Preparing for the birth of a child can be full of joyful anticipation but also trepidation about the unknowns. If you have hidradenitis suppurativa (HS) and are pregnant, you may wonder how your skin condition will affect your labor and delivery.
To better understand how HS can affect the birthing process, myHSteam spoke with Dr. Haley Naik, an associate professor of dermatology at the University of California, San Francisco (UCSF) School of Medicine and the founder and director of the UCSF Hidradenitis Suppurativa Clinic.
“It’s important to go into pregnancy with your HS as well controlled as possible and to work very closely with a dermatologist to maintain that control throughout the pregnancy,” Dr. Naik said. “This will give you the best chance at having good control of your HS and being comfortable throughout pregnancy.”
Dr. Naik recommends discussing your family planning goals with your dermatologist well in advance of trying to conceive. This is important for determining which HS treatments are appropriate for you. “Working with a physician to plan your pregnancy gives you an opportunity to control certain aspects of your pregnancy and can make the process of pregnancy, labor, delivery, and the postpartum period go much more smoothly,” she explained.
As you prepare to give birth, consider which health care providers you’ll need during pregnancy and birth. “In my view, the role of a dermatologist caring for a pregnant HS patient is education, both for the patient and for adjacent providers,” Dr. Naik said. “Dermatologists play an important role in ensuring that HS care is coordinated across providers because, by and large, knowledge about HS is quite limited even among doctors.”
Some people with HS may need to see a high-risk obstetrics provider, sometimes called a maternal fetal medicine doctor. “Those who have significant comorbidities should be managed throughout their pregnancy by a high-risk OB and should have that doctor involved at their labor and delivery,” Dr. Naik said. Reasons you might need care from a high-risk obstetrics provider include:
If you have mild HS and few flares while pregnant, a check-in with a high-risk provider before delivery might be sufficient, Dr. Naik noted.
Your obstetrics provider may also be able to help you find support for postpartum care, such as a lactation consultant to support breastfeeding or a mental health professional. According to the American Academy of Dermatology, depression is more common in people with HS, and postpartum depression affects up to 15 percent of people who’ve had a baby. Exploring your options before delivery can help you connect with help more quickly in the postpartum period.
Having HS doesn’t necessarily make a particular mode of childbirth — vaginal delivery or cesarean section (C-section) — better for you. “I think women with HS should be able to make choices analogous to those that women without HS would make,” Dr. Naik said. “They should be able to deliver vaginally if they want to or deliver via C-section if they want to, regardless of their HS status for the most part.”
Dr. Naik explained that the role of physicians is to support people with HS through the decision-making process. They can also help you understand why certain medical interventions during labor and delivery may be needed.
Many people with HS may have HS symptoms in the groin. Genital lesions at the time of delivery may cause additional discomfort, but they don’t prevent you from having a vaginal delivery. “Thousands of women with HS who have groin involvement have had safe vaginal deliveries,” Dr. Naik said.
Dr. Naik said that people she treats often raise concerns about possible bacterial exposure from HS lesions in the groin during a vaginal delivery. “Bacterial exposure to newborns is an important consideration but not necessarily determinative about whether a person can deliver vaginally or via C-section. We have tools to help prevent infections and to help calm one’s HS,” Dr. Naik stated. “OB-GYNs are able to support women through vaginal deliveries and through related bacterial exposure to newborns.” Bacterial exposure can occur during C-sections, too.
Another concern with vaginal deliveries is whether they cause HS flare-ups. In one survey, nearly 24 percent of participants with HS who delivered vaginally said the delivery caused an HS flare, and 3 percent believed that their HS interfered with delivery. It’s important to note that these are qualitative findings based on survey respondents’ experiences. Your doctors can help you understand the risks and benefits of a vaginal delivery and how you can help control your HS after delivery.
According to some research, pregnant women with HS are more likely to deliver via C-section than those without HS. Many factors can influence C-section likelihood. Your doctors can help you understand your personal risk factors and what may be best for you and your baby.
