Sjogren's Strong

Introduction

Sjogren’s: Pregnancy – Labor & Delivery

Many of you have asked questions in regards to Pregnancy, Labor, and Delivery with Sjogren’s Syndrome as a diagnosis.

Sjogren’s: Pregnancy – Labor & Delivery

Many of you have asked questions in regards to Pregnancy, Labor, and Delivery with Sjogren’s Syndrome as a diagnosis.

Shelby returns to the show to discuss this with us and we answer some of the questions that have been sent in in this episode.

If you missed Shelby’s first episode with us it was Episode 14 “MAKING SENSE OF SJOGREN’S SYNDROME, A Q&A WITH SHELBY”.

Let’s Dive In!

Welcome to another episode of Sjogren’s Strong.

[00:00:03] Brian: [00:00:03] This is Brian

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[00:00:04] Lupe: [00:00:04] And this is Lupe.

[00:00:05] Brian: [00:00:05] And this is your podcast discussing how to live an active and healthy lifestyle  despite a diagnosis of Sjogren’s.

[00:00:11] Lupe: [00:00:11] Guess what day it is?

[00:00:14] Brian: [00:00:14] Let’s see, is it, we’re in the studio a day earlier than we normally  are, day?

[00:00:19] Lupe: [00:00:19] Are we?

[00:00:20] Brian: [00:00:20] We are.

[00:00:22] Lupe: [00:00:22] Okay besides that. But why are we in the studio a day early?

[00:00:26] Brian: [00:00:26] Because we have a special guest.

[00:00:28] Lupe: [00:00:28] Who do we have?

[00:00:30] Brian: [00:00:30] Miss Shelby Colburn.

[00:00:34] Lupe: [00:00:34] Drum roll.

[00:00:35] Brian: [00:00:35] She’s joining us, yet again. And for those of you who haven’t heard Shelby’s last episode, it’s all the way back. January 2019, over a year ago.

[00:00:46] Lupe: [00:00:46] Wow.

[00:00:48] Brian: [00:00:48] Over a year ago. And that episode was Making Sense of Sjogren’s Syndrome with Shelby. And, uh, she’s back in the studio with us today.

[00:00:55] Welcome Shelby.

[00:00:57] Shelby: [00:00:57] Hi everybody. It’s great to be back.

[00:00:58] Lupe: [00:00:58] Yay. And a little backstory for those that don’t know, Shelby as Brian’s daughter.

[00:01:04] Brian: [00:01:04] The one and only.

[00:01:05] Lupe: [00:01:05] She’s the smartest person that I know.

[00:01:08] Brian: [00:01:08] She’s the smartest person in this room right now.

[00:01:10] Lupe: [00:01:10] Yeah, she is! Welcome back, Shelby.

[00:01:14] Shelby: [00:01:14] Thank you. I’m happy to be here.

[00:01:16] Lupe: [00:01:16] And!

[00:01:17] Brian: [00:01:17] You’re not  going to brag about how smart you are.

[00:01:19] Shelby: [00:01:19] No, I’m not a bragger.

[00:01:20] Brian: [00:01:20] You’re like, my Dad’s dumb.

[00:01:21] Shelby: [00:01:21] My dad’s always asking me to brag, I’m not a bragger.

[00:01:24]Lupe: [00:01:24] And Shelby moved back to California.

[00:01:27] Shelby: [00:01:27] I did come back.

[00:01:28] Lupe: [00:01:28] Welcome back, Shelby.

[00:01:29] Shelby: [00:01:29] I love this state. Great place to be.

[00:01:32] Brian: [00:01:32] Remind our listeners of what you were doing last time you were on our show.

[00:01:37] Shelby: [00:01:37] Oh, the last time I had just finished up my nursing program. So, I did, for those of you that don’t know, my first degree was in biology. I did research for a few years, and then I decided that a PhD in a research life wasn’t quite the right fit for my personality. So, I went back to nursing school and I’ve been working as a labor and delivery nurse, since I graduated.

[00:01:54] Brian: [00:01:54] Yeah. And last episode, you were a T-cell researcher, researching cancer?

[00:01:59] Shelby: [00:01:59] Yes.

[00:02:00] Brian: [00:02:00] Are you happy? That’s behind you?

[00:02:02] Shelby: [00:02:02] I’m miss it sometimes, research is great. I still  engage in a lot of primary literature because I’m a science nerd.

