UVA Health System Blog

Stories about the patients, staff and services of UVA

 

Maternity Monday: The Partner’s Role in Pregnancy

On May 18, 2015 | At 10:18 am

Forty weeks of pregnancy is a long time and can put a toll on a woman’s body. She’ll experience every emotionfrom stress to excitement to feeling out of control. Pregnancy can put a strain on a relationship as well, and without the emotional and physical support of a partner, a woman may feel completely overwhelmed with everything going on. The partner’s role is quite simple: to be there.

preconception, pregnancy and childbirth

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

Meanwhile, partners are trying to navigate through their own emotions. There’s an old saying that goes, “a mom becomes a mom when she finds out she is pregnant. A dad becomes a dad when he sees the baby.” Partners play their own special role in the journey of pregnancy. Julie Ruffing is a labor and delivery nurse at UVA and a new mom. Here’s her perspective on the role her husband played in her pregnancy.

Question: What role did you husband take in your pregnancy?

Julie Ruffing: During pregnancy my husband was incredibly supportive. I think for a man, expecting a child can be a difficult time that is often underrepresented. For me, physical and emotional changes were obviously apparent, but for him, his life was changing slowly without his full comprehension. Early in my pregnancy I went through normal morning sickness and I just wasn’t myself. My husband struggled to understand why I was not excited to eat the meals he cooked and he often tried to get me motivated to be active when all I wanted to do was take a nap. As the pregnancy progressed, he was great! He massaged my aching feet after a 12 hour shift, made food that I was craving, and didn’t care that I needed 10 pillows to get a good night sleep. He did everything he could to support me in the changes that were taking place.

Q:Did you take labor classes? Did your husband attend?

Julie, her husband Ross, and their daughter, Josephine.

Julie, her husband Ross, and their daughter, Josephine.

JR: Since I am a labor and delivery nurse, I attempted to teach him about the labor process myself. We spent many long car rides discussing his role at the bedside during labor and all of the crazy events that may take place. We also talked about what would happen once the baby was born. Although I tried to cover everything I don’t think I prepared him fully for what to expect.  I’m sure he believed what I had taught him, but there is very little you can do to help someone understand what they’re in for when being a part of labor for the first time.

Q: Did your partner attend doctor’s appointments?

JR: My husband was present for the first appointment as well as the most important appointments throughout, including both of our ultrasounds. I find the ultrasounds important for the partner because it helps them to conceptualize that there is a living person growing inside the pregnant mother. During the process my husband was very excited and wanted to be a part of each step.  He is also the kind of person who seeks understanding and was quick to ask questions along way. At first I found this slightly frustrating because many of his questions I felt like I could answer.  However, as the process went along this trait proved to be very helpful and encouraging.

Q: Do you think there was a difference in how you felt toward the pregnancy and how your partner felt toward the pregnancy? Why or why not?

JR: Absolutely. I don’t think any man can fully understand pregnancy because they can’t go through it. It’s a crazy feeling to have a baby moving around inside your belly. During the pregnancy, I was constantly reminded that there was a living being inside me. She was always so active, rolling around and kicking me — 24/7. For the man, or a supportive partner, this simply is not the case. You may see the belly moving and continuing to grow but in many ways the reality of that does not sink in until that baby is born. Pregnancy can be a difficult time for any woman. A support system can be quite helpful.  For me that support came from my husband and has continued into raising our child together.

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Maternity Monday: UVA’s Free Prenatal Classes

On May 11, 2015 | At 11:11 am

Are you a new parent or a parent-to-be and looking for some free advice? Oh Baby! is a free night of advice from UVA doctors.

preconception, pregnancy and childbirth

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

Diane Sampson, education director for UVA Obstetrics and Gynecology, explains the event: “The talks are based on what our obstetricians and pediatricians wish they had known as first time parents themselves, and what our physicians want our patients to know before baby comes.”

