RHEUMATOID ARTHRITIS & PREGNANCY: MY JOURNEY

The Discovery:

I was working at a Plasma donation center on Saturday May 21, 2022 when I experienced my first pregnancy symptom. A donor was walking out of the building when his bandage started leaking. I called him over to the sink to rewrap his arm when a wave of metallic smell hit me like a truck. I have never been able to smell blood before, but it was so strong. I had brushed it off like maybe he had lots of iron in his diet and that it was warmer outside now. The next day I was thinking about it and realized that I have an over sensitive sense of smell. I should probably take a pregnancy test.

I took the test alone in my master bathroom while my husband was sleeping on the couch taking his Sunday nap. (This was not planned just how it happened). I’m not sure why I expected a line to develop automatically, but I did, and when I saw no immediate line, I tucked the test back into the wrapper and threw it away. I was working on my computer when I felt the need to go back and look at the test. So I crawled out of bed, and dug through the trash. I pulled out the test and carefully inspected it. Low and behold… a faint positive.

I ran downstairs, woke up Garrett and showed him the test. He was just waking up and it took him several minutes to comprehend what was happening. I wish I would have planned a fun way to tell him, but my excitement could not wait. He didn’t show much emotion, he said “You’re pregnant?” smiled, then fell back asleep for another hour or two.

In that short hour, the excitement wore off, and the fears came rushing in. I have an autoimmune disease called Rheumatoid Arthritis and was born with a congenital heart defect. I had doctor appointments scheduled to talk about family planning for both conditions. Surprise! We got pregnant without really trying, the first month I was off birth control, and I had not even had a full cycle yet. I had no idea how far along I was. What was I going to do? I had no Idea.

First Trimester:

The next couple weeks were awful. I was nauseous and tired 24/7. I tried every trick in the book: Ginger, Peppermint, Saltines, Pedialyte, "Preggie pops," Benadryl, Unisom, B6, Prenatal Vitamins at night... you name it, I tried it. They helped a little but I was still sooooo sick. All I could do was wait for my first appointment and hope the doctor could help.

First OB Appointment:

I had my first OB/GYN appointment at 8w0d. They did a pap smear, breast exam, and transvaginal ultrasound. We were able to get crystal clear pictures of baby and listen to baby’s strong heartbeat. Dr. W counseled us on things to do and things to avoid. She prescribed me low dose Zofran, which turned out to be the hero of my pregnancy. I highly reccomend getting help for nausea ASAP. DO NOT WAIT.

First Cardiology Appointment:

I had my first cardiology appointment since being pregnant. They did and Echo and EKG. I was told there was narrowing in my Aorta, but it did not look different since my last surgery. They are going to continue to monitor me. I am supposed to take my blood pressure frequently. The Cardiologist said he wanted to see me once every trimester for Echo and EKG

Cruising:

My whole extended family took a cruise to the Bahama's when I was 9 weeks. I'll post later about how I managed cruising during my first trimester.

The Day it Started to Rain:

( Trigger warning: Loss of child)

At 12w0d I went in for a ruitine OB appointment. Garrett and I were so excited to hear Baby Curry's Heartbeat and take the genetic screening test to find out gender. The appoinment started off normal with the urine test, blood pressure and weight. When Dr. W came to check Baby Curry's heartbeat with the doppler she couldn't find anything. We were moved over to the ultrasound room to double check. There was no heartbeat and Baby Curry was only measuring 8w6d. I was having what was called a "missed miscarriage." It was in that moment that I offered a silent prayer that it would rain that day. Our Southern Utah desert recieved rain everyday for the next 3 weeks.

Missed miscarriage:

I had no idea that you could just lose your baby and not know for weeks. I didn't cramp or bleed. I had every single pregnancy symptom still. I was taking pregnancy tests and they were still positive. My body wanted to hold onto Baby Curry as long as it possibly could. My body did not realize I had lost Baby Curry. For 3 weeks I carried Baby Curry after they had passed.

My options:

Since my body wouldn't release Baby Curry on it's own I had 2 options:

Misoprostol: Misoprostol is a medication that brings on a miscarriage more quickly. It works by causing the uterus to contract and push its contents outside the body. Misoprostol also causes the cervix (or neck of the womb) to soften. This is why this medication is used to treat miscarriage.

Dilation and curettage: A dilation and curettage procedure, also called a D&C, is a surgical procedure in which the cervix (lower, narrow part of the uterus) is dilated (expanded) so that the uterine lining (endometrium) can be scraped with a curette (spoon-shaped instrument) to remove abnormal tissues.

My doctor talked about the pros and cons of both treatments. I chose to have the D&C procedure for a few reasons.

1. Misoprostol doesn't always result in a "complete abortion" meaning I could have leftover tissue and need a D&C anyway.

2. I could be put under general anesthesia. I felt that this would better for my emotions and mental health.

3. Bleeding could go away faster.

4. I had already hit my catastrophic cap for the year so the procedure would be free.

D&C:

Due to scheduling issues I had to wait for 5 days before I could have my procedure. It was seriously one of the longest weeks of my life. I was due to have my procedure around 3pm. I fasted and didn't eat for 12 hours prior. I was given an oral antibiotic, and then my procedure was delayed. I ended up throwing up my antibiotic. Don't take any antibiotics on an empty stomach, just request the IV antibiotics. I was able to see Dr. W before the procedure and requested that Baby Curry be sent off for genetic testing. The Anesthesiologist came in to talk to me and gave me the first of several cocktails to make me kinda loopy and help with my nausea. I was taken back to the operating room, I don't remember anything after that.

The procedure was quick and easy. I woke up relieved. I remember the post op nurses were talking about TikTok dances while I was waking up and I asked them to dance for me. I ate some ice chips for an hour or so and then was brought to my recovery room. Garrett was already waiting for me. I changed into my clothes and got my IV taken out. We drove home in the pouring rain.

Recovery:

I didn't know what to expect when it came to recovery. Some things were easier than I expected and others were harder. The emotional part was so much better after my surgery. I did't bleed after that first night besides a day of spotting about 10 days after the proceedure. I didn't have any cramping. The hardest part of recovery was waking up feeling like I had just been hit by a truck. My whole body was tense and sore. My shoulders didn't want to move, and I had a random sore on my elbow that I can remember having before surgery. Getting out of bed was really hard because of this overwhelming muscle soreness.

Funny story I didn't realize that I had one of these heart monitoring stickers on me until I got to take my first shower a few days after my proceedure.

I was able to go back to work after 2 days at home. It was so nice to return to work and have a second family of co-workers cheering me on.

How pregnancy, miscarriage and surgery impacted my Rheumatoid Arthritis:

I heard horror stories about being pregnant and having RA. I also heard stories of women who went into remission while being pregnant. I didn't really know what to expect. Everyone is a little different, but I'll share my experiences.

• I felt a significant reduction in my symptoms of RA by week 6 and by week 8 my symptoms were gone. I didn't have any joint pain until about a week after my D&C procedure. I had a short but painful flare. I came out of it within 3 days.

• I take a biologic called Cimzia. Cimzia is approved by the FDA for use during pregnancy and breastfeeding so I was able to continue my medication. I don't take anything else besides occasional Ibuprophen and that was easily swapped with Tylenol. (I think I only needed it once for a headache.)

• My arthritis had nothing to do with my miscarriage. We did receive our results back from Baby Curry about 3 weeks after the procedure. Baby Curry was a Baby Girl with Turner syndrome. She was missing one of her X chromosomes. It is estimated that 99% of babies with Turner syndrome will miscarry. The babies that are born with Turner syndrome have significant life challenges.