[00:02:08] Brian: [00:02:08] We wanted to bring Shelby back in the studio to talk about a subject you guys have been asking for. And I do not have Sjogren’s nor have I ever labored a baby.

[00:02:22]Shelby: [00:02:22] Or even have the ability to get pregnant.

[00:02:24] Brian: [00:02:24] That I don’t. I am lacking.

[00:02:26] Lupe: [00:02:26] I mean science, it could happen. I do have Sjogren’s, but I’ve never been pregnant.

[00:02:32] Brian: [00:02:32] And Shelby does not have Sjogren’s but has delivered a lot of babies.

[00:02:36]Shelby: [00:02:36] Not myself, but I help patients have some babies.

[00:02:41] Brian: [00:02:41] So we wanted to bring her in to talk about what you guys have been asking for, pregnancy and Sjogren’s, labor and delivery with Sjogren’s. Um, we’re going to ask her some of the questions that were sent into us and let’s get this kicked off.

[00:02:58] Lupe: [00:02:58] Let’s do it. You ready Shelby?

[00:03:01] Shelby: [00:03:01] I think I’m ready.

[00:03:02] Lupe: [00:03:02] Can Sjogren’s impact woman’s ability to get pregnant?

[00:03:07] Shelby: [00:03:07] So, all of the evidence and research we have says that, um, the ability to conceive is not affected by autoimmune diseases, be it Sjogren’s or other autoimmune diseases. We have a handful of cases of personal accounts where people have struggled conceiving, and they think that maybe it had to do with their autoimmune disease.

[00:03:28] Without the research, without the answers we don’t know for sure. So, we can’t really say that it, you know, takes away your chance to conceive, makes it harder for you.

[00:03:37] We know that, you know, conceptions very complicated. People struggle to get pregnant for a lot of other things. And maybe that’s, what’s causing some of these complications for people that have Sjogren’s and I just attribute it to their Sjogren’s.

[00:03:48] But all the evidence suggests that no Sjogren’s shouldn’t be affecting your ability to conceive and get pregnant.

[00:03:54] Lupe: [00:03:54] A lot of the followers and listeners they’ve had babies, they’ve had successful pregnancies and delivered normally.

[00:04:01] Shelby: [00:04:01] Right. And we see that in a lot of the stats. Many people with Sjogren’s, they get pregnant, they have fairly normal and healthy pregnancies. They have deliveries that aren’t impacted by their Sjogren’s. And, you know, that postpartum period, the recovery from delivery isn’t impacted by their Sjogren’s either. So, there’s a lot of hope for normal unaffected pregnancies.

[00:04:21] Lupe: [00:04:21] If women with Sjogren’s do you have issues getting pregnant, does it have something to do with the moisture and the fallopian tube and you know, you know what I mean?

[00:04:33] Shelby: [00:04:33] I know what you’re saying. I know what you’re saying. So, we have to look like Sjogren’s, of course, it affects people differently, on different scales. There’s a range of how impacted your body is. So of course, if you’re Sjogren’s is affecting your  ovaries, your fallopian tubes, your uterus, the inflammation reaches those organs and those organs are involved in your Sjogren’s disorder then, yeah, it should affect. Reasonably, we can think that it should affect your ability to conceive because those organs aren’t functioning as perfectly as they, otherwise, would.

[00:05:02] Lupe: [00:05:02] Okay.

[00:05:03] Shelby: [00:05:03] I was reading in my research, preparing for this podcast, um, a lot of the resources we’re suggesting if, you know, you have, Sjogren’s, it’s important to plan for your pregnancy. So if you’re trying to conceive, you know, that that’s what you want to accomplish, then it’s really important to start involving your rheumatologists, your doctors that are in your normal routine, make sure that your OB knows, um, you know, whoever you go for your routine pap smears. They are all aware that you’re trying to conceive.

[00:05:27] That way  you can make sure that your medications, that you’re taking, whatever your routine is for managing your Sjogren’s is all set-in stone. It’s really important that you’re controlling your Sjogren’s like three to six months before you’re becoming pregnant.

[00:05:39] That way there’s not a lot of, you know, questions or unexpected  bumps, thinking about Sjogren’s flare ups and inflammatory flare ups, that sort of thing. We want to have that Sjogren’s well controlled before you’re conceiving, before you’re becoming pregnant and, you know, being pregnant so hard on the body in itself.

[00:05:56] We don’t want medication complications, flare ups during that pregnancy and during that time.