What You’ll Learn:

  • Typical newborn behavior
  • Tips for calming a fussy baby
  • The top 10 things to know about breastfeeding before your baby is born
  • Postpartum: the good, the bad and the ugly

All participants receive door prizes, refreshments and helpful take-home materials.

Where: Quayle Learning Center, Battle Building. Park for free in the 11th Street Garage.

When: Wed., May 20th 6-8 p.m.

UVA also offers a variety of prenatal classes for family members of all ages. From breastfeeding and newborn care basics to grandparents and siblings classes, you can learn all aspects of welcoming a new addition to the family. They’re free, and new sessions start all the time.

Learn more about our available class options and sign up for Oh Baby!

 

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Maternity Monday: Twins, Triplets and Multiple Births (Infographic)

On May 4, 2015 | At 10:09 am

Multiple Births

 
 

Maternity Monday: Working Out While Pregnant

On April 27, 2015 | At 10:12 am

Spoiler alert: Your body is going to change when you get pregnant. It’s healthy and normal to gain weight throughout your pregnancy, but at the same time you can gain too much weight. Keeping yourself in shape may not be in the forefront of your mind, but doctors say that working out before, during and after pregnancy is extremely important. In fact, being at a healthy weight may increase your chances of getting pregnant. Being in good shape during your pregnancy will make your labor and delivery a little easier on your body. 

preconception, pregnancy and childbirth

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

When To Start Exercising If Pregnant

UVA pediatrician Ina Stephens, MD, highly recommends women work out during pregnancy. ”A pregnant woman can certainly work out and should be encouraged to do so,” she says. “Heavy weight lifting should be deterred, but otherwise, working out as you had been doing prior to becoming pregnant should be continued as long as you are feeling well and your ob/gyn feels that you are having a healthy pregnancy without complications.”

In fact, Stephens herself earned a black belt in Tae Kwon Do while she was eight months pregnant.

“If you work out before getting pregnant, continue to do so during pregnancy,” Stephens says. “It’s healthy, normal and safe.”

On the other hand, if you weren’t big into exercise before getting pregnant, Stephens warns that it may not be the best time to start pushing yourself to the limit. It is still safe to be active, of course. Great options include low-impact exercises such as:

  • Stretching
  • Walking
  • Swimming

In addition, Stephens highly recommends prenatal yoga. The stretching benefits along with the connection you will have with your body are valuable for both you and your baby.

Body Expectations & Healthy Weight Gain During Pregnancy

So, what is a healthy weight gain? Stephens says to expect about 20-23 pounds of weight gain during a healthy pregnancy. This range will depend on your body type and whether you start at, below, or under your ideal weight before getting pregnant. Pregnant women should expect to gain about a pound per week during the second and third trimester. You’ll gain less weight the first and last month of your pregnancy than the remainder of the time.

One myth that must be busted is that a smaller baby is easier to deliver. Some pregnant women will go on a diet while pregnant to ensure a smaller baby. This can be incredibly dangerous to both you and your unborn child. You should add calories to your diet, not take them away. An additional 300 calories per day should be extremely helpful to keep up your energy as well as give your baby the nutrition it needs to grow.

Losing the Baby Weight

If you’re breastfeeding, continue to eat extra calories after giving birth. “There is no place for dieting when it comes to breastfeeding moms,” says Stephens. “Your body needs the extra calories, and it can take a toll on the baby if they do not get the calories they need. Your body is already going to be exhausted from lack of sleep, so stamina is important.”

Losing weight after giving birth comes naturally when breastfeeding. Continue on the healthy diet that you followed while you were pregnant, and your body will begin to shed the baby weight naturally.

Be sure to ask your obstetrician before resuming your workout routine after giving birth. Your body has been through a lot of trauma and needs time to repair itself before you start working out. Stephens says two weeks is a safe amount of time for those moms who had a natural birth and a little longer for those who had a cesarean section.

 
 

Maternity Monday: All About Gestational Diabetes

On April 20, 2015 | At 9:17 am

Gestational diabetes is a common condition that affects up to 10 percent of pregnant women. We talked to Annelee Boyle, MD, a maternal-fetal medicine specialist at UVA Health System to find out more about it.

