Melanie’s Pregnancy Planning Guide

ICN volunteer Melanie developed a pregnancy planning guide for patients struggling to decide if they wanted to become pregnant and have a child while also struggling with IC and/or chronic pain. She brings up some excellent points that you will definitely want to talk with your physician about. Thank you Melanie for contributing this so that other patients could learn from your thought process! Oh and Melanie had twins!

Step 1: Making the decision of a lifetime

Keeping perspective: Pregnancy is for nine months. Parenting is a lifetime commitment.

Here are some of the questions that I explored with my husband. I can’t answer these for you…. and it’s important that you think about it honestly and openly. They can be tough questions. So, write down yours and and then sit down with your husband and talk about them. Don’t rush!

Do we want to be parents?
Do we want children?
Are we willing to change our lifestyle?
Can we afford children?
Will we make good parents?
Do we have family, friends or neighbors who can support us?
Will both parents work? Who will be the primary care giver? Who will be the primary financial supporter?
Can we afford childcare?
What does our health insurance cover?

Step 2 – Considering Pregnancy & Assessing The Impact of IC

Here are some of the IC questions that I was worried about and took the time to ask my doctors and other patients:

A. Which medications would I have to stop? How far in advance?
See section on treatments

B. If sex is painful, how will I handle the increased sexual activity?

Women with IC may experience increased symptoms and/or what feels like an IC flare, usually 12-48 hours after intercourse due, we believe, to the gentle yet persistent pelvic floor spasms which occur for several hours after orgasm. Luckily, we have many self-help strategies that can reduce those symptoms which you can read in the ICN Intimacy and Sexuality Resource Center

C. Will my pregnancy be considered high risk because of IC?

Every patient is different. Your personal medical history, current symptoms and/or medications you may be using will be assessed. Ultimately, only your doctor can make this determination. Ask them and then talk about the pros and cons?? Will it require bedrest?? Will medication be an issue?? What does “high risk” actually mean??

D. What will childbirth be like for me? Is vaginal or cesarean preferable with IC?

IC patients have had both. Again, it depends upon your physiology and pregnancy conditions. You can talk with other patients about the pros and cons in our ICN support forum. (See support links below).

E. Will my OB/GYN really understand all aspects of my IC?

You’ll have to sit down and have a thorough discussion about this. The use of prenatal vitamins is a perfect opportunity to test the waters. Some patients can easily tolerate vitamins while others have more trouble. Don’t expect your OBGYN to understand the daily grind of life with IC but they should be able to talk about various treatments and medical care issues. For example, it may be very reasonable for you to ask for some physical therapy post delivery to help any pelvic floor dysfunction that may have occurred or been exacerbated by labor and delivery.

F. How will my Urologist be involved in my pregnancy?

Good question. Ask him or her!

G. Do I want to breastfeed?

This is a very personal decision based not only on your personal preferences but also any medication you may take that could be transferred to your child through breast milk.

H. Can I be a good parent with IC?

IC doesn’t change your ability to love but, ultimately, you do have to take some time to think about your personal situation. Talk with a trusted friend, your parent, a counselor or your doctor about any questions or concerns that you may have.

I. Can I physically and emotionally handle caring for an infant (then toddler, then child) with IC?

Your doctor should be able to give you a good assessment on healthy you are and if you can physically support a pregnancy. It’s fairly normal for your emotions to become quite confused during a pregnancy. Prior to pregnancy and during a pregnancy, this is a great time to find a counselor or therapist that you can work with to help you sort through any emotional issues you may have. There’s no shame in seeking help. In fact, a good mother will role model to their child that it’s perfectly fine to ask for help from a professional rather than suffer in silence at home alone.

J. As my child ages, how will I explain about my illness?

The ICN book My Mom Has IC: A Painful Bladder Story can be quite helpful. See info below.

K. Will we need to hire help and can we afford it?

This is worth a heart to heart discussion with your partner and family. Can you do it all?? Can family members or friends help?? Would hiring someone ease the burden??

L. Will I be able to find the time to continue ongoing treatments (bladder installations, physical therapy, etc)?

The worst thing you could do is ignore, or sacrifice, your own health. Your family needs you to be strong and healthy. You MUST find time to care for yourself, including visiting your doctor, trying treatments and/or doing physical therapy.

M. How will I care for my child when my IC is flaring?

Ideally, you can prevent flares from occurring.. but, if not, having a backup plan is essential. Who can help with the kids?? Who can take you to the doctor if you need to go??? Try to have a safety net of options so that if your IC flares, you can get the care you need while still caring for your child.

Step Three – Planning for Pregnancy

When planning for pregnancy, it makes sense to try conceive when your IC symptoms are in remission or under control. Diet, of course, will play a role. Even prenatal vitamins might be a concern because of the high levels of Vitamin B and C, commonly known to irritate the IC bladder.

