What Makes a Pregnancy High Risk?

What Makes a Pregnancy High Risk? (and how can a doula can help?)

A high-risk pregnancy is when the health of the mother, the baby, or both is at an increased risk compared to a typical pregnancy. These risks can be caused by many different factors, potentially making additional monitoring and care throughout the pregnancy necessary. Understanding your risk factors is crucial for expectant mothers and healthcare providers to ensure the best possible outcomes.

I specialize in high-risk pregnancies, because I have experienced first-hand what it is like to have a high-risk pregnancy and feel like you have less choice and say in your birthing experience. I am here to tell women that even if you are labeled “high risk” you are still in control.

Let’s go over some common factors that contribute to the “high-risk” label, what they mean.

1. Pre-Existing High Blood Pressure (Hypertension):

·      This is when the mother had diagnosed high blood pressure before becoming pregnant. Medications can be utilized to help control BP before and during pregnancy, but not all medications are safe during pregnancy, so make sure to follow your providers guidance.

·      Risks associated with untreated hypertension include preeclampsia, premature birth, low birth weight, and still birth. Close monitoring of BP is important during pregnancy.

·      You can still have an unmedicated vaginal birth if that is what you desire, but make plans for if you have to deliver early/via C-Section, since hypertension can increase the risk of these happening.

·      A doula can offer emotional encouragement, stress management tools, and support informed decision making.

2. Polycystic Ovary Syndrome (PCOS):

·      PCOS is a hormonal disorder that prevents or complicates the ovulation process, making it challenging to conceive. Women with PCOS should work closely with their providers to address specific concerns and close fetal monitoring.

·      This disorder introduces increased risk of complications such as Preeclampsia, miscarriage, gestational diabetes and large birth weight.

·      Many women with PCOS have “normal”, healthy pregnancies and births. You can still have the birth you want.

·      A doula can help navigate the fear of fertility and affects on pregnancy. A doula can also help birth plan with unique aspects of a pregnancy with PCOS.

3. Pre- Existing Diabetes:

·      This is a diagnosis of diabetes before the mother becomes pregnant. There is type 1 where the mother does not produce insulin, and type 2 where the mother has an insulin resistance/impaired insulin production. In all cases, close monitoring with health providers is of the upmost importance.

·      Importance of blood sugar control before becoming pregnant is key. If blood sugar is not under control during pregnancy, this can lead to complications:

Type 1: increased risk of birth defects and a higher likelihood of the baby being large for gestational age.

Type 2: increased risk of gestational diabetes, hypertension, preeclampsia, large birth weight.

·      Always remember that if you have pre-existing diabetes, you have increased risks, but You. Can. Still. Have. Your. Dream. Birth.

·      Doulas can help by providing information about diabetes management during pregnancy, refer you to support groups for managing diabetes postpartum, and provide ongoing support.

4. Obesity:

·      Obesity is generally defined by a body mass index (BMI) of 30 or higher. Maternal Obesity can pose risks to both mother and baby.

·      Risks associated with obesity during pregnancy include increased risk of gestational diabetes, preeclampsia, prolonged labor, blood clots. In the baby, these risks include large birth weight, neural tube defects, and respiratory distress.

·      Obese women have happy and healthy pregnancy and births every day.

·      A doula can help build confidence and offer non-judgmental care. They also teach moms self-advocacy to ensure their preferences are heard.

5. Young Age Pregnancy:

·      Teenage Pregnancies (mother is 19 or younger) come with unique challenges such as financial, educational, and social limitations. Teen moms are more at risk for preterm birth, anemia, inadequate prenatal care, social isolation, mental health issues, infant low birth weight and developmental delays.

·      Teenagers that have babies are also at risk for poverty, educational disruption, and unintended subsequent pregnancies.

·      Teenagers still deserve, and can have, compassionate prenatal care and to have the birth experience that they desire.

·      A doula can be a very valuable resource for a teenage pregnancy. They can offer guidance and help navigate through emotional challenges. They can advocate for the teenager ensuring that their voice is being heard in a medical setting. Doulas can refer the mother to numerous local educational, financial, and social resources. Last, they can teach fundamental parenting advice that they may not find elsewhere.

6. First-Time Pregnancy Over Age 35:

·      Pregnancy over the age of 35, often referred to as advanced maternal age or AMA, is associated with certain risks and considerations. These include increased risk of preeclampsia, gestational diabetes, miscarriage, chromosomal abnormalities, preterm birth, low birth weight, and stillbirth.

·      Prenatal screening such as NIPT, amniocentesis, and genetic counseling may be encouraged to test for chromosomal abnormalities and other genetic conditions.

·      Many women in this age group have successful pregnancies and deliver healthy babies.

·      Doulas can be a vast source of information for the mother, support their partners in actively participating in the birthing process, and offer emotional support postpartum as the new family adjusts to the major life change.

7. Preeclampsia:

·      Preeclampsia is a pregnancy related condition, characterized by high BP that typically presents after 20 weeks gestation. Symptoms include consistent high blood pressure, protein in the urine, swelling of hands and face, headaches, blurred vision, and nausea.

·      Preeclampsia is more common in mothers who: are on their first pregnancy, over 35, having multiples, have pre-existing hypertension, obese, or have a family history of preeclampsia.

·      Regular checkups to closely monitor blood pressure, medication, and bed rest are common ways to manage symptoms. The only way to cure Preeclampsia is delivery of the baby. In severe cases, the baby may be delivered prematurely to prevent damage to the mother’s and baby’s health.

·      A doula can help a mother diagnosed with preeclampsia by providing reassurance, explaining aspects of preeclampsia and what to expect during various medical interventions. They can also offer emotional support and comfort measures if bed rest or induction is required.

8. Gestational Diabetes:

·      Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy. It occurs when the body cannot produce enough insulin to meet the increased demands, leading to elevated blood sugar levels.

·      GDM leads to increased risk of mother developing type 2 diabetes later in life, preeclampsia, large birth weight, infant hypoglycemia, and risk of baby developing type 2 diabetes later in life.

·      Decreasing carb intake, monitoring glucose levels daily and in some cases using insulin to help control glucose levels are ways GDM is managed.

·      Inductions are extremely common for moms diagnosed with GDM in order to prevent any complications. However, if your glucose levels are stable and the mom and baby are both safe and healthy, this may not be necessary.

·      A doula can help a mom with GDM by offering an empathetic ear to listen to fears, help explain medical terminology and encourage informed decisions, and help with breastfeeding, since it may be negatively impacted by GDM.

9. Previous Preterm Birth:

·      If the mother has had a previous preterm birth, it increases the likelihood of another preterm birth. Increased risk of preterm birth can also include short time period between pregnancies (<18 months), weak cervix, or maternal health conditions.

·      Some ways to manage risk factors for preterm labor can include cervical length assessment, progesterone supplement, and management of any health conditions.

·      Doulas can help develop coping strategies for any anxiety and uncertainty, as well as assistance in the hospital setting to help ensure a smoother experience.

To wrap this all up, pregnancies can be called “high-risk” for what seems a never-ending list of reasons. However this label does not mean your pregnancy and birth can’t be everything you want and more. With proper management and care, these conditions do not have to dictate your experience. I cannot express this enough: Your prenatal care and going to your scheduled check-ups is incredibly important. Pregnancy can be unpredictable, so take control by doing what you can to manage your symptoms.

Also, having a doula by your side can be extremely helpful. And always remember, knowledge is power; If you are diagnosed with a “high-risk” pregnancy, read up on your condition, learn what you can do, build a support team, and know your rights.

** I am not a medical professional. Please consult your healthcare provider for any information and guidance for your specific situation. **