Stories about preconception, pregnancy, childbirth and postpartum

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

What causes gestational diabetes?

We don’t know exactly what causes gestational diabetes, but if you think about it, there are certain hormones that the placenta produces that increase a woman’s glucose levels. That’s because glucose, a type of sugar, is a fuel the fetus needs to grow, so it makes sense, in certain women, their bodies can’t compensate for what is a normal physiological response.

How is gestational diabetes diagnosed?

If we have a suspicion that a woman is at risk in the first trimester, we’ll check with a sugar test at her first visit. At-risk women may be overweight, have a family history of diabetes or have had gestational diabetes in prior pregnancies. We screen everyone at the end of the second trimester, about 24–28 weeks gestation, using a simple glucose tolerance test. That’s where you drink a sugary liquid, fondly described as “the gross orange stuff,” and have your blood drawn an hour later.

The liquid contains 50 grams of glucose. This allows us to see how your body responds to a large influx of sugar. If your blood glucose is high on the screening test, then we get a more detailed glucose tolerance profile. During this diagnostic test, you drink twice as much glucose and, instead of drawing your blood once, we draw four times over three hours.

Why do you test at 24-28 weeks?Patient with diabetes montitor

We test then because we know we can make a difference in outcomes. Diabetes in pregnancy affects mom, but it also affects the fetus. Babies born to moms who are diabetic are at higher risk of:

  • Stillbirth
  • Birth defects
  • Getting too large, which puts them at higher risk of birth injury

No pregnancy has zero risk, but by controlling blood sugar, the risk for mothers with diabetes is about the same as mothers without diabetes. That’s really our goal: to give babies and mom the best shot.

How do we treat gestational diabetes?

For a lot of women, following a diabetic diet and increasing physical activity, particularly after meals, will control their gestational diabetes. Our fabulous nutritionists can help with meal planning. I encourage my patients to take about a 10-minute walk after each meal. For other women, gestational diabetes is a little more difficult to control. In these cases, oral medication may do the trick. As a last resort, we may have to use insulin, which I try to avoid because people don’t like giving themselves shots, but it may be necessary in some cases. Whether you do the shots, pills or no medication at all, you have to test your blood sugar about four times a day and do what it takes to keep it within the proper range.

Does this mean your pregnancy is considered high risk?

It is higher risk. I don’t like to say high risk because women may feel they have a big sign or target on them, but it does require some special care and attention.

Do you need to see a maternal-fetal medicine (MFM) doctor if you have gestational diabetes or can you see your regular obstetrician?

It depends on your regular OB. I know a lot of doctors are very comfortable dealing with diabetes that’s well controlled with diet and exercise or even with oral medication, but if you need insulin, I would recommend seeing a specialist. A woman and her doctor should work this out together. If you do get to the point that you need medication, either with pills or with insulin, we would recommend an ultrasound to make sure the baby is growing properly. That can be done at a high-risk doctor’s office or at your own doctor’s office. You may also need to monitor the baby’s activity through something like a non-stress test or biophysical profile. Those are two different tests, but both look to see if the baby is healthy and active.

Are you more likely to get gestational diabetes with subsequent pregnancies?

You are. Think of pregnancy as a stress test for your body. You’re also eight times more likely to develop type 2 diabetes later in your life if you have gestational diabetes. I tell my patients to look at this as positive. Knowing you’re at increased risk for type 2 diabetes, you can make better choices and changes outside of pregnancy. By placing a high priority on maintaining your weight and staying physically active, you may be able to stave off type 2 diabetes.

What can you do to prevent it?

Try to enter a pregnancy at the peak of health. If you’re at normal weight before pregnancy, you’re less likely to develop gestational diabetes. Also follow a reasonable diet and exercise plan while you’re pregnant. Your baby really only needs an extra 300 calories a day, and you probably don’t need to gain any weight until after the first trimester. Remember:  You’re eating for two, but you’re not eating for two linebackers.

