Table 1.

Personal perspective from patient co-authors

Patient perspective 1 After living with dialysis (peritoneal dialysis then hemodialysis), my husband and I had hoped children were in our future. Having a family was a dream come true, even after a kidney transplant. We discussed pregnancy options with my Renal Specialist and made the decision to have my IUD removed. Amazingly, I fell pregnant naturally and chose a shared maternity care arrangement with my GP, Renal Specialist, and Obstetrician. I was closely monitored during my pregnancy … there were a lot of extra appointments, scans, and time off work. However, we were able to ask kidney and pregnancy questions throughout the process and developed relationships along the way which put us at ease. Things were smooth sailing until about 26 weeks, and I became sick with CMV. I had a steroid injection at 29 weeks to prepare for an early birth. Our beautiful girl Jade arrived at 30 weeks, because my kidney function levels were unstable and CMV made me unwell. My local hospital could not cater for a 30-week gestation baby, so I was rushed to a metropolitan hospital. This meant I did not have my usual Obstetrician or Renal Specialist when I had my cesarean section. This was not the birth plan I hoped for. I had complications during the birth and my transplanted kidney was slightly cut in the cesarean. It was a stressful birth; it took me mentally and physically a long time to recover. However, the joy of the beautiful baby my husband and I had always dreamt of made it all worth it. A partnership between Renal Specialist, GP, and Obstetrician creates a supportive environment for the patient during pregnancy.

Patient perspective 2 I never thought I wanted children, or that it was even possible with a transplant. But after meeting the right person, my mind started to change. Ten years after my kidney transplant, I was having a serious discussion with my nephrologist about falling pregnant and was told that I was high risk. It was important to me that my obstetrician has experience in caring for transplant patients and ideally has worked with my nephrologist previously. It took a while to fall pregnant, but I finally had a positive pregnancy test at the beginning of 2020, just when COVID hit Australia. This meant that my nephrology appointments were all conducted by telehealth; however, my obstetrical appointments were still face-to-face, which I was thankful for. I felt that I could manage my nephrology care via telehealth as I had my own scales, blood pressure machine, and thermometer at home. When I got to around 28 weeks, I started to get nervous because I really was hoping to make it to 30 weeks. I celebrated at 30 weeks when I was still pregnant with no signs of pre-eclampsia. At 37 weeks, it was decided that I would be induced as my creatinine was starting to creep up. I ended up requiring a cesarean section as the induction was not successful and my baby was born at 37 weeks and 3 days, full term! I felt very confident in my care because the obstetrician and my nephrologist were in contact discussing my results and plans going forward. My nephrologist always answered my many questions, which were mainly about my graft function during and after pregnancy. On reflection, the positive partnership between my Renal Specialist, Obstetrician, and my husband and I was critical in kidney prepregnancy and pregnancy conversations. If we can encourage these partnerships for kidney patients who are wanting a family, we will see better outcomes than those already possible.

CMV, cytomegalovirus; COVID, coronavirus disease; IUD, intrauterine device; GP, general practitioner.