High-risk pregnancies require more careful monitoring and follow-up to watch for developing complications during pregnancy, labor, and delivery. There are a lot of reasons a pregnancy might be considered high-risk. Some women enter a pregnancy high-risk, while others start out with a low-risk pregnancy but develop complications that put them in the high-risk category. Once a pregnancy is considered high-risk, doctors should treat it as such and provide extra prenatal care. However, it may also be important to be your own advocate when it comes to your care. If you feel like something’s not right, it’s imperative that you discuss that with your doctor. So, what exactly does advocacy entail in a high-risk pregnancy?
1) Know What Conditions in Pregnancy Qualify as High-Risk
It’s very important to know what constitutes a high-risk pregnancy. Some factors can be modified (or changed) while others cannot. An example of an unmodifiable risk factor is the mother’s age. Women under 20 years old or over 34 years old are at risk for developing certain complications during pregnancy, labor, and delivery.
Other risk factors, like smoking cigarettes, can be minimized if the woman stops or decreases smoking early in the pregnancy and avoids second-hand smoke while she is pregnant.
There are a lot of conditions that can place a mother into the high-risk category and necessitate an increased level of care, including (among many others):
- Diabetes (Type I, Type II, and gestational diabetes)
- Obesity and excessive maternal weight gain
- High blood pressure/Preeclampsia
- Multiple pregnancy (twins, triplets, etc.)
- Pregnancy before age 20
- Pregnancy after age 34
- Polycystic ovarian syndrome (PCOS)
- Previous preterm birth
- History of preterm premature rupture of membranes (PPROM)
- Kidney disease
- Autoimmune diseases
- Thyroid disease
- Drug use
- Alcohol use
- Placenta previa
- Cardiac issues
- Large or small baby
2) Ask Questions
Unfortunately, medical professionals sometimes fail to identify high-risk pregnancies and provide the appropriate care. This frequently happens when women are overweight or obese. Care providers may be so concerned about body-shaming issues that they don’t inform patients how being obese can increase the risk of complications during pregnancy, labor, and delivery.
Because doctors do not always discuss the potential impacts of obesity with their patients as they should, mothers-to-be may want to address this issue directly by asking whether their weight is in the range of obesity and what that means for the pregnancy. Obesity is not something for moms to be ashamed of. Think of it as any other risk factor.
Once those questions are answered and a patient has confirmed whether or not she is high-risk, she can continue advocating for her health by asking more questions. For example, asking questions about methods of controlling blood pressure or blood sugar is one way that parents can be more involved in their care during pregnancy, which can help keep them healthier in the long run.
3) Be Completely Transparent About Your Medical History
It is a doctor’s responsibility to report information between offices, but emphasizing your health history is one thing that you can do to empower yourself in your own healthcare. Report all your health history details to all of your care providers. One of the best ways to do this is to have a notebook in which you prepare notes beforehand, so you don’t forget during your doctor’s appointments.
Be completely honest with your obstetrician about any and all health issues you’ve ever had. This includes things like:
- All surgeries (major, minor, and cosmetic)
- Any prior high or low blood pressure
- Being overweight or obese
- Any prior history of thyroid issues (under- or overactive thyroid or other thyroid disorders)
- Any chronic conditions/diagnoses (asthma, diabetes, etc.)
- Hormonal or fertility issues
- Any prior bacterial vaginosis, bladder infections (UTIs), or other infections
- Immune system issues
- Any current alcohol use
- Any current or prior drug use (prescription medications and/or illegal drugs)
- Any current or prior smoking, vaping, or tobacco use
- Any current or prior physical dependencies (like pain medication or methadone)
- Any prior sexually-transmitted infections (STIs)
Reporting STIs to your doctor is particularly important, especially in the case of diagnoses like herpes. If a mother had a herpes diagnosis in the past but hasn’t had an active outbreak in a while, she might think there’s no risk to her baby because she doesn’t have any current lesions.
However, obstetric care providers need to know about any prior herpes (even if was only one outbreak or if the last outbreak happened a very long time ago). The herpes virus stays “dormant” in the mother’s body and can shed or become active again without notice. Transmission of herpes to your baby during birth can cause a very serious and potentially neurologically-damaging infection called herpes encephalitis.
The same thing goes for any STI, UTI, or bacterial infections of the vagina – transmission of infection during birth can cause serious neurological damage in a newborn. When providers are aware of a current or past infection, they can take measures to minimize any transmission to the baby during the pregnancy and birth.
4) Pick the Right Healthcare Provider
There is a wide array of care providers who can supervise medical care during pregnancy. These include midwives, nurse practitioners, nurses, primary care doctors, OB/GYNs, and maternal-fetal medicine specialists. All pregnancies should have qualified providers supervising appropriate care.
It’s important to remember that not every kind of medical care provider is necessarily qualified to provide care for all types of pregnancies. For example, women who are high-risk likely should likely not go to a midwife, because they need their care overseen by an experienced doctor to help treat or advise parents about complications. They likely should not be planning a homebirth, either, because high-risk pregnancies translate to higher-risk labor and deliveries. To avoid health complications, it can be important for high-risk women to deliver in a hospital with a high-level NICU in case the baby has complications.
Generally, because unexpected complications can arise very rapidly during labor and delivery, it is recommended that most women give birth in a hospital setting with NICUs available. It’s better to have intensive resources and not need them than to need them and not have them.
5) Getting the Right Consultations
Women with high-risk pregnancies should have their care managed by an OB with high-risk pregnancy experience. These doctors may also refer you to consultations with a maternal-fetal medicine (MFM) specialist. If you’re not automatically referred to one by your OB, you may want to ask if referral to an MFM is appropriate for your pregnancy.
MFMs are professionals that specifically focus on mitigating the risks of a high-risk pregnancy to minimize complications and ensure good outcomes for both mother and baby. For a full list of the kinds of health conditions MFMs can help address, please see the Society for Maternal-Fetal Medicine’s page on when to see an MFM specialist.
6) Know That Doctors Must Obtain Your Informed Consent
Physicians and other care providers must obtain your informed consent prior to beginning a procedure or treatment. In order to do so, they must ensure that you a) understand your treatment options, and 2) are able to make a free choice. This requirement is meant to protect you against unwanted medical interventions and to ensure that you are an active participant in your own medical care. If you are confused about something your doctor is saying or they are using complex medical jargon, you are well within your rights to ask for a clarification. Medical professionals must take the time to explain everything in terms you will understand (this may involve providing a translator if there is a language barrier), and also must respect your choices. Ultimately, it is your body and your pregnancy.