Hi Henci,

Thank you for this forum. I have debated emailing you privately, but seeing as a lot of doulas and midwives read these forums, I thought perhaps it might be good for all to see.

I am a 31 year old caucasin female of a mostly Irish background. I am obese but with no issues with sugar, hypertension or thyroid issues. I was diagnosed in 2008 with Familiar Mediterranean Fever but it has changed to TRAPS (Tumor Necrosis Factor Receptor Associated Periodic Syndrome). I am on a maintenance dose of Prednisone 5mg and take Citalopram and Seroquel for anxiety/sleep problems and Losec. During flares, I often take Tramadol, Voltaren and a paracetemol+codeine mix.

When not in a flare, I have relatively stable health, all things considered. During a flare, I will often start with oral ulcers, and progress to sore joints and most likely pleurisy. Occasionally, I will have some inflammation in my right kidney or my gallbladder. The flares can last from 2 weeks to 4 months. It's all dependent on how much physical stress my body is put through. Exercise is a really huge trigger for my body.

I have had 8 miscarriages and 1 live birth. My daughter will be 7 in August. Hers was a hard, difficult pregnancy but with few complications other than low weight gain, vomitting all the time, headaches and sore joints. I bled at 7 weeks and 14/15 weeks. She was fine neural tube wise with her NT scan and she did have a small hole in her heart at 19 weeks but it was gone by 22 weeks.

She has been diagnosed with Asperger's Syndrome and has ongoing issues with digestion, mostly reflux and constipation. Her joints are often sore and are very hypermobile. Her birth was fraught with midwifery neglect and I was forced into a c-section.

I was induced at almost 42+2 by LMP and 41+4 by my count. The initial induction did not work, however, I was stuck in bed with constant fetal monitoring and baby went into distress. When they let me up (finally!!) to go to the toilet, I began having contractions of my own. However, they decided I needed a section, and when I attempted to stop it all, they told me they had booked the room and since I was being charged for it, I might as well have it. It was a very rough c-section with a rounded incision as baby began to decelerate and she was 'whipped out' as I was told. Apgars were good and she was 8lb 5oz.

She did not feed well and was FTT. She had reflux and was on 3 drugs by her 13th week. It was a horrible first year that saw her having a gastroscopy and admitted twice. She was almost ported for feeds, but I refused and struggled with nursing her. We nursed for 21 months until my prednisone dose was too high.

I became unexpectedly pregnant again in 2007 and my betas were not 'good', however I was never given an ultrasound. I was booked in for a D&C which was unsuccessful. No one knew it was a twin pregnancy until I began bleeding excessively and had a scan. The sonographer said: Don't look. I don't want you to see but here is all of Baby B and most of Baby A.

I wound up having 2 more D&Cs for retained tissue. It was karotyped as normal. I became septic and was given an antibiotic I was allergic to. That caused a seizure and a flare so large I lost my ability to walk, feed myself, etc.

I have worked incredibly hard to be in 'good' health, all things considered, however, I do worry another pregnancy is out of the cards for me. I was diagnosed with PCOS in 2003 and my daughter took quite a long time to conceive.

I had a miscarriage last year, albeit an early one. I have not had a successful pregnancy outside my daughter.

I am worried about the stress of a pregnancy on a body with an autoinflammatory disease.

I am worried about my weight possibly causing stillbirth or other horrible complications I keep reading about online, including deformaties.

I am worried about the drugs I take, mostly the Seroquel. I will not wean off the Seroquel as it has given me a lot of mental peace and helps me sleep; the others I am fine going off on a slow wean.

I am worried about having another reflux baby who will have to be hospitalised and require surgery again.

I am worried my uterus will not handle a c-section, 4 D&Cs (1 previous to the 3 in a row) and all the miscarriages.

My family has a history of neural tube defects which we worry one of the twins had, causing it to die, hence the wonky betas.

I would like to homebirth but realise it is not feasible, however, I would like to follow a path of least intervention.

I realise this is a very complicated patient enquiry and before I posted, I looked into your background and felt it was worth posting.

I am also a victim of sexual abuse as a child and feel this stalled my induction. I have since had a lot of counseling for it, as well as for the grief from my daughter's birth and first year.

Thank you for your time Henci. I really appreciate it.

Jen

I apologize, but I am not qualified to advise you. I am neither a doctor nor a midwife, and my area of expertise is confined to determining what the research supports as best promoting safe, healthy birth in healthy women experiencing uncomplicated pregnancies. The best that I can think for you to do is to seek out a maternity care provider who will treat you as a whole person, not just a set of organs or symptoms, and who is willing to work with you and any specialists involved in your care in order to sort out what is reasonable and practical for you so that you can make an informed decision about whether to pursue another pregnancy.

~ Henci