[00:06:01]Lupe: [00:06:01] I could imagine that a flare up would be pretty bad while you’re pregnant. Can Sjogren’s affect the baby’s development?

[00:06:09]Shelby: [00:06:09] Right? So, this is pretty much everyone’s main concern, right? Is my disease is going to affect my baby?

[00:06:16] Um, so we know.

[00:06:18] Brian: [00:06:18] You sound so Southern, when say baby.

[00:06:20] Shelby: [00:06:20] I know, I heard it. As I said it, I heard the Southern flare up.

[00:06:24] Brian: [00:06:24] Too much time in Alabama.

[00:06:29] Shelby: [00:06:29] Goodness.

[00:06:30] Anyways, we know Sjogren’s, back to if you want to go review my previous episode and think more about the science of Sjogren’s,  we know that the SSA and the SSB antibodies, anti-romantic law antibodies are increased in Sjogren’s. That’s the main reason there’s a lot of inflammation in the body.

[00:06:48] And through research, we know that these are also associated with some of the fetal abnormalities. Of course, the most dreaded complication is fetal heart block. Um, and we see it’s really important for you to get antibody screening. You have to know where your antibodies are standing at  your current place in your disease.

[00:07:09] And you need to know, most importantly, if you’re SSA positive. We see that increased SSA antibodies in the body. You know, those pass over to the placenta, starting as early as 12 weeks. So, all the antibodies in your system are transferring to the baby. Um, and that’s going to affect their development because it’s causing that same inflammation in the fetus.

[00:07:29] So when this happens, we’re seeing that it interferes with the AV node, which is the electricity of the heart. That’s how the heart functions, right? Um, so this can cause a congenital heart block, which could range from being mild to severe. So, it just affects the rate and the rhythm of the fetus heartbeat.

[00:07:46] And let me tell you guys, I don’t want you to be scared, 1 to 2% of pregnancy, with Sjogren’s  see this congenital heart block.

[00:07:54] So it’s this dreaded complication, but it’s super rare. And all you need to do during your pregnancy is to get extra fetal monitoring during pregnancy.

[00:08:02] So fetal monitoring starts about 16 weeks and most pregnancies. And in Sjogren’s you just want to have fetal heart monitoring, weekly, at your weekly appointments, a little more regularly, then otherwise healthy pregnancies.

[00:08:14] And that way you can just catch these hearts, um, abnormalities earlier in the pregnancy. If we know that it exists, then we know that we have to pay attention to it and we’ll have to there’s chances that we might have to intervene, when it comes time to deliver. But there’s also a chance that your baby’s going to be born. absolutely perfect, with no heart abnormality at all.

[00:08:33] Lupe: [00:08:33] Good. But you definitely want to tell your doctor that you do have Sjogren’s um, because obviously you don’t go to a rheumatologist, when you’re pregnant, right?

[00:08:42] Shelby: [00:08:42] You can.

[00:08:42] Lupe: [00:08:42] You want to be sure that they talk. Really?

[00:08:44] Shelby: [00:08:44] Yeah. You can tell your rheumatologist. I’m trying to get pregnant.

[00:08:47] Lupe: [00:08:47] Oh, right on.

[00:08:47] Shelby: [00:08:47] I want to be pregnant. I am pregnant and I would like some extra care during my pregnancy to make sure my Sjogren’s is well controlled.

[00:08:53] Lupe: [00:08:53] And that way they talk to each other. So yeah. Always tell your docs.

[00:08:56] Shelby: [00:08:56] Inter collaborative health care teams are great. And if you are somebody that ends up having a baby with fetal heart block, they’re seeing some abnormalities on these weekly screenings. Um, all you have to do,  your OB they know what to do.

[00:09:11] You can involve in neonatologists you can involve a peri neonatologist. Um, we have the technology now. We see these things. We know how to help babies, once they’re born, if they have these complications. And we’re able to intervene in it. You know, your baby, even with a heart block can have a normal life.

[00:09:30] Lupe: [00:09:30] Can Sjogren’s cause the heart block?

[00:09:33] Shelby: [00:09:33] Yeah. So Sjogren’s is causing a heart block cause it’s the increased SSA antibodies. Um, they cause the inflammation, those crossover to the baby. So, they cause inflammation in the baby, which affects the heart development. Um, and when the heart, it causes like scarring in the heart tissue.

