Caring for Pregnant Patients With CKD---An Ethical Discussion of 5 Cases

Abstract

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Parenthood With Kidney Failure: Answering Questions Patients Ask About Pregnancy

“…will define the patient experience of parenthood planning. Table 2 7,8,[14][15][16][17] outlines our recommended approach to counseling women with kidney failure. Contraception should be in place while these discussions occur (reviewed by Sachdeva 2020 18 ).…”

“…14,19 Shared decision-making is essential and must reflect the patients' values and preferences, clinical context and complexity, the level of risk they are willing to accept, and the level of autonomy they desire. 7,8,15,20 Input from other clinicians who may be part of the future antenatal care team, especially highrisk pregnancy obstetricians, is recommended to cocreate a management plan. 12,21 Peer support is also highly valued by women, if available.…”

“…15,16 The question "Should I have a baby?" raises ethical issues 7,22 that may conflict with the clinician's values, creating tensions between clinician duty to the patient, fetus, health system, and society. Navigating this requires shared decision-making and trusting relationships between clinician and patient.…”

“…With improvements in outcomes over the decades, historical attitudes have evolved toward shared decision-making that supports patient goals and autonomy. [5][6][7][8][9] Although nephrologists should be prepared for questions about parenthood, nephrologist confidence and leadership in addressing women's health issues remain suboptimal. 10,11 The rarity of events and heterogeneity of data at all stages of kidney disease in pregnancy give rise to uncertainties that make counseling challenging.…”

Recognizing and renaming in obstetrics: How do we take better care with language?

“…For instance, when caring for people with chronic kidney disease who are pregnant, 'pregnant patient' denotes a medicalized component of a pregnancy while avoiding the erasure of trans people. 11 However, in the absence of relevant intercurrent disease, referring to pregnant people rather than pregnant women or mothers ensures that no one's core gender identity or pregnancy/birthing experience is devalued by scholarly discussions of obstetric medicine.…”