Had you rung him because you thought you might be getting a seizure, or was it complete chance?
I have them totally out of the blue -
And we were literally - he'd phoned me to say he'd arrived at his mother's after, you know, three hours on the M25, and and I just happened to have it while I was on the phone to him.
So, it was quite unusual for you to have one, was it?
No, not at all. I actually had been, I've been more well since I've been pregnant and a mother than I've ever been, which is very bizarre. So it obviously suits me down to the ground. But when I had a career, and at university - well, I actually had to give up work because they got so bad, just before we got married. So about a year before I had the baby, well, the year before I got pregnant.
Is that a, a common experience amongst people with epilepsy, do you know, or?
That they have to, it gets as...
That they - no, that they improve in pregnancy?
I, not that I know, no. But you could probably argue that epilepsy - a lot of epilepsy - is about having a sort of stable, calm lifestyle, and despite the fact a baby gets you up in the night and things like that, you are quite in control of what you do and don't do, you know. If I don't want to go out for the afternoon, or - it's not like having to go to work, you know. I can control my life. And actually that was one of the reasons I gave up work initially, was my consultant thought I could have a much calmer, stress-free, less - I had a very, quite a physically exerting job and that had an impact so, quite interesting.
Tina had extra scans to make sure everything was OK with the baby because of her epilepsy.
G’s epilepsy medication was tweaked when she was pregnant and she had some seizures.
The doctors tweaked it a little bit, to sort of level out while I was pregnant. So, it's stead- steadied by medic- my epilepsy out through the pregnancy. I had less, less turns. And then, and then I think it was a couple of weeks before I had [son’s name], I had like a couple of them in a day. But they knew that was down to building up to going to have him.
Some hospitals have special units for women with more complicated pregnancies. One woman, whose spleen was removed in childhood because of a blood disorder, found the extra care very reassuring. Having no spleen made her more prone to infections, and she was due for a five-yearly booster injection to protect her from pneumococcal infection, but could not have it while pregnant. The condition hardly affected her daily life, so she had not considered that it might complicate pregnancy.
Shared care between her midwife and a specialist unit for complex pregnancies has been excellent....
Do, how well coordinated are the different lots of care that you're receiving? You've got a midwife, and you see a midwife and you see a GP and you see the people at the special unit. Is it quite joined up or is it not very joined up or..? How, how much coordination is there between them?
The coordination I think, I've opted out of seeing my GP now, because you can either see your, your midwife then your GP alternately throughout your pregnancy, but I was just feeling that there were too many people involved and I just wanted to get to know my midwife. So I've said that, you know, from early on in my pregnancy that I was, I just wanted to see her. They have been brilliant, they've coordinated with the unit, the special unit very well.
A woman with a blood-clotting disorder was able to be looked after mostly by her GP during pregnancy with input from her specialist and an obstetrician. She needed daily injections of heparin but felt sure the benefits outweighed the risks of taking medication in pregnancy.
She needed daily injections of heparin during pregnancy because of a blood clotting disorder.
So and who discussed the sort of issues and risks around your condition with you?
Well, I, my GP primarily, initially. And I had already had contact with a consultant in [city] who had, who's a specialist in this condition, and she sent a letter to my GP explaining what the treatment should be. And then I went into [town], I went into the local hospital, and met with the consultant there and he confirmed that, what the, the treatment would be. And he was the person that I saw sort of now and again throughout the pregnancy to, to just discuss how things were progressing. He was very helpful.
So did you feel that, confident that that was being sort of looked after and..?
Yes, I did, I felt that everyone knew what the issue was and everyone seemed to be agreed on the treatment. I did actually also consult a few websites on, on the internet. And there was actually a support group for people suffering from this condition with a lot of information about pregnancy, and it confirmed that this was the appropriate treatment to be taking. And in fact at the very beginning, even before I got pregnant, I was slightly reluctant, wondering whether I would actually not, not do this and risk going ahead without having the injections. But having read some of the stories on the website I felt that it was very important that I did go through with this due to the risk of having a miscarriage.
What, what were some of the, what was some of the information that was available on this website?
There were quite a lot of personal stories about people who had lost babies at various stages in the pregnancy because of this condition and not having been diagnosed. And they were all basically saying, 'If only we'd known, we could have had the treatment'. There are no known problems to the baby. The risks to, I think there is a slight risk for, to the mother of blood, bone thinning, thinning over a period of time. But it's a minor sort of risk really compared to the sort of positive side of knowing you've got a much higher chance of having a healthy pregnancy. And that, that was all very clear on the website. So it was, it was mostly personal, it was, it's more a sort of exchange of information site between, between people with the condition.