Make appointments with every doctor or medical care provider necessary.

This could include your OB/GYN, Urologist, Primary Care Doctor, Pain Specialist, Psychiatrist, etc. This is also a good time to get physicals, annual GYN exams, dental cleanings and x-rays, etc.

Go to these appointments prepared.

Take a list of all your medications and treatments, how often you take them and for what reasons.

Ask your doctors which meds are safe during pregnancy and which are not.

If there are meds that you must stop, find out when you must stop them (prior to conceiving, once you confirm pregnancy, etc). You may also want to ask which meds are safe during breastfeeding. Be advised that you may get different opinions from each doctor. This information can be especially helpful if your IC flares during pregnancy.

Ask your OB/GYN and Urologist about prenatal vitamins.

Folic Acid, Calcium and Iron are the most important nutrients that may need to be supplemented. It is advisable to start taking Folic Acid before getting pregnant. Unfortunately, many IC patients have difficulty taking vitamins. One major source of problems is Vitamin C which is usually sourced from citrus fruit, and can be very acidic and irritating to the bladder. Look for vitamins that have less acidic forms of Vitamin C (like Ester-C). Another irritant in vitamins can be the dyes and additives. Look for more natural alternatives. Your OB/GYN may give you several samples of prenatal vitamins.

Step Four – Learning when and how to get pregnant

Do you know when to time sex? Do you really know when your body ovulates? Are your cycles always the standard 28 days long? Do you always ovulate on day 14? Are you (or were you) taking meds that was delaying or preventing ovulation? When do you have to stop the pill before TTC (trying to conceive)?

It’s time to learn more about it. One book to consider is Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health (Revised Edition) by Toni Weschler. As the book explains, by using simple fertility signs including peaks in morning body temperature and changes in cervical position and cervical mucus, it’s possible to determine when ovulation is taking place. Fertility awareness is therefore useful for not only couples who are trying to conceive, but for those who are aiming to avoid pregnancy without the use of chemical contraceptives.

Google “Fertility” for more resources!

Step Five – Making A Baby

Okay let’s face it, if you have IC, sex isn’t always easy. In fact, sometimes it’s downright painful. So now you want to get pregnant and that means you have to have a lot more sex. Well, atleast you have to have a lot more sex at a certain time of the month. Here are a few tips that you may find helpful.

Physical therapy

PT isn’t right for everyone, but if you experience pain with sex it may be worth trying. Ask your Urologist or OB/GYN for a referral. It’s often helpful to have an object to contract against. Your physical therapist can supply you with a vaginal dilator, a small plastic rod that you can insert. Your therapist can also give you a “Mr. Frosty”, a condom filled with ultrasound jelly that you can discreetly store in my freezer. Or you can make one by filling a condom with KY jelly. It’s used after sex to cool down the vaginal tissues.

During Sex

Foreplay. It’s necessary to loosen up and lubricate those pelvic muscles and vaginal tissues. Plus it’s fun!
Communication. Keep in mind that baby making can be a bit different than love making. Be sure to communicate with your partner about this transition.
Lubrication. Some lubricants have been proven to kill sperm, including KY Jelly. Granted, you wouldn’t want to rely on them as a contraceptive, but they could hinder your ability to conceive. There is some debate about whether or not Astroglide is sperm friendly. There is a product on the market called Pre-Seed that is recommended for TTC, but there are mixed reviews and it is quite pricey and difficult to find.Egg white is recommended because it is most like our natural cervical fluid that’s present just before ovulation. Yes, plain old egg white, although you might want to look for pasteurized eggs which are available in most grocery stores these days. Simply separate the egg and discard the yolk. It helps to allow it to warm up to room temperature. You can use a small syringe (no needle) to insert it in the vagina. Many women, who struggle with fertility or simply don’t produce enough quality cervical fluid, highly recommend using egg white. And let’s face it, lube is usually necessary with IC.
Positions. Certainly some positions allow deeper penetration and more probability of the sperm reaching the egg. For example, missionary position is considered best and woman-on-top is often considered worst. However you must weigh this against which positions are most comfortable for you. Experiment and have fun!

After Sex

Void as soon as possible. You may want to consider waiting 10-20 minutes to allow the sperm time to travel up, but there is debate whether or not that’s necessary.
If you are prone to UTI’s, ask your Doctor about taking a preventative antibiotic after sex. One product that might help is called Very Private Body Wash. Both of you should consider showering before and after having sex. At the very least, have your partner wash his hands before sex. A removable showerhead is most helpful for cleaning up afterwards and preventing the spread of bacteria.
When to test? Some home pregnancy tests claim you can test up to 5 days before your expected period. But remember that they are NOT 100% accurate that early. Try not to stress and remember that you can always try again next month (that’s half the fun after all!)