Hi there,

I have autoimmune issues and I am also currently 38 weeks pregnant. I am scheduled to have a c-section on December 1st, mostly at my own insistence, because there are some small risks associated with vaginal delivery for my baby. Not to do with my autoimmune, but because the umbilical cord is inserted in a fragile way (velamentous cord insertion), and I want to avoid any possible risk to my baby. The doctors have said that it would likely be safe to do a vaginal delivery, however, they are allowing me the option to have a c-section and I have accepted it to eliminate any risks to the baby. I am scheduled to have this done on December 1st. Now, however, I am beginning to worry about whether or not having a c-section is more likely to cause a flare in my autoimmune disease - or activate it. Can you advise me as to whether or not there is a difference in the likelihood of an autoimmune flare between a c-section and a normal vaginal delivery? I currently have SSA- autoantibodies and I am ANA positive. Prior to pregnancy, I also showed RNP antibodies in my blood work, which I know is associated with Mixed Connective Tissue disease. However, in my first trimester, the RNP disappeared from my blood work. I'm not sure if it will return after the baby is born (IE is the pregnancy suppressing my immune system to the point that it suppressed the RNP activity only for it to return upon delivery?). Anyway, the only clinical symptoms I have ever exhibited are: dry eyes, dry mouth, dry skin, sun sensitivity and an episode of pigmented purpuria on my legs that cleared up on its own. In the past few weeks, I have noticed that my fingers are slightly swollen and that it feels mildly painful to make a fist - especially first thing in the morning. I'm not sure if this is autoimmune related or pregnancy related. It's hard to tell. Throughout the pregnancy I have felt fine other than those symptoms, which are not bothersome and very manageable without medication. I am really hoping to remain that way so I can be a good mother to my new baby. Due to the SSA auto-antibodies, and their association with Neonatal Lupus and Congenital Heart Block, I have been closely monitored throughout the pregnancy, and have had serial echocardiograms done on the baby. The baby's heart is fine, thank goodness. Do you think that means that the baby will likely be born without Neonatal Lupus (IE skin rash, liver problems, etc)? I worry about this too, and whether or not a c-section will be better or worse for the baby in terms of autoimmune possibly affecting it.

I guess, all around, what I most want to know is: do you think I have a higher chance of having an autoimmune flare up following a c-section than a vaginal delivery. And, do you think that my baby is more likely to develop an autoimmune issue in one form of delivery versus the other. I have read articles online linking c-sections to greater chance of autoimmune development and I am already worried about the Neonatal Lupus.

Really looking forward to your answer as I am quite anxious and find that I cannot stop worrying about this….Thank you in advance!

Krista