Family planning and kidney disease: Labor and delivery and postpartum

With help from nephrologist (and one of our former Clinical Scientist in Nephrology fellows), Dr. Jessica Tangren, AKF is answering questions about family planning and kidney disease in a three-part series. Part one focuses on fertility and sexual health, part two on pregnancy and part three focuses on labor and delivery and postpartum. This is part three: labor and delivery and postpartum.

What impact does kidney disease have on your delivery?

The most common complication of pregnancy in women with kidney disease is preeclampsia. Preeclampsia occurs when the placenta — which provides oxygen and nutrition to the baby through the umbilical cord — does not develop normally. When this happens, the placenta "can release factors that cause high blood pressure and can make mom and baby sick," according to Dr. Tangren. Less than 5% of healthy women develop preeclampsia, but more than 20% of pregnant women with kidney disease do.

"Currently the only way to treat preeclampsia is by delivery because you have got to get that sick placenta out of mom. Fortunately, delivery cures preeclampsia," said Dr. Tangren. However, this can mean delivering your baby prematurely.  

Women with kidney disease are five times more likely to have a premature delivery (before 37 weeks of pregnancy are completed) or have a baby who is small for their gestational age (smaller than expected for the number of weeks at birth). If a baby is delivered prematurely, it is possible it will not have had time to develop fully and may require further medical intervention after it is born. 

Additionally, when compared to the general population, women with kidney disease are twice as likely to need a cesarean section (C-section) delivery. This is when the baby is surgically removed from the mother instead of being delivered vaginally. 

Dr. Tangren added, though, "The rates of live births for women who are on dialysis while pregnant used to be less than 50% in the 1990s and now we're upwards of 80 or even 90%. So successful pregnancies can happen at all stages of kidney disease."

Do dialysis or kidney disease factor into birth plan decisions, such as the type of delivery or anesthesia the parent elects to have?

It is possible for you to have a vaginal delivery at any stage of pregnancy. However, again, women with kidney disease are at an increased risk of delivering early (before 37 weeks) or requiring a C-section delivery.

"The planning around delivery can be more complicated [for women on dialysis]," Dr. Tangren noted. "Mostly because administering dialysis, especially near term, becomes more challenging with fluid removal and the hemodynamic changes that can happen with dialysis. So, in many cases, at the end of pregnancy, women may need to be admitted to the hospital for fetal monitoring during dialysis to make sure that the fetus is tolerating the dialysis and that that we're not seeing any distress [in the newborn] that would cause the OB [pregnancy doctor] to want to deliver sooner."

How does kidney disease factor into pain management for delivery and postpartum?

"Because I'm not an obstetrician, I'm not involved in the actual delivery, but most of them have labor that looks fairly typical with epidurals — which are totally safe," said Dr. Tangren. An epidural is a catheter that is inserted into your back that delivers medicine to help lessen pain from contractions and delivery. "In our [end-stage renal disease] ESRD population, though, the considerations that come up would be dosing of medicines." 

For example, a woman without kidney disease who is experiencing preeclampsia may receive magnesium to prevent her from developing eclampsia — which is a more severe form of preeclampsia and can cause seizures. "You just have to be really careful in patients on dialysis because dialysis is the way that magnesium is cleared and because their kidney function is reduced, there's considerations about reducing the dose of magnesium if that's going to be given," explained Dr. Tangren. This can also be the case if you have kidney disease and are not on dialysis yet.

Another medicine consideration would be if you need any antibiotics during your delivery. The dosing may also need to be adjusted because of your kidneys' reduced function.

After delivery, women with kidney disease also may need to avoid certain pain medicines that can make kidney disease worse. "For delivery and postpartum pain, we would avoid [non-steroidal anti-inflammatory drugs] (NSAIDs) in patients with significant kidney disease and opt for high doses of Tylenol or low doses of opiate medicines for pain if needed," said Dr. Tangren.

What is the impact of kidney disease, kidney failure and/or a kidney transplant on lactation and breastfeeding?

"In almost all scenarios, women can breastfeed and are encouraged to breastfeed if that is their goal," said Dr. Tangren. 

However, you may need to ensure you are on medicines that are compatible with breastfeeding. 

To find out more about kidney disease and fertility and sexual health, check out part one in this family planning and kidney disease series.

To find out more about kidney disease and pregnancy, check out part two in this family planning and kidney disease series. 

We hope this series is helpful for your family planning and that you can be the one making the decisions for those plans — not your kidney disease.

Disclaimer:The information provided here is not intended to replace professional medical advice, diagnosis or treatment. Please consult your obstetrician (OBGYN), primary care doctor and/or nephrologist about your specific family planning needs and goals.