"Finding out my wife, Chrissy, was pregnant for a second time brought forth a few different emotions. I was having another child so, of course, that part of me was happy,” recalls Brian Davis, Bell Buckle father of two. “But after knowing what Chrissy, and our first baby, Kendri, went through last time, I was scared. Not just for the baby, but for my wife and how her body would handle another pregnancy.”
The Davis’ first pregnancy was not a typical one. Chrissy had an incompetent cervix, which means the cervix starts to thin and dilate before it should. Their daughter, Kendri, was born at 29 weeks and spent 78 days in the NICU at Middle Tennessee Medical Center (MTMC) before she was able to go home. She is a healthy 12-year-old now.
Sometimes, the desire to have baby will overpower the fact that it could mean a risky pregnancy. Understand your risks to be better prepared.
Prepare your family
When you know you’ve got a good chance at having high-risk pregnancy, and yet you really want to have another baby, know the risks and be ready for them. Soon-to-be fathers are part of the pregnancy, too, and it can really take a toll on them as well. The more informed they are the better.
“Was I happy? Yes. Scared? Yes. It was all of this wrapped into one ball of emotion, that was hard to talk about at the time,” says Davis. “It was her body going through it, but I was emotionally stressed as well as her. You never forget something like that.”
Of course you will discuss everything with your OB/GYN — are you ready for another baby? Go over all of the risks involved and make sure you have a complete understanding of them and what may happen. When you are fully prepared for your pregnancy and know what to expect should complications arise, you will be ready for it.
Be aware of some of the most common risk factors. According to Brad S. Chesney, M.D., F.A.C.O.G., of Murfreesboro Medical Clinic Department of Obstetrics and Gynecology, "Five of the most common factors for high-risk pregnancies include obesity, hypertension, advanced maternal age, history of preterm delivery and previous uterine surgery. With careful education, planning and monitoring we can mitigate some of these risks."
“Pregnancy complications are scary,” says Cornelia “Connie” Graves, M.D., medical director at Tennessee Maternal Fetal Medicine and the director of perinatal services at Baptist Hospital and MTMC. "Some complications may mean you need special care, some can be managed easily and some can be life threatening. But having a high-risk pregnancy doesn’t mean you can’t have a healthy, full-term baby."
Risk: Previous Surgeries
Women who have uterine surgery from previous pregnancies or other complications are also at an increased risk. When the Davis family was expecting its second child and knew that their pregnancy was a high-risk one, certain precautions were taken. Because of her incompetent cervix, Chrissy required a cervical cerclage (suture) procedure. It's what helped their second baby, Payton, arrive full-term and healthy, however should the Davis family try for another child it could cause complications.
"Those with a history of surgery on the cervix are more likely to have cervical incompetence resulting in the loss of a pregnancy during the second trimester," says Chesney. "Patients with this history can be monitored more closely with serial ultrasounds and a cervical cerclage to attempt to take some of the pressure off of a shortened cervix."
Women who have had a cesarean section are also at a greater risk should they decide to have a vaginal birth after cesarean (VBAC). Although there are risks of uterine rupture, Chesney states, "These risks can be moderated with close, continuous monitoring of the mother and fetus during the labor process or a scheduled cesarean delivery. The cesarean is, of course, a surgery with its own risks to mother and fetus. Those with a history of surgery requiring operation on the contractile portion of the uterine muscle such as the removal of fibroids or a classical cesarean are at even greater risk. A VBAC is contraindicated and a scheduled cesarean is the only way to reduce the risk in these patients."
Chesney says that preeclampsia (pregnancy induced hypertension resulting from a previous condition), affects seven percent of pregnancies. "It's an extremely serious medical condition that can result in temporary or even permanent injury to both the mother and her fetus," Chesney adds. "Maternal brain injuries such as eclampsia (seizure) and stroke as well as damage to the maternal kidneys and liver are all possible." Preeclampsia, or chronic hypertension, poses a risk because the mother can have restricted blood, oxygen and nutrition flow to the baby which can result in low amniotic fluid and poor fetal growth. Mothers that have had preeclampsia have a 25 percent chance at having it again with each pregnancy afterward. "The only known cure for preeclampsia is delivery," adds Chesney.
Risk: Complicated Health History
Your health before conception as well as your overall family history can have a major impact on your pregnancy.
"Obesity is more and more prevalent in the United States with greater than one-third of women in this category," says Chesney. "Obese mothers are more likely to have pre-existing conditions such as hypertension or diabetes and are more likely to have prenatal complications including gestational diabetes, hypertension and preeclampsia. Delivery complications like shoulder dystocia with the fracture of fetal bones, possible permanent nerve injury and a nearly 50 percent cesarean rate are known. Miscarriage and stillbirth are also more prevalent in this population." Chesney suggests that women that fall into this category should highly consider losing weight before conception.
Graves also states, "Poorly controlled chronic disease during pregnancy can increase the risks of significant maternal and fetal complications. Counseling prior to becoming pregnant is recommended for all women with chronic disease, especially those with diabetes."
If you have a family history of certain genetic diseases (such as cystic fibrosis or sickle cell), you may face a high-risk pregnancy. Graves suggests consultation and genetic testing regarding your best next steps. Maternal-fetal medicine specialists have special training in performing invasive genetic testing — such as amniocentesis — to know what you're facing.
Risk: Older Age
Women who are or become pregnant for the first time at 35 or older may be a candidate for high-risk pregnancy. "Pregnancy after age 35 can present challenges for both the mother and fetus," says Chesney. "Women in this age group are more likely to develop medical issues during pregnancy such as hypertension, preeclampsia and gestational diabetes and are also more likely to have multiples (twins or more), preterm delivery, miscarriages, stillbirth or may need a cesarean delivery." Chesney suggests that with the right help from your doctor which may include prenatal counseling, weight management, smoking cessation, medication modification, genetic counseling and others can mitigate some of these risks.
Graves agrees, "Women who have children younger than 17 or older than 35, are at increased risk for complications during pregnancy."
"Women older than 35 are also more likely to have a baby with chromosomal problems like Down syndrome and others so screening and diagnostic testing are offered as part of the prenatal care," adds Chesney. "Closer monitoring of fetal well-being may be indicated as well, especially in women ages 40 and older."
"Mothers with a history of preterm delivery in the past are twice as likely to deliver preterm again," says Chesney. Progesterone injections starting between 16 and 20 weeks with the last dose administered at 36 weeks is recommended to help the pregnancy along. "Those with an ultrasound documented short cervix may be treated with vaginal progesterone or a suture that ties the cervix closed," Chesney says. But, knowing that you are at risk for preterm delivery can have it's advantages. For instance, your doctor can administer a vaginal swab for a glycoprotein known as Fetal Fibronectin. "This can be helpful in identifying those at risk for preterm delivery," says Chesney. "The test can be administered between 24 and 34 weeks gestation to a patient with contractions. If negative, there is a 99 percent chance that she will not deliver over a two week time frame. If positive, administration of steroids to decrease the risk of common preterm fetal morbidities, admission for observation, rest and some medications may be indicated."
ARE YOU AT RISK?
Your OB/GYN may decide that your pregnancy is "high risk" if you develop complications or if you have a greater chance of developing certain complications. Common high risk conditions include:
- You are either under 17 or over 35 years old.
- You have a chronic medical condition such as obesity, diabetes or hypertension.
- You develop diabetes (gestational diabetes) during the pregnancy.
- Your pregnancy involves more than one baby.
- You have had a previous miscarriage.
- You have given birth prematurely in the past.
- Prenatal testing indicates a suspected birth defect.
- You have a history of fibroids or other gynecologic problems or surgery.