When does gestational diabetes go away?

It should go away when we remove the placenta because the placenta is what causes the extra hormones that increase your glucose. But sometimes it doesn’t go away. We want to test everyone with gestational diabetes at six weeks after birth to make sure it’s gone and the patient isn’t really a type 2 diabetic. If you have gestational diabetes, let your primary care doctor know and be tested periodically, usually once a year, to make sure you’re not developing type 2 diabetes outside of pregnancy.

Anything else?

The word diabetes sounds really scary, but you can still have a healthy pregnancy. We’ll work with you to achieve the very best outcome for you and your baby.

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Maternity Monday: Prenatal Genetic Counseling FAQs

On April 13, 2015 | At 9:27 am

Pregnancy — or even planning a pregnancy — comes with a lot of questions.

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

You may have heard that the older you get, the higher your baby’s risk of Down syndrome. Maybe one of your relatives has sickle cell anemia or cystic fibrosis. How do you know how high your baby’s risk is? Are the screening tests you’ve read about worth it?

We sat down with prenatal genetic counselor Logan Karns, who frequently sees couples wrestling with these issues, and asked her some common questions.

What is prenatal genetic counseling?

Genetic counseling is a process of gathering information and evaluating the risk for a woman to have children with certain genetic conditions. I look at the couple’s family history and, if they are already pregnant, we discuss any screening tests they may have had.

If they are at a higher risk to have a child with a specific genetic condition, or if they have already had a screening test that indicates a birth defect, we talk about the next steps. This helps them to decide if they want to have more testing.

What are the chances of a significant birth defect in a low-risk pregnancy?

The background risk for any couple to have a child with a birth defect is 2-3 percent. The risk increases if the mother:

  • Is over 35
  • Has a family history of birth defects
  • Had a previous child with a birth defect

Many birth defects happen by accident, with no known cause. When they do happen, most women wonder whether the birth defect happened because of something that they did. We try to reassure women that this is not the case.

What are the more common conditions you’re looking for?

  • Spina bifada
  • Cystic fibrosis
  • Down syndrome
  • Heart defects
  • Sickle cell anemia

“Common” is, of course, a relative term, and everyone needs to look at a number and decide whether it feels like a high risk or a low risk to them.

When should a couple see a genetic counselor?

what is prenatal genetic counseling

Prenatal genetic counselor Logan Karns

Usually I see couples in their first trimester. But it’s also not uncommon for me to see women in their second trimester, after they have received abnormal results from a screening test or procedure.

The best time for us to see people is before they are pregnant. We go through their family history, answer questions and talk about different approaches to screening based on either their family history or their ethnic background.

It is helpful to hear the information and make choices ahead of time. It can be more complicated when couples come in and they are already pregnant, and they have to make choices in a timely way. If we review the family history and identify something that requires testing, then timing can be a critical element.

What prenatal screenings and tests detect genetic conditions?  

First trimester screening

Type of test: Blood test and ultrasound

When performed: Weeks 11-14

Recommended for: All pregnancies

Screens for: This test gives you your baby’s risk for certain chromosomal abnormalities, including Down syndrome. However, as it’s not a diagnostic test, you’d need more testing to determine if your baby has these conditions.

Non invasive prenatal screening (NIPS)

Type of test: Blood test

When performed: After 10 weeks

Recommended for: High-risk pregnancies, women over 35

Screens for: Specific chromosomal abnormalities. Like first trimester screening, this is a screening test and you’d need a diagnostic test to be completely sure. 

Chorionic Villus Sampling (CVS)

Type of test: Placental cells collected either by using a catheter that goes through your cervix or by inserting a needle through your abdomen (similar to amniocentesis)

When performed: Weeks 11-13

Recommended for: High-risk pregnancies, women over 35

Screens for: Chromosomal abnormalities and genetic disorders

Amniocentesis

Type of test: Amniotic fluid cells collected through a needle inserted into the amniotic sac through your abdominal wall.

