Managing Pregnancy and IC Together

Getting pregnant should be an exciting time, but for moms-to-be with IC, it can also be stressful. Though my oldest child was born nearly 12 years ago, I clearly remember my fears and anxiety of having a baby while also having IC. I worried how my symptoms would be throughout my pregnancy, what medications I would be able to take and how delivery itself would impact my bladder.

My concerns weren’t unique. Most IC patients considering pregnancy or newly pregnant have many of the same concerns. Though each patient has a different story and outcome, we’d all agree pregnancy and delivery are well worth it. I’m now a proud and thankful mom of two even though I had various health challenges with each pregnancy.

And while you can’t predict exactly how your pregnancy and delivery will go with (or without!) IC, knowing as much as you can about other patients’ experiences and research can alleviate some of your anxiety. (Just remember that what worked for one patient may not for the next. Make ALL decisions regarding your health and your baby’s health with your doctor.)

IC Symptoms During Pregnancy

The biggest concern is usually what will happen to your IC symptoms during pregnancy. The answer isn’t simple. There hasn’t been much research about pregnancy and IC. But there have been some data analysis and surveys done. One survey found more IC patients had either an improvement or no change in their IC symptoms while pregnant than had symptoms worsen. It also showed that while symptoms were often worse or increased in the first trimester, the second trimester had the most improvement of symptoms.(1)

That seems to be the case anecdotally as well. For both of my pregnancies in 2009 and 2013, I had increased pressure during the first trimester and then almost no symptoms during my second trimester. In fact, I could even eat and drink foods that would otherwise have bothered me. Kristy Zhe, a 42-year-old mom of two from Wisconsin, had the same experience with her pregnancies for babies born in 2014 and 2017. Kim Wayne, a 42-year-old mom of one in Illinois, had even better results during her pregnancy in 2010. She said other than a flare from a UTI, she was basically in remission during pregnancy.

However, not all patients experience any sort of remission during pregnancy. In the same survey mentioned above, 27% reported worse pain during the first trimester, 35.8% during the second and 27.6% during the third trimester. Within the group surveyed five women decided to terminate their pregnancies with two of them saying severe IC symptoms were why they did so.(1)

Aside from pain, urinary frequency (how often you need to go) and urgency (how badly you need to go) are affected by pregnancy as well. Even without IC, pregnant women often complain about urinary frequency. For IC patients, 60.5% and 72.4% had improved or similar frequency during the first and second trimesters respectively. The third trimester, however, had 56.3% of patients with worse urinary frequency than usual, which may just be par for the course.(1)

Urgency was like pain and fared better in pregnant IC patients. Among the 384 surveyed patients, 74.9% and 71.2% reported improved or similar urgency in the first and second trimesters respectively. The third trimester brought a bit more urgency, but the majority of patients (61%) still reported improved or similar urgency.(1)

Another thing to keep in mind is all pregnancies are different — even within the same person. My first and second pregnancies were different. I ended up on modified bedrest during the third trimester of my second pregnancy due to extreme pressure and pain thanks to uterine prolapse caused during my first delivery. Zhe said she was in remission during her first pregnancy, but in the third trimester of her second pregnancy her bladder was in an uproar. She worked closely with her doctors to keep the pain under control and reduce the stress on both her and her baby.

IC Treatment Options During Pregnancy

IC prescription medications

Another concern for IC patients considering pregnancy is what treatment options are available and safe while they are pregnant or trying to get pregnant. When it comes to medications, always consult your doctor. I found a difference in what my urologist and my gynecologist told me for medication. My urologist recommended I keep taking my IC medications and then stop when I got pregnant. My gynecologist wanted me to stop the medications before I got pregnant. I opted to go with the advice of my ob/gyn since that is his specialty, and I didn’t want to take any risks. Of course all medications bring some risk along with them. I did have to continue on my blood pressure medication, for example, which was something I’d needed for a few years previously as well.

None of the commonly used prescription medications for IC have an FDA rating of “A,” meaning the drug has adequate studies on humans and hasn’t shown increased risk to the fetus. You can find more information about common prescriptions for IC and their FDA ratings in the ICN’s “Resources for Pregnancy” section.