One concern people with HS may have about a C-section delivery is whether it will lead to an HS flare-up. In the survey above, which was published in the International Journal of Women’s Dermatology and had about 280 respondents overall, 51 percent of those who delivered via C-section said they developed new HS lesions on their scar.
In Dr. Naik’s experience, pregnancy and delivery are stressful events that can be associated with HS flares but aren’t necessarily limited to vaginal delivery itself. Dr. Naik noted that more research is needed in this area. “While there’s very little data about the likelihood of developing HS, it has been reported, and I have seen it on occasion,” she said.
“We know friction plays an important role in HS development and initiation of HS lesions, and the friction of skin sitting on skin right at that C-section wound may play a role in HS developing at that site,” Dr. Naik continued.
Dr. Naik also recommends paying close attention to how your incision is healing and contacting your care team if you’re concerned. She noted that, while rare, it’s possible to develop a condition called pyoderma gangrenosum, a chronic (nonhealing) inflammatory wound that can be associated with HS at sites of trauma.
“If a wound doesn’t appear to be healing as you’d expect it to, then you should see both your dermatologist and your OB as quickly as you can so we can assess what’s happening, because the treatments for HS and pyoderma gangrenosum include managing the inflammation with medication, sometimes by injecting medicine directly into that wound. This really is quite different from just managing a wound conservatively with good wound care,” Dr. Naik explained.
Here are three terms you may hear when discussing possible complications related to pregnancy and birth:
Although experts have studied and continue to study the effects of HS on pregnancy outcomes, Dr. Naik said more research is needed.
“Some data suggests that there isn’t an increased risk of preterm labor or preeclampsia with HS,” Dr. Naik explained. “Other data suggests that there is a real risk. I think what’s less clear is whether that risk is directly related to HS or related to risk factors for those complications.”
Common factors that contribute to pregnancy complications generally include:
“If we could limit those risk factors, we may be able to reduce the risk of preterm birth or preeclampsia in the context of HS,” Dr. Naik said. “But that really remains to be seen.”
Talk to your doctor about your personal risk factors for pregnancy complications like preterm birth, preeclampsia, and gestational diabetes.
You may stay in the hospital for several hours to a few days after delivery, depending on where and how you give birth. Communicating with your care team and bringing the supplies you need to care for your skin can help make your hospital stay more comfortable.
It’s helpful if the staff caring for you postpartum know that you have HS, especially if areas such as your groin or breasts are affected. Dr. Naik suggested “communicating early with a nurse or a nursing team.”
She also noted that your OB-GYN can help you communicate with the postpartum care team or suggest the best way to communicate with them. “I think proactive conversations around HS in this context are important,” Dr. Naik said. “It helps everybody get on the same page.”
For those who are nervous about how a nurse might react to their wounds, Dr. Naik said, “I think we might be surprised at how much postpartum nurses know about HS. Because they’re taking care of so many patients postpartum, I imagine HS may be something they encounter not infrequently.”
If you need to use HS medications such as a topical or oral antibiotic or a biologic while in the hospital, it’s also important to share that with your care team. Talk to your dermatologist and OB-GYN before delivery about the best way to ensure you’re following your HS treatment plan while in the hospital.
“Postoperative or post-delivery wound care can sometimes be more challenging in people with HS,” Dr. Naik said. “In my experience, most HS patients are great at wound care because they are caring for their wounds regularly. So, make sure you have the materials you need to take care of your wounds or ask for the materials you need.”
Prioritizing your well-being after you leave the hospital is important for you and your new baby. “I would recommend having a visit scheduled with your OB and dermatologist in the postpartum period so that we can make sure you are doing well and are able to take care of your baby as well as yourself,” Dr. Naik said.
On myHSteam, the social network for people with hidradenitis suppurativa, more than 36,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.
Have you given birth with HS? If so, what tips do you have for others? Share your experience in the comments below, or start a conversation by posting on your Activities page.