Pregnancy and Methotrexate

QUESTION

Dear Midwife,
My husband and I have just found out that I am 12-14 weeks pregnant with our first child. This has been completely unplanned as I for the last 2 years have been taking Methotrexate for Juvenile Rheumatoid Arthritis, my dose is 20mg per week taken via an injection format.

When I was originally prescribed the drug we were told that under no circumstances should I think about having children without having come off it for at least 6 months. This was not an issue to us so we had planned our lives around just being the two of us.

Despite taking the contraception pill, I have discovered that the reason my tummy has swelled is not over indulgence at Christmas!! I have an appointment on Monday for a scan where we have been told we do not need to look at the screen and that termination is the likely advice I will be given. I naturally have not taken the drug this week however I cannot imagine that stopping it now will make much difference.

Can you tell me please is there any chance that this baby could be okay and the likelihood of it. We are so confused and are unsure of how to even talk to each other about Monday as there are so many ifs? Will the scan show abnormalities? Whilst we know that this was unplanned we are wondering if we now have a chance that this baby is "just meant to be"?

Thank you very much for reading this.

ANSWER

There is always a chance! But I agree that you should also be prepared for the possibility that this child may not be healthy.My experience is that no two people handle bad news in the same way, so it is not surprising that you and your husband are having trouble talking about it, especially when you don't even know for sure what is going on. If the news is not good, you might consider waiting a few days or even longer to make any final decisions.

For instance, in some cases, although this child might not be viable in the long term, maybe it could live long enough to become an organ donor. My only point is that sometimes even the worst news can result in some good. This child is clearly a miracle child in any event, and I hope you can find a way to celebrate its life, however long that might be.

If you are able, I would appreciate knowing how the tests on Monday come out. I'm so sorry you are going through all this, and will have you in my thoughts and prayers.

-- Cynthia, CNM

FOLLOWUP:

Thank you so much for your email I received today.

You may have gathered that we live in the UK. I have been scanned today by, as my doctors put it, a "primitive" system that has proven the size, etc of our baby. Imagine our horror to find that I am not indeed 12/14 weeks but 24! My husband and I are completely flabbergasted!

We have been referred to a main London hospital on Wednesday where more detailed scans may me carried out to prove all is well. The one thing we could confirm is there is a definite heartbeat and that he is a little boy.

We are now hoping that Wednesday proves good news. I have had the alternatives explained should it not be, so please those kind prayers will go a long long way!

Comments

Also Taking Methotrexate

I'm EXTREMELY curious to learn how this situation turned out!

I took my first round of Methotrexate last week and just learned today that I'm prego. Shocked!

We have had years of infertility, despite treatments. I'm scared to death of what comes next, but would love to hear the outcome from someone else who has been through this.

I'm unfortunately on a multitude of other medications as well due to trying to control RA, but the Methotrexate is the most alarming.

Thanks ~ Shelli

Cynthia Flynn

Cynthia Flynn, CNM. PhD, is the General Director of the Family Health and Birth Center which provides prenatal, birth, postnatal, gynecological and primary health care to underserved women and their families in Washington, D.C. Recently Cynthia served as Associate Professor of Nursing at Seattle University. There she not only taught, but remained in full scope clinical midwifery practice at Valley Medical Center where she cared for pregnant and birthing women, and practices well-woman gynecology, family planning, and treatment of sexually transmitted diseases.

Cynthia founded Columbia Women's Clinic and Birth Center, where she took care of pregnant women and infants up to two weeks of age and attended both birth center and hospital births. Before Cynthia earned her CNM, she worked as a registered nurse in labor and delivery and postpartum and is a certified Doula and Doula trainer.