IC self-help treatments

You should also discuss non-prescription, self-help treatments for bladder pain or discomfort with your ob/gyn. My go-to for symptoms is my heating pad. My ob/gyn recommended only using a small amount on the lowest setting. Since I can have marathon heating pad sessions, I opted to not use the heating pad at all while pregnant. Other ideas for helping to reduce pelvic discomfort during pregnancy include exercising in water, wearing flat shoes with good support and doing simple and gentle stretches for your pelvic floor, stomach, back and hips.(2)

The IC Diet and Pregnancy

Figuring out what to eat

Maintaining a well-rounded, healthy diet during pregnancy is important regardless of whether a mom-to-be has IC. You want a diet full of healthy proteins, grains and dairy along with fruits and vegetables. If you can better tolerate foods during pregnancy, branch out and try small amounts of things that would typically bother you. For example, I found during my first pregnancy and the first half of my second that I could tolerate small amounts of low-acid orange juice, which is not the case any other time. Check the IC Diet list for healthy food choices that are usually OK for IC bladders to ensure you’re having a well-rounded diet. You can find some healthy IC friendly food ideas all sorts of places starting with the following:

Prenatal vitamins

Finding vitamins that don’t irritate IC bladders is tricky for some patients. Most ob/gyns recommend a prenatal vitamin for expecting moms to ensure your body gets enough of the vitamins you and your baby needs. I had no trouble taking the prenatal vitamin my doctor prescribed that I picked up at my local pharmacy. Wayne and Zhe said they were both able to take prenatal vitamins without causing increased bladder symptoms. However, a variety of IC friendly vitamins are available to choose from if prenatal vitamins are problematic for you. Be sure to discuss all vitamins and/or supplements with your doctor before starting them.

Labor and Delivery with IC

Another concern for IC patients is labor and delivery. I doubt any first-time mom goes into labor and delivery feeling confident. (I sure didn’t!) But preparing ahead of time as much as you’re able to can help.

Before labor and delivery

One of the best things I did before my first labor and delivery was go on a tour and meet with a nurse to discuss my concerns one-on-one. While I’d talked with my ob/gyn throughout my pregnancy about my bladder concerns and he’d treated me for a UTI, I still wasn’t sure what to expect in the hospital. Seeing how labor and delivery was set up helped. Hearing from the nurse what to expect also helped.

I learned that if I got an epidural then I’d have to have a catheter. The nurse told me it was common after birth to drain 1,000 ccs from bladders. Since I knew from a hydrodistension a few years prior that my bladder only holds 600 ccs, the nurse recommended I share that with the medical staff during labor and delivery. I did so both times and the catheter was left in longer so that wasn’t an issue. I also requested a pediatric catheter because they are smaller and generally easier on sensitive IC bladders and urethras. And I wrote all of this down on a sheet with my list of medications that I put in my hospital bag just in case I wasn’t able to communicate my concerns. I knew it would be easier for my husband to advocate for me with the information written down.

Wayne said she also felt better after meeting with someone at her hospital and taking a tour prior to labor and delivery.

“It eased my fears to go over my IC, knowing the nuances and quirks that come with it were addressed before I was in labor,” Wayne said.

During labor and delivery

Labor and delivery isn’t predictable for any woman. Both of mine were different. And Zhe and Wayne also had different experiences than I did. Zhe had her babies two weeks and six weeks early due to preeclampsia, which she was told had nothing to do with IC. However, last month a database analysis of 793 pregnant women with IC found that pregnant IC patients had a greater risk of developing pregnancy-induced high blood pressure and/or preeclampsia.(3)

Wayne’s labor and delivery ended with an unplanned C-section after her son got stuck in the birth canal during delivery. She lost a lot of blood afterward, including from her bladder, but fortunately within a few hours she stabilized and didn’t require further intervention.

