[layla983]

I'll spare you the long version of this story, but yesterday we randomly found out at 35 weeks at an ultrasound we only had at the last minute just because we wanted to see if we could get some better pictures of the baby than we already that from the 20 week scan that the baby we're expecting has unilateral renal agenesis, meaning his missing a kidney. As if finding that out isn't hard enough, turns out it was found at our 20 week scan but for some reason it wasn't in the report for my MW, nor were we told at that scan (policy of the office is if anything like that is suspected, they are suppose to have a doctor come in & check it out & explain this to us, but that didn't happen). We went in yesterday expecting an uneventful ultrasound, but it turns out in my chart it was noted from the 20 week scan that there was no left kidney, nor was there a bloodflow to the area meaning it's unlikely the kidney is just a pelvic kidney. So they thought we were there aware of this being a scan to confirm no kidney, but we had no idea, nor did my midwife. They actually called in a specialist from the hospital to come over to do a scan & tell us because it wasn't until the end of the ultrasound when the tech realized we had no idea that she had been looking for a kidney. We were just there for a positioning scan like my MW had ordered, but when the tech got my chart she saw it noted that it was expected that our baby was missing a kidney.

Good news is that the baby is healthy otherwise as far as we know, the right kidney is doing well & the specialist gave us the OK to go through with our birth plans. About the only thing that changes now is I need to go in weekly for ultrasounds to make sure the fluid level & the right kidney is doing well until I deliver. I spoke to my MW yesterday after the scan, the report is suppose to be to her Monday so I'm guessing we'll know more then. She did mention on the phone that she wasn't sure if this would risk me out of the HB, that she's never had a client with this before so she'll have to look into it more before she makes that decision. But to be perfectly honest, DH & I aren't too sure if we're comfortable with the idea ourselves even if we aren't risked out now.

So my question is this, what sort of problems with babies usually risk someone out of HB? Have any MW's had a client whose baby had this condition, or has anyone here delivered at home with this condtion in their baby? Like I said, we aren't sure we're comfortable with it ourselves, but if it's unlikely it's even an option I'd rather just wrap my mind around that now & move onto making other decisions about the delivery, since we don't have that long to go anyway. Thanks in advance. Hope I didn't ramble too much, my head is just still spinning over the news.

 

[nashvillemidwife]

Quote:

Originally Posted by layla983 So my question is this, what sort of problems with babies usually risk someone out of HB?

You should be risked out if you anticipate the baby will be born with complications that could best be handled in the hospital. What is the prognosis for your baby when he makes the transition from fetal life to newborn physiology? Will he need to be examined immediately by a specialist? Is there a chance he will require urgent treatment? You said the specialist gave you the okay to continue with your plans. If you're looking for a second opinion you should seek one from another specialist; only they are qualified for that.

 

[layla983]

The prognosis for the baby, as long as nothing changes over the next few weeks he's being monitered, is fine. The only real special treatment the baby would need is an ultrasound to be sure the 2nd kidney isn't a pelvic kidney, which we were told isn't likely since they also saw no bloodflow in the area but they always check for it just to be sure. The perinatologist said it was something our ped would set up after birth, nor should a specialist be needed unless our ped suggest it later on as the baby will have to be monitered through life to make sure the 1 kidney remains functioning as it should, & he suspects no problems for birth or special treatment after birth will be needed, again, as long as everything stays well with the fetal monitering we're going to have until the delivery. Obviously if things change in the baby, plans change automatically, but as of right now there isn't a concern about the health of the baby as everything seems to be fine otherwise & there are no signs of issues with the 1 kidney.

I'm asking for more of a midwife opinion than a specialist such as a perinatologist. The perinatologist said it was fine, yes, & I trust that as long as everything stays good through the pregnancy, but the midwife said she wasn't sure she was comfortable with it & would have to look into it more to see if she personally would risk us out of the HB option. She's previously told us that she's risked a couple clients out of HB even though OB's the clients spoke with & other specialist gave the clients the green light to go ahead with the HB. I of course have no idea what those conditions were, but I do know this is the first time she's had a client with this issue with a baby since that's what she told me yesterday.

So like I said, I'm just kinda wanting to see if anyone else has had a HB with a baby with this condition or if any midwives have done a HB with a client with a simliar situation to see if there is even a chance we won't find out next week that we've been risked out. Like I said, we aren't sure what we want to do yet but there is no reason discussing the HB option if it's not possible, plus part of me wants to prepare myself to be told it's not possible after planning a HB all this time, then getting to jump in head first to find an OB, hospital, etc when I'm due in just 4-5 weeks. My MW does have an OB she can refer us to, but they aren't local to us so it wouldn't be the best option for us to use that OB or that hospital. I know that risking out can depend on the MW, but I was just wondering if anyone else has had a simliar situation.

