Lupus and Pregnancy
3 months before her wedding, Michelle Tang was diagnosed with a chronic autoimmune disease called Lupus. While such news might have shattered the life of most, this fighter was more than ever determined to lead a normal life. This is her story...
I was diagnosed with lupus, or SLE (short for Systematic Lupus Erythematosus) in 2006. Lupus is a chronic autoimmune disease that is incurable and relies on daily medication of steroids.
Autoimmune diseases are illnesses that occur when the body’s tissues are attacked by its own immune system. It usually affects women in child-bearing ages, and I think in Singapore there are close to 9000 women affected by it.
It happened when I woke up one morning with terrible joint aches and the joints at my fingers were swollen, I could not even take out my ring! Worse, when I wanted to brush my teeth, I could not even lift up my arm and bend it. I was terrified and cried my eyes out, thinking that I was suffering from arthritis, at such a young age!
Soon, I was referred to a rheumatologist and one blood tests led to another. Finally, the Doctor broke the news to me, I had lupus. The moment he told me about my condition, I could feel the world crumbling down. I was going to get married in three months! My first thought was, to break up with my now husband. There was no way that I wanted to burden him with my illness. But my knight in shining armour, stood by me and reassured me that he would take care of me.
How does lupus affect pregnancy or the newborn? As a lupus patient, pregnancies for us are considered “high-risk”. We are more susceptible to miscarriages, and secondly, we might have flare ups during pregnancy which could cause some complications. There was also a chance that I could pass this hereditary disease to my newborn.
Despite all these factors, we wanted a kid badly but made sure we went through careful consultation and advice from my specialist. After deciding that my condition was stable and I was on fairly low dosage of medication, we were given the green light. But my specialist wanted me to be placed under special care and insisted on close communication between him and my gynaecologist.
Of course, we prayed to God about it as well. Looking back, it seems that He really wanted us to have a kid, as we only had to try once and we hit the bullseye! I was pregnant right away.
The pregnancy was smooth-sailing, except for the morning sickness during the first trimester. I had lost nearly 5kg as a result of it, and was a frail 38kg. I could not stand the smell of foodcourts and even my favourite foods like carrot cake and roti prata made me nauseous. However, by the 13th week, I was regaining my appetite and soon my weight crawled back to normal, and then, I gained about 2kg each month.
In total, I gained about 11kg. Usually, preggies would see their gynae every 2-3 months, for my case, I saw my gynae every 4 weeks. My specialist would also write little love notes, reporting my latest blood test results and the dosage of my medication which I would bring along to every gynae visit. And somehow, I always felt that my baby would do something good for my condition. True enough, my lupus blood test results taken during my pregnancy showed my condition improved. My results were beginning to show no signs of lupus.
I would be lying if I said I was not worried about my baby’s health. I was always thinking about what if I passed it on to my newborn, what if the labour became complicated, what if my baby had some defects? However, these thoughts were quickly dispelled with each visit to the gynae.
I was into my 38th week, when I felt that the foetus was not kicking as frequent as before. One morning at about 8am, while doing my usual business in the toilet, there was some blood discharge. My husband called the gynae immediately, they were still not opened yet so we left a message. As I was not experiencing any pain, we went on to our usual breakfast place to have carrot cake. Soon after, the nurse from the clinic returned our call and we explained to her that I was having some blood discharge. After she consulted my gynae, they suggested I come down to the clinic right away.
We reached the clinic at about 11am, my gynae checked me and said the baby’s head is already engaged in the pelvic area, so if I wanted, “we could deliver your baby today”, he said. I was stunned, no way had I imagined today would be the birthday of my baby, I was 10days early!
My gynae said he could send me home and wait for contractions, but because of my lupus condition, he would rather induce my labour. He then instructed his nurse to send me upstairs into one of his “operating rooms” to burst my water bag. I shall not go into details on how he did it, but surprisingly it was painless.
Soon, I felt a warm gush of water and I was made to wear adult pampers. This was quite embarrassing. And I had to wear it all the way to the hospital, it was humongous and I was praying it did not slip en-route!
At the Hospital
We arrived at the hospital just before 1pm, and carefully, I walked to the delivery suite myself while my husband did the admission procedures. The nurse asked me to change into their gown, the minute I removed the pampers, another huge gush of water flowed out, I looked at the nurse guiltily and gasped “oh oh”, because I dirtied the whole bathroom. She laughed and said “nothing to worry about child, I’ll have that cleaned up right away, come over here and sit on the bed”.
I was then strapped to the CTG machine. For the next four hours, I could not feel any pain at all, even though the machine showed peaks, meaning my contraction had started. My dilation was about 4cm. I was thinking, “Hey, if this continues, I think I can endure leh”. Ha, I spoke too quick! At about 5pm, the contractions grew stronger, and at shorter intervals.
Whenever I saw the peak going up, I squeezed the bedsheet, preparing for an eruption of tightening at the lower abdomen. Within a minute, the sensation would dissipate. This kept happening every two minutes. Shortly I began to wear out, I asked the nurse to check my dilation. It was barely 5cm. I raised the white flag, meaning hurry get the anesthetist here now! Within an hour, the anesthetist was injecting my spine with the drug. It was instant relief.
Soon enough my dilation grew to 8 cm. By that time, I felt like I was going to poop! The nurse said this was a sign that I should get ready to push. It was 10pm. I had been in labour for nine hours.
By 10.30pm, the nurse instructed me to push when I saw the contraction peak coming…and so I did, and she exclaimed “yes yes, that’s it! I can see the crown of the baby’s head!”. My gynae soon came in and did the rest of the job. Within 5 pushes, baby Caelyn was out. She didn’t wail at all, which got me worried. They then lifted her upside down and sucked out the mucous from her mouth. In an instant, she gave a loud cry. Tears flowed down my eyes, there she was, my miracle child.
Baby Caelyn weighed in at a healthy 3.04kg and 49cm. Her time of birth was 11.23pm.
She is now 11-months-old, and growing very healthy. I hope my story inspires other lupus patients that they can go through pregnancy just like normal women. Don’t worry about the 2 per cent chance of your baby getting neonatal lupus, just focus on that 98% that they will be healthy.