Both of my labors were induced right around my due date thanks to my chronic high blood pressure. With the delivery of my daughter, I opted for an epidural, but it didn’t work well. After 24 hours of labor and two hours of pushing, the baby still wasn’t moving so my ob/gyn recommended the use of forceps. I deliberated and then agreed. Labor and delivery with my son just over three years later was quicker at only 12 hours and my epidural worked. After a very painful and uncomfortable third trimester, it was such a relief. He was born vaginally. I had no complications, but he did with his cord wrapped around his neck, cutting off air flow. Fortunately, we had a great team of nurses and doctors who got to work right away and he had no residual effects.

Planning ahead is a good idea. You want to have an idea of what to do in various situations, but you also have to be flexible because birth plans often get thrown aside when things change up. I was thankful to have the catheter information ahead of time so I could request it be left in longer and request a pediatric catheter in both deliveries. Have a list ready if you want to so you are prepared no matter what. Being able to remember everything in the midst of labor and delivery is certainly a challenge!

Zhe said the best thing she did was work closely with her team of doctors, which is something she’d recommend to any IC patient considering pregnancy.

“Be comfortable with you ob and primary [doctors] and speak up for yourself,” she said.

Post-delivery with IC

After delivery, the body goes through lots of changes and can impact your bladder. With my first pregnancy, I had two UTIs and a yeast infection within the first six weeks after my daughter was born. My urologist speculated that with everything shifting around during pregnancy and delivery, I probably wasn’t completely emptying my bladder, which led to the UTIs.

Hormones continue to shift throughout the weeks after delivery as well. And if you decide to breastfeed, that can change things up a bit as well. The good news is that many patients remain in remission or with decreased symptoms for the first few weeks (or longer) after delivery, especially with breastfeeding. The survey of pregnant IC patients found that 71% decided to breastfeed and of those, 52% had improved pain from before pregnancy, 38% had the same pain and 10% reported worse pain. In general, symptoms returned at an average of 27 weeks postpartum for the majority (63%) of patients.(1)

Zhe said her remission ended after her first delivery when she stopped breastfeeding eight weeks out. With her second pregnancy her symptoms improved from how intense they were during the third trimester and didn’t return until she finished breastfeeding.

My experiences were very similar. I breast fed my oldest via pump for her first year and didn’t need to restart my bladder medications until after I was finished breastfeeding. With my son, that happened nine months after his birth when I had a hysterectomy and blood loss cause my milk supply to dwindle.

Wayne nursed her son for two years and struggled to find effective pain treatment during that time. Her bladder pain returned, but she opted to live with it so she could nurse her son as long as she wanted to — a decision she doesn’t regret.

Risks for IC and Pregnancy

Pregnancy risks can vary based on so many factors. Until recently, IC didn’t have a known impact other than discomfort for pregnant patients. However, in the last couple of months a database analysis and editorial in a medical journal indicate there may be some increased risks for certain pregnancy complications in IC patients. Along with being at higher risk for pregnancy-induced high blood pressure and preeclampsia, IC patients also have an increased risk for premature membrane rupture, c-section deliveries, maternal infections, uterine inflammation and/or infection, and deep vein thrombosis (blood clots in deep veins).(3) However, these are preliminary findings from a database study. Even the researchers themselves say more studies are required to confirm the findings. While none of these alone should stop IC patients from having a baby, they are good topics for discussion with your medical team.

One other Internet survey-based editorial was released a few months ago. Over two weeks, 193 IC patients completed the questionnaire about miscarriages. Of them, 87% had been diagnosed with IC. And of those, 76% reported having had at least one miscarriage. Miscarriage rates for the general population is in the 10-20% range. The patients all reported experiencing stress that has been associated with miscarriages, which most likely caused an increase in bladder and uterine immune cells.(4) These very preliminary findings should be taken in stride and with caution. A survey request for IC patients who have had miscarriages is definitely going to have a higher rate of patients who had miscarriages, even compared to the general IC population.

When it comes to the variety of challenges and risks associated with IC and pregnancy, the decision to have a child is best made by each patient in conjunction with her medical team. Of the challenges Zhe, Wayne and I went through bringing our kiddos into the world, none of us would change a thing. Not one painful moment.

As Wayne said, “Do not let IC stop you from having a family. Speak up, and don’t be afraid to reach out to your friends in the IC community.”