Timing: Weeks 15-22

Recommended for: High-risk pregnancies, women over 35

Screens for: Chromosomal abnormalities and genetic disorders.

QUAD Screening

Type of test: Blood test

Timing: Weeks 15 to 21

Recommended for: All pregnancies, offered to women who haven’t already had a screening test

Screens for: Down syndrome, trisomy 18 and spina bifada, but like FTS and NIPS, you’d need a diagnostic test if your results are abnormal.

A lot of these tests are recommended for women over 35. What’s so special about 35?

Because amniocentesis and CVS are considered invasive tests, there is a risk of complications, including miscarriage. The chance to have a miscarriage depends on which test you choose. At 35, the odds of having a baby with a chromosomal abnormality like Down syndrome or Trisomy 18 are about equal to the odds of having a complication from one of these diagnostic tests.

Why is NIPS only recommended in high-risk pregnancies?

The majority of studies involving NIPS have so far only looked at high-risk women.  At this time, there is not enough information about the ability of the test to be helpful to low-risk women. The current recommendation from the American College of Obstetricians and Gynecologists is therefore not to offer NIPS to women considered low-risk. UVA has chosen to follow those recommendations.  This may change as more published data become available.

I’m adopted and don’t know my family history. Should I still see a genetic counselor?

Genetic counseling isn’t just about going through your family history. We can still talk to you about your risk factors, including your ethnicity and the chances of a birth defect based on your age.

What happens if screening does reveal a significant birth defect?

When a birth defect is diagnosed during a pregnancy, support services are available to help parents decide how to manage their pregnancy. This is obviously a very painful and complicated time. We work with pregnant women and their families to outline all the options, help them choose how they would like to proceed and get them the support that they need.

Interested in meeting with a prenatal genetic counselor? You can:

 
 

Maternity Monday: Expecting the Unexpected — High-Risk Pregnancy

On March 30, 2015 | At 8:47 am

Laura Aimone’s pregnancy was progressing along normally, although she did feel tired in her second trimester, which she didn’t expect. “I just kind of figured that’s what me being pregnant was,” she says. Her baby was measuring small, but doctors at University Physicians for Women at Northridge were monitoring it.

Stories about preconception, pregnancy, childbirth and postpartum

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

Headaches: A Warning Sign

Due on August 28, 2013, Aimone began experiencing bad headaches in July. “I didn’t know that was a sign of anything,” she says. Headaches can, in fact, indicate preeclampsia, a serious pregnancy-related condition characterized by high blood pressure. It can cause poor growth, placental abruption (separation of the placenta from the uterus) and damage to the mother’s organs.

Preeclampsia is diagnosed by testing for protein in the urine. But when Aimone next went to her doctor, a test didn’t find any protein. While her blood pressure was elevated to 130/95, her baby looked fine during an NST (non-stress test), which measures a baby’s heart rate and movements. Aimone was ordered to take it easy, but she admits she didn’t understand what that meant. She took a yoga class that night that which left her with a horrible headache; when she called UVA’s Labor and Delivery Department, the staff had her come in.

Aimone’s blood pressure was high but it went down after resting and there still wasn’t any protein in her urine. Tests again showed the baby was in good condition. “They said, “We’re not going to deliver the baby tonight. I think my husband and I said, ‘Well, no, we’re not going to deliver the baby tonight! We have six weeks to go and I’m going to be late because first pregnancies are late.’”

Aimone was scheduled to do a 24-hour urine test, which more accurately measures the amount of protein in the urine, but without those results doctors still weren’t prepared to officially diagnose her. Still, at this point she learned what taking it easy really meant when doctors told her she could get out of bed to use the bathroom.

What is a High-Risk Pregnancy?

Aimone’s pregnancy had quickly progressed from normal to high-risk. A high-risk pregnancy means there are complications that could affect the mother, the fetus or both.