 

[Mary-Beth]

If the specialist doesn't suggest any birth plan changes and doesn't expect this to require any special medical care during or after birth then I'd probably want to keep my home birth.
Maybe you could discuss this with the specialist and possibly have him consult with your midwife (maybe you could all talk by phone)

How do you feel about your midwife? I trusted mine completely. She worked in a hospital for years before going into home births and had to help in some really high risk situations but also worked with many, many low-risk, natural labors so she was well experienced with what natural labor and birth is like.

 

[MidwifeErika]

Quote:

Originally Posted by nashvillemidwife You should be risked out if you anticipate the baby will be born with complications that could best be handled in the hospital. What is the prognosis for your baby when he makes the transition from fetal life to newborn physiology? Will he need to be examined immediately by a specialist? Is there a chance he will require urgent treatment? You said the specialist gave you the okay to continue with your plans. If you're looking for a second opinion you should seek one from another specialist; only they are qualified for that.

:

 

[MsBlack]

I used to be married to a guy with only one functioning kidney. It was only in his early 20s, when he took a kick to the 'non functioning kidney' (luckily for him), and had some urinary bleeding, that he even discovered that he only had one functioning kidney! He went to the hospital where imaging showed that the kick-damaged kidney was not formed right at all and had never worked. Before then, neither he nor his parents had the first clue that there was an issue--not a sickly kid in any way, very healthy and an athlete (and the kick was received in karate class, horsing around

).

Just to say that living well and strong can indeed occur with one kidney

Remember also that many people give a kidney to a relative for transplant--and this would not be done if it were expected that having only one kidney--even when you've lived all your life with 2 (unlike my exh)--is not necessarily a problem.

I agree with PPs--if the specialist is good with your plan, then put your worries away and continue on your chosen path. I think, between your own intuition and good sense, and the help of your specialist and mw, that you will know if/when that plan should change.

all the best!

 

[Mary-Beth]

Any update?

Thinking of you and hoping all is well.

 

[Jilian]

I have no experience with kidney issues but DS2 was born at home (after our 20 week level 2 u/s said he was healthy) with a rare congenital heart defect. He didn't go into distress until he was 2 weeks old and the MW is the one who helped up discover that something serious was going on. We were told after the fact by our pedi that when a baby has one congenital defect it increases his chances for having multiple congenital defects that may not be immediately apparent. Luckily DS2 is almost 2 now and so far we haven't discovered any other issues.

If I were in your shoes I'd want to meet with some specialists and discuss all of the possible issues that may be present at birth and how urgent they are. I'd honestly strongly consider giving birth in the hospital if your local hospitals aren't completely horrible. Just my honest opinion.

 

[jitterBug mom]

I'm really sorry, that must've been hard to hear.

I'm neither a midwife nor a medical expert, so take all of this with a HUGE grain of salt....

The fact that the specialist gave you the ok to go ahead with your birth plan seems like a really good sign - it is my experience that most hospital/-clinic affiliated doctors are quite likely to err on the side of caution and discourage HB if anything worries them at all. Heck, maybe a HB would still be safer because there is less risk of infection for the one healthy kidney.

The other thought I had was just that there is so much that ultrasounds miss or get wrong or catch that would not have been noticed in the past. I guess since in your case you've had two ultrasounds that looked at kidneys they must be pretty confident in their diagnosis. I'm just speaking as someone who seems to always end up with soft markers and other oddities that show up in ultrasounds that turn out to be nothing serious in the end. So I tend to ultrasound findings with a grain of salt. Ultrasounds can be great tools but can also cause worry and almost tell us too much - after all, how many of us are 100% normal and healthy if put under a microscope?

Again, sorry you had to experience this, and I hope you have a wonderful, healthy birth no matter if it is at home or in the hospital.

 

[larkish]

FWIW, my nephew had enlarged kidneys due to blocked uriters and SIL was induced early for risk of them exploding. She had him but they didn't do anything to the baby and I know she was upset because she wanted to go into labor naturally like she did with her oldest and still says how he wasn't "ready." Her son had to go in every so often for checkups and then around 6 months for a surgery, but there was nothing the hospital did right after his birth that made it different then if it was at home.
I'd check to see what risks are involved and what precautions a hospital would take.. take into mind if the hospital didn't do anything extra for your son would you feel like you got jipped? or would you feel better knowing that if there was an emergency you had the backup on hand? Ultimately YOU and your husband need to be comfortable with wherever you choose to birth.
HTH

 

[Dmitrizmom]

another 'didn't find out ony had 1 kidney until adulthood' - friend from high school found out that she only had one kidney when her dad needed a transplant and she was a perfect match - they did a scan and found she only had one to start with. No problems, very healthy and athletic woman to this day.

 

[Otterella]

This is just my personal opinion, but I would be far more worried about birth in a hospital than at home with a condition like this. At home, you don't have to worry that someone will cut the cord early without your consent, which could and often does happen in the hospital, even with delayed clamping explicitly stated in a birth plan. As a doula, I've seen it happen (or would have if I had not been there). If for some reason your baby does need a few minutes to adjust to the outside world, which most do even with two functioning kidneys, it would be better to have that lifeline to mom intact.