[00:09:49] So then the, the electricity can’t travel through the heart as easily as it otherwise does. It’s kind of interrupted in the flow. So that regular, like bump, bump, bump, bump, bump, bump that we hear, it’s going to be disrupted. Sounds a little different because the heart’s functioning a little different.

[00:10:03] Lupe: [00:10:03] So does that mean that the baby is born with Sjogren’s or?

[00:10:08]Shelby: [00:10:08] No, they’re just born with a heart block.

[00:10:09] Lupe: [00:10:09] Okay.

[00:10:10] Shelby: [00:10:10] So, um, they don’t necessarily have Sjogren’s. We do know that Sjogren’s has a hereditary factor. So, having Sjogren’s or any other autoimmune disease and getting pregnant, there’s a chance that you could be passing that autoimmune disease onto your offspring. It’s not a guarantee, but it’s always a chance.

[00:10:25] And that’s seen with all sorts of things too, not just your auto immune diseases.

[00:10:28]Lupe: [00:10:28] Right? Definitely a possibility.

[00:10:30] Brian: [00:10:30] Like smarts. I passed them all on to Shelby.

[00:10:33] Shelby: [00:10:33] Got it all from my dad.

[00:10:39] Lupe: [00:10:39] Those did not come from Brian.

[00:10:40] I like rubbing elbows with Shelby. You know, maybe some of her brain cells will come to mine. Mine are disappearing with my Sjogren’s.

[00:10:51] Shelby: [00:10:51] I wanted, there was one more thing too, with Sjogren’s effecting baby development, sometimes we see that the babies are born with a rash and it’s called neonatal Lupus because it kind of mimics that butterfly Lupus rash.

[00:11:02] And that’s kind of the same thing as these antibodies are being transferred to the infant. But in this case, the antibodies are only in the infant’s body temporarily. So, they have these antibodies, it causes the rash, after a couple of weeks, the antibodies out of the system and the rash resolves. Very minor complication.

[00:11:19] Um, that complication happens again in 1 to 2% of pregnancies. Um, with the rash, if you have it in your first pregnancy, then in subsequent pregnancies, the chances of it happening again are five times higher. With this congenital heart block,  again, it’s 1 to 2%. And if, chance in your first pregnancy, if you see it in your first pregnancy, then in subsequent pregnancies, then that chance increases 10%.

[00:11:43] We see it once, it’s likely that we’ll see it again, essentially.

[00:11:47] Brian: [00:11:47] Now you’re very much into a holistic approach to labor and delivery.

[00:11:52] Shelby: [00:11:52] Yes.

[00:11:53] Brian: [00:11:53] Can a mother with Sjogren’s still have a natural birth with no medications?

[00:12:05] Shelby: [00:12:05] Yes, absolutely. Um, so when he says holistic birth, I’m very, uh, I guess you can say granola, I just favor unmedicated, natural deliveries.

[00:12:16] Of course, I’ve been involved in many deliveries with epidurals, with IV pain medications. There’s no right way to have a baby or a wrong way to have a baby. Um, none of the research indicates that Sjogren’s affects delivery, really. So, whatever you want to do for you, it’s your birth story.

[00:12:32] You get to make it. Don’t let your show influence that. Um, with any labor, there’s always a chance of an emergency C section. There was one study that suggested Sjogren’s has a slightly increased chance of emergency C section, but there are a lot of factors in that study. So it wasn’t, they couldn’t definitively say Sjogren’s, was  the cause of that.

[00:12:55] Brian: [00:12:55] I’ve done some research and reading on my own and not just with Sjogren’s, but doctors tend to want to go to the, OR. It seems like it’s a snap decision on the doctor’s part. Is that your experience? If something starts to get a little wonky, do they make that decision just so they can have more control over the situation?

[00:13:20] Shelby: [00:13:20] Sometimes. Doctors are different, doctors like to practice differently. Um, sometimes going to the OR, it’s a more controlled environment. We know exactly what to expect, we have a delivery. If we’re seeing during your delivery, there’s always fetal heart monitoring. We listen to the baby’s heart rate. We see the rhythms that they have during labor. Make sure they’re tolerating labor, fine.

[00:13:45] Um, if we have a complication such as the congenital heart block, we’re going to hear that and see that on the monitors. That’s probably, we’re going to be a little more suspicious, a little more cautious with that, and we’re going to watch that. That might be a reason to jump to a C section.

