Facing a Tough Choice: Should I Have Surgery While I'm Pregnant?
Ever since my first child was born, my wrists have been in pain. When my daughter was just three months old, I was diagnosed with de Quervain's disease, a kind of tendinitis that can be severely aggravated by motherhood. With this, my third pregnancy, the pain has become unbearable, and I've just been told that my only option of finding relief is surgery during pregnancy.
Apparently, the wrist actions required for breast-feeding and carrying an infant can be incompatible with a woman's wrist structure (which seems antievolution), causing tendons in the wrist to swell and become painful to use. Pregnancy can also aggravate tendinitis, and many women experience their first symptoms of carpal tunnel syndrome while pregnant.
When I was first diagnosed, I didn't even want to take the anti-inflammatory drugs my doctor prescribed, because I was breast-feeding.
I wore hand splints and did special hand exercises and yoga in order to heal the tendon, but nothing worked. Even when my daughter began to wean herself, the problem only got worse. I could barely grasp a diaper, let alone fasten one to my child.
I finally found relief with corticosteroid injections. Within two days of my first shots, my wrists felt as though I'd never had any pain at all.
Thereafter, when the de Quervain's would flare up, I'd report to the orthopedic surgeon for another set of shots. He would freeze the skin over my aching tendons, then inject the corticosteriod, almost painlessly "solving" the problem for another six months or so.
But this latest swelling of my wrist tendons has been 10 times more painful than any before. In tears, I went to the emergency room on Sunday morning, where the radiologist draped my pregnant belly with two lead aprons and X-rayed the offending appendages; then a nurse affixed a plaster cast to my most painful wrist.
Once my orthopedic surgeon studied those X-rays, he told me that the only solution to my advanced condition is surgery. He then replaced the cast with a fiberglass splint on each hand.
Next Page: Should I do it? [ pagebreak ]
The pain has continued, and the splints have prevented me from taking care of my children. I've had to hire a nanny despite being a stay-at-home mother. So I really want this surgery. I want the problem solved before the new baby is born, so I can snuggle up to this child and not whack its little head on hard fiberglass splints. But everyone, including me, is nervous at the prospect of surgery during pregnancy.
My surgeon suspects that I will require general anesthesia for the work needed on my left hand, and he doesn't feel comfortable doing the surgery until I am six months pregnant—waiting until the baby is bigger and somehow more capable of withstanding general anesthesia, but still allowing my wrists enough time to recuperate before the birth. Although there are no studies to indicate that general anesthesia is harmful after twelve weeks of pregnancy, it simply seems wrong and scary.
So I called Joshua Copel, MD, a professor of obstetrics, gynecology, reproductive sciences, and pediatrics at Yale University School of Medicine, and asked him whether a woman with such a debilitating condition should undergo or avoid the curative surgery.
He suggested that it may be possible to perform the surgery with a brachial plexus block instead of general anesthesia, exciting in me the possibility of having the surgery sooner than March. I look forward to suggesting this to my surgeon this week.
"We generally try to avoid the first trimester, although there is little evidence of teratogenicity [the production of fetal abnormalities] from current inhalational agents," says Dr. Copel. "For all women undergoing nonobstetric surgery during pregnancy, we also require that there be an obstetrician who is identified as the responsible provider for the patient and who is part of a team approach including the surgeon and anesthesiologist to determine the best course of action."
The American College of Obstetricians and Gynecologists' "Guidelines for Perinatal Care" could give me no statistics on the safety of the procedure: "There are no data to support specific recommendations...Pregnant patients who undergo nonobstetric surgery are best managed with communication between involved services, including obstetrics, anesthesia, surgery, and nursing." In other words, my doctors and I are on our own.
Diedre Lyell, MD, an assistant professor of obstetrics and gynecology at Stanford School of Medicine, also tells me that, "General anesthesia can be used (during pregnancy), but a local block may be better if it allows the surgeon to perform the surgery adequately."
Now I pray that such a local block will be possible for the more intense surgery of my left hand. A brachial plexus block would involve a needle inserted into the tender tissue under my arm, but if I can break free of these clunky fiberglass casts before June, with minimal risk to the new baby, I will jump at the chance. And, if not, well I'm going to need your help making a very tough decision.