This is part 3 of a 3 part series called Preparing for Pregnancy with Sjogren’s.
If you missed part 2, click here to get caught up.

Part 3. 

By early spring, I was feeling the telltale signs of early pregnancy that I had experienced with the girls including nausea, breast sensitivity, constipation, and total exhaustion. 

In bed and asleep before 8 pm exhaustion. 

Finding out we were expecting was incredibly exciting but we also knew and reflected on how lucky we were. One in every 4 of my female physician colleagues struggles with infertility. 

Similarly, the autoimmune community also includes so many having experienced the heartbreak of pregnancy loss and/or infertility. 

Deviating a bit from the style of parts 1 & 2, I am going to share a bit of a play-by-play as to what type of monitoring, testing, and planning we undertook during the 10 months leading up to our little guy’s arrival. 

First Trimester: Weeks 1 - 12 

Week 8-10: First Prenatal Appointment

• Initial ultrasound to confirm the due date, ensure the pregnancy was in the right place and appeared viable.
  
  
• Initial labs around 10 weeks.
  
  
• Consideration for genetic screening tests.
  There are a few different varieties but we opted to do a blood draw called free cell DNA testing. Essentially small amounts of the fetal DNA end up in the mom’s bloodstream.
  
  This is then screened for several genetic conditions including Down Syndrome, Trisomy 13 & 18, and sex chromosome problems...
  
  This test also provided the ability to learn the sex of the baby if we wanted to know too. 
  
  My approach to testing both as a physician and as a patient is to consider how a particular test may or may not change future decisions or planning.
  After some discussion, we opted to do the testing so that if there were abnormalities or anticipated health challenges we would be able to prepare as best able.

• Under the advice of my rheumatologist, we started monitoring my complement levels, kidney, and liver function. 
  
  
• Additionally, typical prenatal labs that screen for infections, anemia, and thyroid problems were checked. 
  
  
• It was also recommended that I start a daily regimen of aspirin which has been proven to decrease the risk of developing pre-eclampsia. 

Second trimester: Weeks 13-24

• Referral to Maternal-Fetal Medicine (MFM) a.k.a. the high-risk obstetricians 
  MFM physicians have undergone an additional 3 years of training to specialize in treating higher-risk pregnancies.
  
  During this visit, we met with a nurse practitioner and physician who went over my health and pregnancy history. We had an in-depth ultrasound that looked at the baby from head to toe called the Level 2 Anatomy Scan.
  
  
• The biggest concern with Sjogren’s is the development of congenital heart block (CHB) between weeks 18-24 of pregnancy. This can occur about 1% of the time.
  
  There is controversy in monitoring for CHB because it is not known whether or not the treatment for it actually helps. Regionally, some MFM doctors will recommend it whereas in other areas it is not routinely performed.
  
  We appreciated our team’s use of shared decision-making- we discussed the pros and cons and made the decision to proceed with monitoring together.
  
  Monitoring consists of performing additional ultrasounds specifically measuring aspects of the baby’s heart rhythm called the PR interval. 
  
  
• Additionally, more lab work was checked to see if I had antibodies that would put me at higher risk of late-term pregnancy loss and that may require the use of different blood thinners.
  
  
• Lab monitoring- continued to watch complement, kidney and liver, and blood counts.
  
  
• Deciding on delivery location/hospital.
  
  
• Considerations will include how high risk you and your baby are, where your team has privileges to deliver, insurance coverage, and preference. 
  
  
• Started planning for maternity leave and initial postpartum preparations.
  
  
• Discuss options with Human Resources.
  
  
• Consideration for who or what might help with the birth process.
  I decided pretty early on that I wanted to explore using a doula this time.
  
  During my previous two deliveries, I had experienced pretty significantly low blood pressure after epidural placement. As a result, I wanted to attempt an unmedicated delivery.
  
  
• Gestational diabetes screening- Weeks 24-28. 

Third trimester: Weeks 25-40ish

• Ongoing monitoring.
  
  
• Growth scans monitor the baby’s growth trajectory over the final weeks of pregnancy. The frequency of the testing may be adjusted if the baby appears to be growing too fast or too slow.   
  
  
• Non-stress tests are also common non-invasive tests used during the last trimester.
  I ended up going twice weekly for the last 8 weeks.
  
  Two monitors are placed on the abdomen to watch the baby's heart rate and monitor for any contractions. Although these were time-consuming, they require the mama-to-be to sit relatively quietly for 30-60 minutes which was not the worst.
  
  
• Lab monitoring: continued to watch complement, kidney and liver, and blood counts.
  
  
• Group B strep swab: about 25-30% of women are colonized with a bacterial called group B strep. This bacteria can cause life-threatening infections in the newborn baby (and mama) under certain conditions.
  
  Mom’s are screened for this bacteria during the last 3-4 weeks of pregnancy to determine if they may need antibiotics during delivery. 
  
  Interestingly, this can change between pregnancies. I was positive for both of the girls’ deliveries but ended up being negative this time. 
  
  
• Postpartum planning: started freezing some meals, enlisting our village for help with the girls, working on meditation and mindfulness leading up to the birth, figuring out what newborn supplies needed replacing, researching/ordering a breast pump from insurance if planning to breastfeed.  

 
Well on 12/11 at 9 pm, it went time. We called in the village to watch the girls and let Deb, my doula, know we were heading to the hospital.

About 6 hours later, with the support of Akira, Deb, the Dublin Methodist, and Avina teams, not so little Oliver Akira Wada was born weighing in at 9lb 10oz!

Stay tuned in the coming months for tips and tricks to surviving the 4th trimester! 

Did you know that I am launching a podcast next month?

Success with Sjogren’s is a podcast empowering naturally-minded and scientifically-grounded women looking to reduce or even eliminate their Sjogrens symptoms! 

I’m on a mission to empower you through education and build the Sjogren’s sisterhood community so we all might be able to forge our own path to Success with Sjogren’s.

Each week, my guests and I will share how modern medicine and lifestyle work better together.

Always rooted in my oath to do no harm, my best tips and advice are served with an open mind and a healthy dose of skepticism. 

Click your preferred podcast app and hit subscribe so you don’t miss an episode!
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