[00:13:59] If things start getting a little stressed out, if we don’t think the baby’s quite happy, it might be easier, faster, healthier to go to a C-section. With emergency C-sections it’s hard to say though, like you really never know if we would have just labored continued laboring vaginally, if you could have had a fine vaginal birth, because we can’t explore that outcome once you choose a C-section.

[00:14:20] Lupe: [00:14:20] I’ve never been pregnant. I don’t have any babies, so I don’t know what childbirth is like or anything like that. But a little TMI here ,Sjogren’s patients don’t have a lot of moisture. So, when you try to go number two, it’s really dry. Right? So sometimes you have issues. So, does that affect where you’re having a baby too? Where does the moisture come from? From the amniotic fluid?

[00:14:46] Shelby: [00:14:46] So, I don’t know for sure. It’s reasonable to assume that the Sjogren’s, if it’s already affected, you know, you have vaginal dryness from your Sjogren’s previous to pregnancy, then you can expect it during your pregnancy and during your delivery. The amniotic fluid should not be affected by Sjogren’s at all.

[00:15:02] So, still you’ll have once, the water membranes break and their water are broken, um, you should still have that fluid. If for whatever reason, the dryness is irritating you, during your labor, during pushing, um, the hospitals should have things such as water-based lubricants. They might have mineral oil, that’s becoming a lot more common in facilities.

[00:15:23] You can talk with the hospitals ahead of time with your OB, with your nurses. You might be able to bring things from home, as long as everyone on the healthcare team is comfortable with it. Um, that can be used during your labor. There’s no reason that they should say no to that.

[00:15:36] Brian: [00:15:36] And since Lupe brought up number twos.

[00:15:40]Lupe: [00:15:40] There I go.

[00:15:41] Brian: [00:15:41] Talk to us about moms and their major concern about having a bowel movement during labor and delivery.

[00:15:48] Shelby: [00:15:48] Yeah. If a baby’s coming out of the vagina, the rectum’s right under the vagina. If you look at diagrams, like looking from a side point of view. The baby’s head has to push on the rectum to get out of the vagina.

[00:16:00] If there’s, um, poop.

[00:16:04] Brian: [00:16:04] Fecal matter.

[00:16:05] Shelby: [00:16:05] Fecal matter. If there’s fecal matter in the rectum and the baby’s pushing on the rectum, of course the baby’s going to push the poop out. So, unless you go poop pretty immediately before you have a baby within a few hours, then you’re going to poop during labor and that’s natural. It’s normal. It’s fine.

[00:16:21] We think, um, that, you know, having the poop come out before the baby, it exposes the baby to some bacteria. It helps begin the development of their immune system. That’s one of the thought processes behind that. It’s natural. Everybody, poops. Doctors have  seen poop. Nurses I’ve seen poop. Nobody needs to be embarrassed.

[00:16:40] Lupe: [00:16:40] It’s just an everyday thing for them.

[00:16:41] Shelby: [00:16:41] Very normal.

[00:16:44] Brian: [00:16:44] Have you ever been pooped on.

[00:16:48] Shelby: [00:16:48] Dad likes to bring this story up? Because one of my patients pooped on me once. Um, they were in a hands and knees position and they have their baby that way. And I caught the baby and the cord was short. So, I had to hold the baby in that position, as I got pooped on. Dad likes to bring it up.

[00:17:04] Brian: [00:17:04] You know, what really blows my mind, is I was in the room when Shelby was born and now 26 years later, we’re sitting in a room having a conversation about labor and delivery, and she’s a nurse. Just kind of mind blowing.

[00:17:24] Lupe: [00:17:24] How about that? Yeah.

[00:17:24] Brian: [00:17:24] It’s crazy.

[00:17:26] Lupe: [00:17:26] Listeners like to.

[00:17:27] Shelby: [00:17:27] They like to get a sense of personality.

[00:17:29] Lupe: [00:17:29] Yeah, they do.

[00:17:31] Does being pregnant, make your Sjogren’s worse?

[00:17:34] Shelby: [00:17:34] So, for many women Sjogren’s Syndrome, kind of worsens during pregnancy and, or like immediately after delivery. And there’s not a lot of clear explanations or understood mechanisms as to why. Pregnancy in general is really hard on the body and on people. They get very fatigued with it.

[00:17:55] Um, we see other diseases kind of get aggravated with pregnancy, too. Probably just because, you know, pregnancy is a lot for the body. The body is doing so much work. We do know with pregnancy, there’s an increased chance of hypertension. That’s pretty common, no matter, healthy, unhealthy, what diseases you have.

