You’re Not “Just Pregnant”: 7 Things I’ve Learned Being A Pregnant Poucher

1. Don’t Let Fear Determine Your Choice, but Consider Potential GI Impacts
   1. When you’re pregnant, there are lots of things that you may need or do that aren’t safe for baby. If you’re planning to get pregnant, consider what you may need for your GI situation and whether those can be done while pregnant. If not, what options are available and what are the potential risks to baby? Some specifics you may want to consider include: 
      1. If you’re currently taking medication, can you continue that regimen while pregnant?
      2. If you would need a medication/treatment change while pregnant, what are your options and risk factors (for you and baby)?
      3. How do you manage a flare? Can those treatments be done when pregnant?
      4. Do you have issues with strictures or other complications requiring surgery? Can those be addressed if one occurs during pregnancy? If not, what are your options until baby is born?
      5. Do you want to have a vaginal birth or are there reasons you would need to consider a planned c-section? (I’ve had two successful vaginal births and know other j-pouchers who delivered without much/any tearing, so it is possible but do what’s best for you and your baby.)
2. Symptoms of pregnancy and a flare / GI complication are VERY similar
   1. Think you’re having a flare but not sure why the regular treatments aren’t helping? If you’ve been sexually active you may want to take a pregnancy test. Bloating, constipation, nausea, vomiting, and loss of appetite are all normal pregnancy symptoms, especially in the beginning, that may be normal for a flare too. Pregnancy hormones impact your entire body! Brain, GI tract, ligaments, milk ducts… the symptoms you have, and how long you experience them, may vary.
3. You’re Not “Just Pregnant”
   1. Don’t let a provider brush you off as “just pregnant”. You know your body and how you feel when something isn’t right or responding to treatment! In two of my three pregnancies, I had bowel strictures/obstructions (more about that in my other post). During my first pregnancy, I was initially brushed off multiple times as a first time pregnancy patient who couldn’t differentiate normal pregnancy symptoms and something wrong with her GI system (I had about 7 ER visits over ~10 weeks).
   2. Keep talking to doctors until you find a doc that LISTENS to you and considers your GI history instead of putting on blinders when the keyword “pregnant” pops up.
   3. Find a GI specialist or surgeon to partner with and monitor/address the issues you encounter. It’s been hard, in my experience, to find good practitioners but your pregnancy could go well….or not as smoothly. So, it’s important to keep looking until someone meshes with your needs (and hopefully your personality).
4. Our Bodies Are Incredible and Pregnancy Hormones Are Crazy
   1. For the two pregnancies where I had GI complications, those complications happened at almost identical times during the pregnancies (roughly 8 weeks – 18 weeks). During my first pregnancy, things with my stricture didn’t actually get evaluated, let alone treated, until I was about 18 weeks along. After my procedure, I recovered and had no other complications. However, the second pregnancy with the same symptoms I knew what the cause was and jumped on it. I was meeting with my surgeon around 9 weeks and got treated around week 10. However, that fix didn’t last so I underwent multiple treatments and began talking long term options for attempting to improve my health and protect baby. It was a loooooong 8 weeks, but almost exactly around 18 weeks my body stopped having relapses. My OB, GI surgeon, and I have no explanation to why this happened during pregnancy (never before) and why it lasted such a specific period of time during the pregnancy. The only explanation is the impact on my body from the pregnancy hormones and fluctuations.
   2. Hormones while pregnant impact EVERYTHING. Your memory (don’t worry, it comes back after the baby is born), ability to sleep (hello my old friend, insomnia we meet again), the things you ‘have’ to do or discuss/know (like strong urges to clean/organize, or the questions you must know an answer to, etc), your tendons and muscles (they become more relaxed and give you that pregnancy waddle), and of course…your GI tract (heart burn, nausea, slowed intestinal processing, increased gas, changes in how food impacts you – like some things that usually are fine may not sit well and others that you can’t tolerate might be ok to eat). Since there are strong impacts on your digestive system, you may have additional changes… if you’re a j-poucher like me, it might increase swelling with scar tissue that causes an obstruction/stricture. 
5. Stay Nourished and Hydrated
   1. During pregnancy, good nutrition and hydration are even more important to help with your symptoms and keep baby healthy. If you also get sick during pregnancy, due to your GI situation, it’s even more important to stay as nourished as possible until you’re healthy again.
   2. Nourishment: 
      1. Dietary supplements that can be rich in calories and nutrients but low volume (to help reduce GI discomfort) are great for a flare or issue like my obstruction. Supplements like a probiotic and vitamin that you take the whole pregnancy should be maintained as much as possible. In addition to those, you have protein shakes (things like Boost, Ensure, or another brand you like – I used Orgain protein powder to be dairy free). Things like jello, ice cream, mashed potatoes, toast, and such are great! Think something similar to a bland or full liquids diet. I personally try to limit gluten and dairy. Gluten is a known GI inflammatory ingredient, so limiting it in your diet can help. 
   3. Hydration: 
      1. In general, the rule I follow for hydration is body weight divided in half…that’s how many ounces you should drink as a minimum per day. So, if I’m 160lbs – I should drink a minimum of 80oz of water a day (if I’m sweating or still feel thirsty, drink more). When I’m pregnant, I aim for 90oz a day and often drink 100-120oz (especially in the summer months). This helps keep your body healthy, provide sufficient fluid for baby and their health, and helps your GI tract move more smoothly (a dry intestine can’t move food through as well, causing lots of discomfort and constipation).
6. Be Adamant and Advocate for Yourself
   1. The biggest thing I wish I did during my first pregnancy was be more insistent and advocate for myself. When I get sick, I tend to fall into “patient mode” where the focus is just on making it through the day, or hour. The spunky medical advocate side falls to the back burner. However, if I had insisted that we check or plan to check and address a GI complication during the first pregnancy it could have resulted in better nourishment for me and baby during that time.
   2. If you’re like me and need to work on self advocating, enlist your partner or a relative/friend to come with you so they can be your advocate. Keep them filled in, and then you can be a patient and still get the advocating you need to find treatment.
7. Babies Are Resilient
   1. Learning you’re going to be a mom comes with its own stresses, physically and mentally (Wait, did I forget to buy the crib?! Where is the hospital bag? I need a nap.). Being concerned about the welfare of your baby(ies) is natural but try not to let it add too much stress if you get sick. Take care of you! Healthy mommy helps for a healthy baby.
   2. In the beginning, the baby/fetus can pull the nutrients they need from your fat and muscles. I know 🙂 I lost about 15lbs during my GI complication period and baby always measured right on track for growth. So, as horrible as it is to be sick AND worry about the welfare of your baby, baby is usually able to get what they need. Your OB will also likely monitor you closely to measure the baby and ensure that baby is growing as expected. If they see something with the ultrasounds, or you have symptoms that are worrisome (like you have bleeding or baby has a low heart rate), the OB should refer you to a high risk doc to help determine the best options for you to ensure as healthy a baby as possible while your situation is managed.
   3. The results for my babies that have also had my GI complications impact the pregnancies have been medically healthy and growing as expected. The birth of baby 1 was a normal induction (at 42wks) with the baby only being slightly smaller than expected (but not so severely to be classified as “low birth weight”). Birth of baby 3, who also had complications during pregnancy, is to be determined but so far everything is on track….strong heart beat, lots of wiggling, and growth measuring as expected.