Esther Aina had only been married for a year when she learned she not only had Lupus but stage-four chronic kidney disease. At risk was not only her health but a lifelong dream: parenthood.
“I remember my doctor telling me that I may not be able to have kids,” she says from her Don Mills home. “That haunted me for a while because we had just gotten married and coming from an African background, kids are everything.”
Four years later, in 2016, she was overjoyed to discover she was eight weeks pregnant. But the situation came with dangers.
“I could have lost my kidneys and fallen into dialysis and needed a transplant,” Esther says. “Worst case I could lose my life. Worst case, I could lose my baby.”
Esther’s doctor referred her to Dr. Michelle Hladunewich, physician-in-chief at Sunnybrook Hospital. She is known to her patients as Dr. Michelle, and The Miracle Worker.
Hladunewich is being honoured Thursday by the College of Physicians and Surgeons of Ontario, which is awarding her its 2019 Council Award.
“Dr. Michelle… I’m getting a bit emotional because she’s a big part of my life,” says Esther.
“That day we met her, she was honest. …She told us everything that could go wrong. I was scared. Then she said, ‘There’s good news: we can manage it.'”
Hladunewich, who founded Sunnybrook’s Pregnancy and Kidney Disease Clinic, has made her name and career by managing some of medicine’s most difficult pregnancies. She has helped thousands of women who were previously effectively infertile because of their illnesses carry babies to term.
“When your kidney disease is more advanced, that’s when its more difficult to conceive,” Hladunewich tells CityNews.
Later-stage and end-stage kidney disease (when a patient’s kidneys are barely functioning or not working at all) can decrease a woman’s ability to produce healthy eggs that can be fertilized. Some women may not menstruate at all, especially those who are at end-stage and undergoing dialysis.
“Dr. Michelle and her team are the reasons we are parents today. I didn’t think I would be a mom, but I have two,” Esther says. Jason is three years old, and Tiara is two months old.
Hladunewich has also helped hundreds of women conceive and deliver babies while on dialysis.
“Its better to wait until after the transplant, about a year or so, so you have a safer window to have a family,” Hladunewich explains. “But you may not have time to wait. So some of our mothers have actually chose to do it on dialysis.”
Pregnancy while on dialysis has a very high risk of complications, and for that reason, the National Kidney Foundation notes that most are advised not to become pregnant. Pregnant women on dialysis need close medical supervision, may require changes to their medication, or more dialysis to have a healthy baby.
“Every woman should have the same opportunities, so if some require extra attention to get there, well, that’s our job,” she says.
Only rarely do women on dialysis become pregnant, and most studies show that 20 per cent of those pregnancies end in miscarriage. But Hladunewich has worked to improve a woman’s odds.
“The first woman who got pregnant on dialysis, and has now had several children on dialysis, has been quite open about it,” she says. “She did sort of get pregnant without planning, and with really intensive dialysis she actually did remarkably well.”
“It sort of became a recipe for us all,” she adds.
For many women, that means undergoing hemodialysis everyday or nearly every day, instead of three times a week.
“Our live birth rates for women on dialysis was about 80 per cent, compared to 50 per cent in the United States,” she says.
Even for women who get a kidney transplant and no longer need dialysis face barriers to pregnancy. Hladunewich has also become their go-to doctor.
After a kidney transplant, patients are required to follow a life-long medication schedule, so their body doesn’t reject the organ. Many of those drugs that keep the woman alive could severely harm their odds of carrying a healthy child to term.
“We make sure the medications you’re on are all pregnancy compatible,” she explains, adding these patients are monitored closely for complications such as pre-eclampsia and premature birth.
Her office is covered with pictures of her success stories, including Tiara and Jason.
“We call her Dr. Michelle’s baby,” Esther says cradling her new daughter. “When I met Dr. Michelle, the words she told me is ‘Its not impossible.’ That still rings in my head.”