[00:18:13] And we see that patient that end up having increased hypertension. There are definitely increased chances of their Sjogren’s, getting worse during that time. And this kind of goes back to making appointments with your rheumatologist throughout your pregnancy, seeing your OB. Make sure this is a continued conversation as you’re going to your prenatal visits. Make sure that you’re calling and making additional appointments,  if you feel like you need them. It’s okay.

[00:18:36] I think it would be a good idea to be keeping journals. Keeping track of your symptoms, whichever way you prefer. And you can kind of just follow the trends. If you think you want extra help, you think somebody should know about it. Then absolutely let your doctors know, involve them in that part of your care.

[00:18:51] Um, and then of course, post-delivery, having a baby’s hard work. Those first few days afterwards, that’s hard time for recovery for the body. And then you have a newborn. And fatigue is absolutely normal.

[00:19:02] I know fatigue’s a big part of Sjogren’s. So just imagine having the fatigue of having a newborn at home  and your body, being tired from having a baby. And then add on your Sjogren’s fatigue. That’s nothing to worry about. I think that’s something to definitely expect and plan for. Make sure you have your family support system, your spouse support system, all lined up and ready for that.

[00:19:23] Lupe: [00:19:23] It’s a good thing that, uh, guys get, um, what is it called?

[00:19:27] Shelby: [00:19:27] Paternity leave.

[00:19:28] Lupe: [00:19:28] That’s right. Paternity leave.

[00:19:31] Shelby: [00:19:31] And involve them in it. And just remember too, you got to take care of yourself first because you’re growing a baby. You’re having a baby. You’re going to take care of a baby into a toddler, into a child. You need to take care of you first so that you’re around to take care of that baby, and that child.

[00:19:44] Lupe: [00:19:44] Um, do you think medications, when you’re pregnant, can you still take the same medications that you ‘retaking to treat your Sjogren’s.

[00:19:55] Shelby: [00:19:55] That’s a great question. So that kind of goes back to planning. If you know that you’re trying to conceive a baby, you get a little more control with this, right? You can adjust medications. There are certain medications we know are not safe for pregnancy. There are certain medications we know are not safe for breastfeeding.

[00:20:10] Um, some of those might be Sjogren’s medications. So, this is a time to involve your doctors. Make sure your dosages are good. Your meds are good. You can make adjustments before you conceive, if, you know, you’re trying to conceive. Of course, if you just get pregnant because you get pregnant, um, there’s not as much room to be adjusting that because we know adjusting meds takes time.

[00:20:29] It takes time to figure out if they’re working for your body. If they’re not working, how you feel on them. If you’re experiencing side effects. It’s harder to know those things. If you’re trying to play with dosages during a pregnancy, trying to adjust dosages during a pregnancy.

[00:20:43] So that’s definitely a conversation to be continued with your physician, um, just to make sure that everything stays kind of consistent throughout your pregnancy and afterwards.

[00:20:53] Lupe: [00:20:53] So definitely talk to the doctor, unless it’s an accident.

[00:20:57]Shelby: [00:20:57] Right. Then it’s a surprise.

[00:20:58]Lupe: [00:20:58] Right? Whoops.

[00:20:59] Shelby: [00:20:59] A little less wiggle room.

[00:21:01]Lupe: [00:21:01] Yeah, but if you’re actually planning, then definitely talk to your doctor about it.

[00:21:07] Brian: [00:21:07] And it would be safe to assume that if you think you may be pregnant, schedule that rheumatology appointment, schedule that OB appointment. And get the ball rolling with caring for yourself.

[00:21:22] Shelby: [00:21:22] And I know there can be a delay in scheduling appointments. So never be afraid on the phone, I’m pregnant, this is more time sensitive. I’d like to be soon, sooner, rather than later, it’s okay to put that pressure on.

[00:21:32] Brian: [00:21:32] Yeah. And I think nowadays it’s a little more, it’s easier with more and more people being exposed to telomeres because of COVID.

[00:21:41] Shelby: [00:21:41] Absolutely. Telemedicine is great for many, many things.

[00:21:45] Brian: [00:21:45] Definitely.

[00:21:46] Lupe: [00:21:46] Yeah. Don’t just get off your meds because Oh man. I just found out I’m pregnant, right?

[00:21:50] Shelby: [00:21:50] Yeah, definitely never do that.

[00:21:52] Lupe: [00:21:52] Yeah.

