Caring for high-risk pregnancies
For many women, finding out they’re pregnant is a moment filled with joy and anticipation. That joy can be replaced with worry and concern when learning that their pregnancy is high-risk. But what does that really mean?
According to the National Institutes of Health, a high-risk pregnancy is one in which a mother, her baby or both are at higher risk for problems during pregnancy or delivery than in a typical pregnancy. Some pregnancies become higher risk as they progress, while other women are at an increased risk even before becoming pregnant.
Some risk factors may put women and their babies at a higher risk for problems. These include, but are not limited to:
“We’re seeing metabolic syndrome, diabetes and high blood pressure more often as the general population is becoming more overweight and trending toward a less healthy lifestyle,” said Dr. Emily Riggs, an OB-GYN with Lawrence OB-GYN Specialists. “All of those can elevate the potential for a woman to have a high-risk pregnancy.”
Lauren, Carson and Josh Woodward
Lauren Woodward didn’t have any pre-existing health conditions before she got pregnant. It took her by surprise when she was diagnosed with gestational diabetes last year during her third trimester.
“I didn’t really have any symptoms before I was diagnosed,” she said. “I had a fasting glucose test and didn’t pass it, so I had to do a three-hour draw and thought things would be fine. I didn’t pass that one either.”
Woodward said that she did a lot of research to learn more about her condition. She discovered that there wasn’t anything that she did to cause her to develop her gestational diabetes. It was just a side effect of the placenta that changed how her body could process glucose, so she set out to find out what steps she needed to take to keep both her and her son Carson safe.
“You get this diagnosis and think, ‘Okay, now what?’ I met with the LMH Health diabetes educators and they laid it all out for me – what I can do, what I can eat to manage gestational diabetes and how to use the glucometer. I felt a lot better after that appointment. Having a plan was a real relief,” she said.
Caring for high-risk patients
Dr. Emily Riggs
There’s no one-size-fits-all recipe when caring for women with high-risk pregnancies. Dr. Riggs said it is standard care to screen all women with risk factors. For example, women with advanced maternal age are screened for thyroid disease in addition to other things.
She also shared that just because a pregnancy is high-risk, that doesn’t necessarily exclude you from using a midwife throughout your journey.
“We’ve spent time reviewing certain criteria and evidence-based literature to determine who would risk out of midwifery care. Our midwives still see patients with risk factors such as those who have a BMI up to 40 or patients with diet controlled gestational diabetes. If they develop a need for medications, they would move to physician care for closer monitoring,” she said.
Recognizing the role of mental health
Mental health is also a huge condition that impacts pregnancy – one that Dr. Riggs said can be overlooked.
“People don’t think about mental health and it’s overlooked as being a real medical condition,” she said. “There’s a lot of stigma and women fear that it will make them look like they aren’t ‘fit’ parents. In reality, we need to help women realize that mental health is something to focus on and improve, like exercise and eating better.”
That’s where Melissa Hoffman comes in. Hoffman is a board-certified psychiatric mental health nurse practitioner who cares for patients at Lawrence OB-GYN Specialists. She said being on mental health medication and having a healthy pregnancy aren’t at odds. You can balance your mental health needs with a successful, healthy pregnancy.
“For someone considering pregnancy, consulting with a psychiatric provider prior to conception is ideal. Many psychiatric medications are compatible with pregnancy and lactation,” Hoffman said. “If adjustments to medications are recommended, that’s ideally done prior to pregnancy whenever possible.”
What if you’ve become pregnant already or develop a need for help during your pregnancy? It’s important to consider the risks and benefits of medication use, as well as the risks of untreated mental illness.
“A risk-benefit analysis is a conversation a woman should have with her provider. There are many options to treat mental health needs in pregnancy, including psychotherapy, peer support and medication use,” she said.
Misconceptions about high-risk pregnancy
Dr. Riggs said there’s a misconception that the clinic only cares for low-risk patients.
“The providers at Lawrence OB-GYN Specialists see and deliver the majority of our high-risk patients. We all perform C-sections and deliver twins,” she said.