Women with a high-risk pregnancy often see a maternal-fetal medicine specialist (MFM). Other names for this type of doctor, who has specialized training in treating high-risk pregnancies, are:

  • High-risk obstetrician
  • Perinatologist

“Fortunately, the vast majority of pregnancies proceed along fairly normally and don’t really need to be seen by someone who’s a high-risk obstetrician. Most women are low risk,” says Donald Dudley, MD, division director of the Division of Maternal-Fetal Medicine at the University of Virginia. “But for moms-to-be who are high risk, at UVA, we have a team of maternal-fetal medicine specialists who treat women at our Maternal and Fetal Medicine Clinic at the new Battle Building.“

Women with high-risk pregnancies usually spend more time with the doctor and are seen as often as twice a week throughout their pregnancy. They also need additional blood tests, ultrasounds and possibly specialist visits. For women for whom these additional visits become a hard to manage, UVA doctors often set up programs with local care providers and use the telemedicine program, making appointments less of a burden.

Diagnosis of Preeclampsia

Farmer Waverly trick or treats on UVA's Lawn with her parents in 2014.

“Farmer” Waverly trick or treats on UVA’s Lawn with her parents in 2014.

After her visit to Labor and Delivery, Aimone had a scheduled appointment for a special ultrasound called a biophysical profile, which is used in high-risk pregnancies to measure the baby’s breathing, movement, amniotic fluid, muscle tone and heart rate. It showed the baby was in great condition. The results of the 24-hour urine test were in, though, and they showed Aimone did have preeclampsia, so Megan Bray, MD, sent Aimone back to Labor and Delivery for an assessment.

“She was very direct,” Aimone says. “She said, ‘At the point where your health risks outweigh the baby’s health risks, that’s when we deliver the baby, because that’s how we fix your preeclampsia.’ I wanted to make it to 37 weeks, but she said it wouldn’t be any longer than that. I was kind of bummed about that. I really wanted to go into labor naturally.”

After bedrest, more headaches and another trip to Labor and Delivery, Aimone’s water broke at 35 weeks, 5 days. She delivered her daughter Waverly, who weighed 3 lbs, 15 oz, on July 29. Waverly spent 10 days in UVA’s NICU (neonatal intensive care unit). Aimone’s doula assisted at the birth and Aimone had the opportunity to hold her daughter before she went to the NICU. Waverly is now a healthy, happy little girl who keeps her mom and dad Ben busy.

Who Has a High-Risk Pregnancy?

Anyone who gets pregnant can have a high-risk pregnancy, but most women won’t, says Dudley. A lot of rare conditions can cause high-risk pregnancies, but some of the most common risk factors include:

  • Multiples (twins, triplets or higher)
  • Previous history of diabetes
  • Blood pressure issues, such as pre-eclampsia
  • Lupus
  • Fetuses with birth defects
  • Previous history of preterm birth
  • Women at risk for preterm birth for any number of reasons, including, cervical insufficiency

Make An Appointment

Make an appointment with a maternal-fetal medicine specialist at UVA.

In many cases, these risk factors mean there’s a risk for preterm labor and/or preterm birth. Dudley says preterm birth is a significant problem in the U.S and the leading cause of neonatal infant mortality worldwide. “Having babies in the NICU is really what we want to avoid. We want to have babies go home with the mom right away. That’s the optimal outcome.”

Other factors that put a pregnancy in the high-risk category: Going past the due date and the mother having late-onset high blood pressure are examples.

What About Gestational Diabetes?

Having gestational diabetes doesn’t mean you necessarily need to see a maternal-fetal medicine specialist. Dudley says it depends on the comfort level of your provider. Gestational diabetes is a common pregnancy condition that affects many women. If you’re seeing a midwife or a nurse practitioner, you should see a high-risk doctor, he says. “Most good general obstetricians can manage you, but most of them would want you seen by a high-risk obstetrician to confirm the management plan and to have that kind of insurance.”