[00:21:52] Shelby: [00:21:52] Find, your physician, let them know. Adjust dosages medicines that aren’t safe for pregnancy. They can be discontinued there’s alternatives that are safe for your pregnancy.

[00:22:03] Um, even if it’s a surprise, you can make those last-minute adjustments and it’s going to be okay.  It’s much better to go with the safe choices.

[00:22:11] Brian: [00:22:11] To wrap this up, can you give the listeners maybe a, just a descriptive checklist of what they should be most concerned with if they find themselves planning on or with child.

[00:22:25] Shelby: [00:22:25] Yeah. So, if you’re planning for pregnancy, we have a little more flexibility. You want to make sure that you’re speaking with your rheumatologists, your main physician team. Um, maybe involving your OB early on. And make sure that you’re aligning your medications. You’re on pregnancy friendly medications, breastfeeding, friendly medications. Um, make sure that your Sjogren’s is managed so that you’re keeping your disease activity low, going into conception and going into pregnancy., that’s going to be best.

[00:22:54] If you find yourself surprised pregnant, you’re going to go ahead and do the same thing. You’re going to call your rheumatologists. You’re going to make an appointment. See your physicians, make sure medications are okay. See if anything needs to be changed. If you need to find alternatives for anything, um, that way that stuff is all covered. We don’t have to worry about medications having any effect on the pregnancy or the infant, and then managing your pregnancy  like any other pregnancy.

[00:23:19] Maybe being a little more aware of your symptoms, keeping a journal or some sort of log and  talking to your physicians and your healthcare team, as you feel is necessary and appropriate for you. And then planning for your birth and your pregnancy.

[00:23:33] And I think, really thinking about the fatigue that you’re going to feel, having a baby, having a newborn. Because that’s going to, if, I’m sorry, cause that’s going to affect you the most, I believe in my opinion.

[00:23:45] So making sure that you’re prepared for that and making sure that you are in a good routine to take care of yourself so that you can take care of your family after that.

[00:23:53] Lupe: [00:23:53] And all this is true, even if you have multiple autoimmune, right?

[00:23:58] Shelby: [00:23:58] Yeah. Essentially. There was a study that suggested, the Sjogren’s that presents with Lupus, there is a higher chance of the complication of preeclampsia. I don’t want any of you guys thinking about these complications, worried about these complications. Don’t think it into existence.

[00:24:15] If complications happen, complications happen, and the healthcare team is prepared and knowledgeable and able to handle that. There’s no sense in worrying about things because you don’t have control over it. So, don’t be reading these horror stories. Don’t be thinking about the worst.

[00:24:31] In my opinion, that’s just a little silly. I know it’s easy to do because I’m also an anxious person that drives, um, a lot of people. Um, but don’t focus on these complications. Okay. Nothing to worry about,

[00:24:46] Brian: [00:24:46] You know, and labor delivery is kind of like a roller coaster, isn’t it? Once that bar comes down and you take off, you leave the station it’s happening. It’s just a matter of when.

[00:24:56] Shelby: [00:24:56] Absolutely so. And I want to remind everyone too, that, you know, most of them. Sjogren’s patients are women. So, pregnancy of course, is a big concern. Think of all the women that were diagnosed with Sjogren’s after having healthy, happy babies, um, that might be you that’s listening right now.

[00:25:12] Think of all the people that are getting pregnant without issue, having these babies, having these families, and it’s all normal, healthy, nothing bad from your Sjogren’s.

[00:25:23] Brian: [00:25:23] And we’ve got quite a few moms in the group. We have a few fathers in the group. I’m not sure if any of the fathers in the group are non-Sjogren’s or Sjogren’s with a Sjogren’s positive wife, whose  had children, as well.

[00:25:42] However, the group is wonderful and if you’re not a member of the Facebook group hit Sjogren’s Strong up on Facebook, join that group. It’s awesome how you guys are stepping up and taking care of each other.

[00:25:56] It’s quite an awesome community to see in motion. Um, for those with Sjogren’s, male and female,

[00:26:05] Lupe: [00:26:05] I don’t know about in the group, but I know that on Instagram we have, uh, several males with Sjogren’s.

[00:26:12] Brian: [00:26:12] Shelby, first time we spoke, you were T-cell researcher. Now you’re a labor and delivery nurse working on your Master’s, what’s after your masters, what are you?