Lori Tillema, director of Maternal Child Services, said that the maternal and newborn staff at LMH Health has significant experience in caring for moms whose pregnancies are at greater risk for complications. This begins with the Inpatient Maternity Navigator who works with the clinics and each patient to ensure the patient’s needs are addressed.
“The navigator communicates the patient’s needs to our team in preparation for their upcoming delivery. She prepares mothers experiencing higher-risk conditions by identifying what to expect while in the hospital and answering any questions the patient might have,” she said.
Sometimes a high-risk condition may not present itself until a mother is already at the hospital and in labor. That was the case when Caitlin Laird was in labor with her son two years ago.
“I’ve never had blood pressure issues throughout my life. Maybe 4 to 6 hours before he was born, mine shot through the roof. I had to have magnesium sulfate – which they called The Mag – and had my pressure checked every half hour,” she said. “After Grant was born, it started to go down.”
Level 2 nursery provides care for infants
Caitlin Laird, Grant and Grace
When Laird didn’t have a lot of blood pressure issues during her second pregnancy, she didn’t think much of it when she went to see Dr. Riggs for her 38-week check.
“When (nurse) Carrie came in and took my blood pressure, that’s when everything changed. It was really high and Dr. Riggs wanted me admitted that day,” Laird said. “Carrie wheeled me straight to Labor and Delivery from the office. I had to be induced because my pressure was so high.”
Laird said that with the induction, she was in labor for over 20 hours - double the time she was in labor for the birth of her son. When Grace was finally born, she wasn’t breathing properly and had to be intubated. She was later taken by life flight to Overland Park for additional care when the team discovered Grace had either meconium or a piece of the placenta in her lungs.
LMH Health’s Level 2 Special Care Nursery inside the Cindy Murray Family Birthing Center cares for babies as young as 34 weeks, including babies with respiratory problems and feeding difficulties or those who require antibiotic and IV therapy.
“If babies need specialized care, our pediatric hospitalists are immediately available 24/7 to work with nursing and other hospital staff to provide appropriate treatment and stabilization,” Tillema said. “We’re also fortunate to have immediate access to neonatal consulting services through Sunflower Neonatology. They’re available at the touch of a button to provide expert guidance and support to care for numerous conditions.”
Laird said that while she was scared for her daughter, she knew that Grace was in good hands with the team at LMH.
“I can’t say enough about Dr. Riggs and the staff, nurses and doctors in Labor and Delivery. Everyone was so kind and they made it a more comfortable process,” she said.
While the team cares for most high-risk patients, there are some situations where it’s safer for the mother and baby to receive care elsewhere.
“If we think there’s a likelihood that you’ll need a higher level of care, we may refer you to a different provider. We want you to have the best care you can for yourself and your baby,” Dr. Riggs said.
What can I do to lower my risk?
Dr. Riggs said that focusing on optimizing your health before pregnancy to decrease your risk factors can go a long way toward reducing the possibility of having a high-risk pregnancy.
“If you have a history of high-risk pregnancy or complicated delivery, talk with your provider before conceiving. We know that substances such as alcohol and drugs can cause problems in pregnancy and when it comes to marijuana, we’re seeing more emerging evidence that links its use to an increased risk for learning disabilities and attention problems in children. If you suffer from substance abuse, stop using before pregnancy and ask for help if you need it,” she said.
Hoffman said that when it comes to substance abuse, it’s important to talk with your care provider to find the most appropriate treatment options.
“Unfortunately, fear and stigma exist around the topic of substance abuse and pregnancy. Therapeutic and medication-assisted treatments are both options for pregnant women. We’re fortunate to have First Step in Douglas County, a program that provides pregnant and parenting women residential and outpatient services,” she said. “There are resources there for a woman to get help at any time throughout her pregnancy.”
Dr. Riggs emphasizes talking with your provider about any concerns you have. They want you to have a safe and successful pregnancy.
“We’re here to help you prepare for this journey and get yourself in a good place before adding the extra stress and responsibility of pregnancy,” she said. “At LMH Health, our focus is on healthy families. Our most important goal is to make sure that you and your baby have the best care.”