The Pregnancy Decision

I have always loved children. When I was a child myself I carried around baby dolls and stuffed animals swaddled in blankets. At the age of eight years old, I started babysitting (looking back, I marvel at how much our social norms have changed in just a generation), and I continued to babysit and nanny for almost two decades, until I finished graduate school. Caring for children was always part of my life, so it wasn’t a huge surprise when, about a year into my marriage, my maternal instinct ramped up, causing every cell in my body to scream, “Baby!”

Unfortunately, at that point in my life I was also suffering from the highest level of disease activity I had experienced since my diagnosis of Rheumatoid Arthritis. The Enbrel that I had taken for the past seven years with good results had lost its effectiveness, and I was in the midst of an unrelenting flare. My symptoms were so bad they rendered me unable to work, and I took a three-month extended sick leave from my job. I was taking Lortab on a daily basis to contend with the pain, leaving me in a foggy haze, and I was taking methylprednisolone for months. I began making trips to the infusion center for Orencia treatments. My life revolved around my RA, and I was having a hard enough time taking care of myself, let alone a baby. I just couldn’t imagine how I could create a new life in the midst of what I was experiencing.

Eventually the Orencia infusions made a noticeable difference in my symptoms, and I was able to go off of the steroids and painkillers and return to work. Life began to feel more manageable, and I felt more like myself again. However, after experiencing what my RA was like before Orencia, I was terrified to go off of it to attempt pregnancy.   After discussions with my husband, we decided that we would consider adoption instead, and I began investigating the adoption process and all the many issues it involves.

However, while we did plan on adopting, and even announced to our families that we were going to make this step, my heart was never in it. I think adoption is beautiful, and as a social worker I value the importance of providing a home to a child who needs one. Yet, for whatever reason and in spite of my fears, I just couldn’t abandon the powerful desire to have a biological child of my own. So about a year after starting Orencia, and after many conversations with my husband, my rheumatologist, and my gynecologist, I decided to attempt pregnancy, which my doctors said would first require three months off of the biologic. After the ordeal that I experienced going off of Enbrel, I was very nervous about how I would feel off of Orencia, especially since I wouldn’t be able to take painkillers while pregnant (although both my rheumatologist and gynecologist agreed that taking limited amounts of methylprednisolone during pregnancy is considered safe). Therefore, my husband and I decided to make a financial sacrifice in order to give my body the rest it would need, and I resigned from my job when I went off of Orencia. While this was economically difficult, I wanted to focus all of my energy on taking care of my health and my baby’s health.

Becoming a parent should always be a decision that is carefully made when at all possible. Parenthood is all-consuming, involves never-ending responsibility (at least for 18 years), is incredibly expensive, and the results will impact the child for better or worse for the rest of his/her life. Signing on for all of that should not be taken lightly. However, when you add RA to the mix, that decision becomes even more complicated. I now have two beautiful, healthy, vibrant children who I had the privilege of bringing into this world. I love them more than I knew I could love; after becoming a mother I have reflected there ought to be a term other than “love” to express the powerful emotions and connection I feel for my children, as “love” doesn’t seem strong enough. If I were given the opportunity to go back in time, I would make the same decision in a heartbeat. However, there was additional pain and financial impact involved in my pregnancies because of my RA. While I would never change my decision to become pregnant with my children, I would do almost anything to change the fact that I have rheumatoid arthritis.