[00:26:21] Shelby: [00:26:21] Being a women’s health nurse practitioner. So, I’ll be seeing some of you maybe. I think I’ll probably be doing., I don’t know, reproductive care, birth control, contraception care. Figure something out, I got a long life ahead of me.

[00:26:36]Brian: [00:26:36] That you do.

[00:26:37] Shelby: [00:26:37] Maybe go  back and be a midwife and help you all have some babies.

[00:26:40] Brian: [00:26:40] Very cool. For those of you who don’t know, and most of you don’t, she is such a proponent for women’s health and has told me stories where she has really worked with moms and helped coach them into maintaining the birth plan that they put together before labor started. And really advocating on their behalf to the doctors who wanted to or were recommending things to deviate from that birth plan that might not have been necessary. So that’s pretty awesome.

[00:27:13] Shelby: [00:27:13] Sjogren’s aside,  when you’re pregnant, you figure out what kind of birth you want, what things you’re comfortable with, what things you’re not comfortable with. You and your significant other, you’re your best advocates, involve, your nurses, make sure your OB team’s aware of what you want.

[00:27:28] Know that you always get to make the choices for you, and you can always fire your doctors.

[00:27:34] Lupe: [00:27:34] I don’t think a lot of people know that. So, thanks.

[00:27:38] Brian: [00:27:38] Is Lamaze t still the thing or do they call it something different now?

[00:27:41] Shelby: [00:27:41] No, Lamaze is still a thing.

[00:27:42]Brian: [00:27:42] Okay.

[00:27:43] Shelby: [00:27:43] Lamaze breathing. Um, that’s really common for natural labors or medicated labors.

[00:27:49] Lupe: [00:27:49] Thank you so much for being here for talking to us about pregnancy. If our listeners have any questions, would it be okay if they sent us the questions and you know, we shoot them off to you and whenever you have time.

[00:28:02] Shelby: [00:28:02] Absolutely. So, I  help people have babies. I don’t, I’m not an expert on Sjogren’s and pregnancy and Sjogren’s deliveries per se. And I just did some research to prepare for this podcast. I’m sure a lot of you are listening and you have questions that I didn’t think of. So, send them to Brian and Lupe, um, and they’ll get them to me and maybe we’ll have pregnancy and Sjogren’s part two, follow up with y’all .

[00:28:26] Lupe: [00:28:26] We’d like that, actually.

[00:28:27] Brian: [00:28:27] Yeah, and something else. Um, I just thought of the foundation is having more and more walks and they’re having virtual walks in these days of COVID. At these area walks they have an “ask the expert” section. Now with a virtual walk, ask the expert is online and there’s a little more anonymity there. So, there are eye doctors, dental professionals, rheumatologists.

[00:28:54] Um, if in between times, that might be a great way for you to get some questions answered, um, if you participate in one of these area walks.  So, check out Sjogren. Org and see what’s coming up in your area. And if it’s virtual, it doesn’t matter if it’s in your area or not. You can sign up for the New York area, walk in, walk your neighborhood in San Francisco.

[00:29:22] Lupe: [00:29:22] So, a virtual walk. Is it like you’re in front of your computer walking, walking? Or is it a walk, walk?

[00:29:29]Brian: [00:29:29] No. So, everybody’s like logging on and they’re having, you know, the opening words and they’re doing the team warmup. So, in front of your computer, you can stretch and warm up and engage with the crowd. And then they’re like, okay, go do your walk and you literally leave your home or your office wherever you are.

[00:29:49] And you can go walk. And, you know, #sjogrens.you know, do any of that. So, you’re participating. It’s a physical walk, but you’re by yourself in your own neighborhood or local park.

[00:30:01] Lupe: [00:30:01] That’s cool.

[00:30:02] Brian: [00:30:02] The virtual portion of its online.

[00:30:04] Lupe: [00:30:04] Okay.

[00:30:05] Brian: [00:30:05] Pretty cool.

[00:30:06] Lupe: [00:30:06] I’m going to do it next time,

[00:30:07] Brian: [00:30:07] Definitely.

[00:30:07] Lupe: [00:30:07] I haven’t a virtual walk yet. So that’d  be fun!

[00:30:11] Brian: [00:30:11] Well, very cool. Anything else, Shelby?

[00:30:15] Shelby: [00:30:15] I don’t believe so I’m looking forward to everyone’s follow up questions or maybe questions about their own pregnancies and deliveries, so we can continue this conversation .

[00:30:24] Lupe: [00:30:24] Until next time, sip constantly and stay hydrated.

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