One mother thought she would never had children because she was told she had multiple sclerosis and had to use a wheelchair. She changed her mind when she was told it was not MS after all (see 'Getting pregnant'). Having a physical disability herself made her feel she could not cope with a baby with a disability, so she was very anxious about antenatal screening. Her feelings about it were different from many of her friends'. She would have liked more contact with other pregnant women, but this was sometimes difficult, for instance lack of wheelchair access to local National Childbirth Trust (NCT) antenatal classes (see 'Antenatal classes and preparation'). Practical advice from her local hospital and Disabled Parents International helped her. The Disabled Parents Network also advised her on cots and pushchairs.
Having a physical disability herself made her feel she could not cope with a baby with a...
Have you tried to talk to your friends about that?
Have they been surprised?
They're - no, they're all completely understanding about it. And, you know, when they've been talking about, 'Oh no, we've said that we'll have the baby and it doesn't matter if it has a disability.' And I've said, 'Mmm, we're not able to say that actually.' And they've always said, 'Oh God, we completely understand, completely understand what you're talking about.' But it's still an issue that's sets me apart from them. I'm not the same.
Have you felt that a lot during pregnancy and parenthood?
I think probably that I've got used to the fact that, you know, I'm a teacher, and I am in a wheelchair, but hey I've just got to get on with it, and that's the way it is, and there isn't a choice in this matter so just cope with it. And I think when you're pregnant you need allies and you need to think, 'Oh yeah, I, that happened to me as well.' Or, 'I know what you mean' whereas there was never really that [sighs], never really that comfort blanket really, for me, so I felt quite alone.
She had good practical advice from her local hospital and a support group for parents with...
There's a unit at the Disabled Service at the hospital that, that has a couple of qualified people who specifically look after disabled mothers, so I was able to go and try out some equipment, and they provided a beanbag that I could breastfeed from and yeah, I was able to hold this nine pound doll and put it back in the cot and I thought, 'Oh there's no way I'm going to be able to hold a nine pound baby, that's really heavy.' And they said, 'There is actually a network that disabled parents have started, so Disabled Parents International brings together parents from all over the world who are handling, being disabled and having children.' So that's actually been a great source of information, but there's also local agencies as well.
Mmm, but none of those organise antenatal support?
No they don't.
I think it's quite rare actually to be somebody in a wheelchair, and having a baby. There seems to lots of blind mothers, or deaf mothers, or learning disabilities, but the wheelchair seems to be quite unusual.
This mother was taking heparin to prevent blood clots during pregnancy. During the birth, she was given a catastrophic overdose of heparin and nearly died. She felt she was an expert in her own condition, but when it came to pregnancy became passive and unquestioning, which was unlike her.
She felt she was an expert in her own condition, but when it came to pregnancy became passive and...
Mmm. Just say a bit about you, your, what you were saying earlier about sort of being an expert in one set of conditions and then this sort of feeling of novice stuff.
Yeah, I don't know whether it was like symptom overload but I was quite au fait with what was wrong with me, and how that affected me and how I handled it, but then having other symptoms put on top which actually belonged to another condition called pregnancy, then that did seem like an overload, and I thought, 'No, no, these people know much more about it than me and I'm, I'll just let them get on with it.' But which is quite bizarre because it was actually happening to me whereas I let them handle it...
But I feel very strongly that it won't be like that again.
See, I don't know really how my situation could be sort of replicated because I am in shock still at how much I gave over to health professionals. And actually they're professionals but they're not experts in me, only I'm an expert in me. And I can't believe that I surrendered so much [laughs]. It really is a big source of surprise to me.
Especially when you are so used to being the expert in your.
Oh yeah, but then ironically I gave over to the professionals and then it all went really badly wrong.
Yes, because you said you were questioning that the Heparin incident?
I actually said, 'Are you sure I should have this?' And the nurse said, 'Yes, it says so in your notes.' But actually the notes hadn't been checked so I shouldn't have had...
And you knew that?
I did, but because I was still in my sponge state of just accepting things being done to me then I said, 'Okay.'
Last reviewed May 2017.
Last updated May 2017.