From conceiving to breastfeeding, the journey through pregnancy and giving birth can be both extremely exciting and super scary, all at the same time. It’s normal to have lots of questions when it comes to pregnancy and if you’re living with Multiple Sclerosis (MS), you’re likely to have even more.
It’s important to talk to a doctor or another member of your healthcare team and they will be able to answer all of your questions. But to give you a head start, we’ve put together some useful information, starting at the very beginning of the pregnancy journey:
1) First stop: Getting pregnant
Before getting pregnant, some people living with MS may worry about the chances of passing MS on to their child. There is a very slight increase in risk that parents with MS will pass on the disease, but it still represents a small risk: children born to a parent with MS are thought to have a 2% chance of developing MS themselves, compared to a 0.3% chance with parents who don’t have MS. If this is still something you’re concerned about, be sure to talk to a doctor.
After deciding to have a baby, one of the first things women with MS, or women whose partners have MS, may ask is whether it could stop them from conceiving a child. MS does not directly affect fertility but can have some indirect impacts on a couple’s ability to conceive. For example, MS may contribute to symptoms such as erectile dysfunction in men or a reduced libido for women.1 If you’re worried about symptoms like this affecting your chances of getting pregnant, it might be a good idea to talk to a fertility specialist or another doctor about what can be done to help.
It’s also possible for some MS treatments to affect a woman’s menstrual cycle which can make conceiving more difficult. Other treatments can be unsafe to continue taking whilst pregnant, so sometimes women with MS will need to stop taking certain medicines approximately three months before trying to conceive to clear the system and make sure the symptoms are managed through other methods. It’s important to visit a doctor or MS nurse before trying to get pregnant, to understand what steps you should be taking before pregnancy and what will give you the best chances to conceive.
2) Rest stop: Time to talk treatment
Deciding whether to continue on medication during pregnancy is a personal choice which you should make with your doctor based on your condition, medication and the risks. There are certain medicines that are not recommended for anyone during pregnancy, while for other treatments it will be down to the individual circumstances. If you decide to stop taking a certain medicine, it may be the case that you can taper off slowly to avoid sudden withdrawals or you might be able to explore alternatives to replace it. As soon as you know you are pregnant, or if you are planning to get pregnant, talk to your doctor to figure out your treatment plan.
3) The long road: Being pregnant
Women with MS are just as likely to have a healthy pregnancy as any other mother-to-be. There is no evidence to suggest that women with MS are more likely to experience a miscarriage, premature birth, ectopic pregnancy or still-birth.
There is even evidence that shows pregnancy can have beneficial effects on MS: it’s been shown that relapse rates are reduced during the third trimester (between month seven and month nine). Great news for those with relapse-remitting MS (RRMS)! Less is known about the impact of pregnancy on the secondary progressive form of the disease. But also bear in mind that some MS symptoms may combine with the regular symptoms of pregnancy so for example, you may experience worse fatigue or muscle weakness. Your balance may be also affected by your center of gravity shifting as your baby grows, so walking aids might be a good idea towards the end of pregnancy.
You might still want some extra support during your pregnancy and special services such as clinics for women with neurological conditions exist just for that reason. Ask your doctor if you’d like to access these services.
4) The home stretch: Giving birth
Some people think that having MS automatically means you will need to undergo a cesarean, but this isn’t necessarily true. Each woman with MS is different and will have a different experience of labor.
As with anyone expecting a baby, one of the best ways to approach giving birth is to prepare! Attending antenatal classes can help you get ready for all stages of pregnancy and can help you in creating a birth plan with your nurse and/or doctor. A birth plan can be a great way to feel as prepared and confident as possible when the day finally comes. Planning for the ways your MS symptoms may affect labor, and vice versa, can be very reassuring. For example, knowing how you will be managing fatigue on the day could be an important part of preparation for you or it might be choosing and practicing the right birth positions to help with spasticity or spasms (although it is very rare to have a relapse during labor). Or, if heat sensitivity is an issue, organizing a water birth could be a good alternative.
Work closely with your health team and figure out what the best plan is for you and your baby.
5) Your destination: Baby’s here
After labor, having the right support around you to help look after you and the baby will be key. Before giving birth, form a support network of family, friends, social services or nurses to help take care of you and the baby. Women with MS may experience an increase in relapses in the six to nine months following labor. It is thought that this may result from the changes in hormone levels in the body, but researchers aren’t yet sure. If relapses do increase during this period of time, the support network will be really important to help take care of the baby when symptoms have worsened.
Something else for mothers with MS to think about post-pregnancy is breastfeeding. You have the option to breastfeed or to use formula and making the choice will be completely down to your personal circumstances. One factor to consider might be fatigue levels. If MS fatigue is something that affects you normally, this could be worsened with breastfeeding as you are more likely to be the one to feed your child at night, unless you decide to use a pump. On the other hand, a potential benefit of breastfeeding is that it requires less equipment, and therefore less washing and tidying up. It has also been shown that breastfeeding can have health benefits for both mother and baby.
You may want to discuss feeding options with a nurse or your doctor before and after giving birth to help in making the choice and in the end, it’s about what’s right for you and baby.
Before you know it, with the support of friends, family and doctors, you will be an expert at taking care of your baby and dealing with your MS at the same time. It may have felt like a bumpy journey but the destination will have been worth it.