Preventing a High-Risk Pregnancy

It’s not always possible to prevent a high-risk pregnancy, especially if you already have an underlying health condition or you’re pregnant with multiples. But here are a few steps you should take:

Before you get pregnant:

  • Eat a healthy diet
  • Don’t be overweight
  • Maintain a healthy lifestyle
  • Exercise regularly
  • Take prenatal vitamins containing folic acid
  • Stop smoking and taking drugs unless prescribed

Once you’re pregnant:

  • Get early prenatal care
  • Continue prenatal vitamins
  • Continue a healthy diet with green, leafy vegetables and include extra calcium and extra protein
  • Do some aerobic exercise  (check with your doctor first!)
  • Minimize chemical and drug exposures
  • Don’t smoke, take drugs or drink alcohol

Worried About the Risks?

If you have underlying health conditions, you may want to consider preconception counseling. Dudley says MFM doctors prefer women with high-risk conditions like lupus, complex high blood pressure, kidney disease, diabetes, seizure disorders and other conditions see a high-risk doctor for preconception counseling.

“We can go over a plan for what we’re going to do when they achieve pregnancy, make sure they’re on medications that are safe for pregnancy as best we can, and that way when they’re pregnant they’re already in an optimal condition,” he says. Women with lupus have a higher risk of preeclampsia, fetal death and other problems; however, if they have their babies while in remission and on medication they usually have good outcomes, Dudley says.

Preconception counseling isn’t the norm because at least half of all pregnancies are surprises. But ideally, a woman with a serious health condition will call an MFM first, Dudley says. This is critical, because maternal mortality rates in the U.S. are increasing. “It’s driven a lot by women who have underlying heart conditions achieving pregnancy and then having problems toward the end of their pregnancy.

“We love to do preconception counseling. It helps us provide a strategy that hopefully will ensure the best possible outcome from the very beginning.”

Choosing a Hospital to Minimize Risk

Worried about a high-risk pregnancy, though you don’t have underlying conditions? Choosing a hospital with a NICU might be your best bet.

Laura Aimone and her husband Ben watch over their daughter Waverly in UVA's NICU.

Laura Aimone and her husband Ben watch over their daughter Waverly in UVA’s NICU.

“Mainly you need a NICU if there’s going to be some need for specialized care. The main one is preterm birth, but if you have a baby that is delivered at term that has a heart defect or spina bifida or some other problem, you would still need a NICU,” says Dudley.

Sometimes, it’s actually care for the mother that’s just as important, if not more so. “There are high-risk maternal conditions where the baby will do fine. For example, the baby’s at term and the mother develops severe preeclampsia. Then the mother needs to be in a place with high-risk maternal care and adult care, but the baby doesn’t always need anything special. You really want a hospital that has comparable levels of care for the mom and the baby. It’s the combination of the two.”

Even without the risks that could affect their pregnancy, some women choose the safety net of a hospital with a NICU to avoid last-minute emergencies.

Aimone expected to have a normal pregnancy and did until the very end. She planned to have her baby at UVA in part because of convenience, but also because of the care UVA provides. UVA is right around the corner from her house. “God forbid anything happen, we wanted to be at UVA. Everyone was like, ‘Oh nothing will happen. It’ll be fine.’ But it did.”

Make an Appointment

Make an appointment with a maternal-fetal medicine specialist at UVA.

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Maternity Monday: Stacy Lynn’s Miscarriage Story

On March 23, 2015 | At 9:38 am

It’s a common story, about miscarriage — that there is no story. People don’t talk about it, and yet it can be a truly traumatic loss.

Stories about preconception, pregnancy, childbirth and postpartum

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

It’s also a fairly common one; studies show that anywhere from 8 to 25 percent of all known pregnancies end in miscarriage. Despite the silence around miscarriage, many women have experienced it.

That’s certainly what Stacy Lynn found to be true. The more she broke the silence, the more she discovered other women who had had miscarriages. She told me her story to help others know they are not alone

Getting the Bad News

I hadn’t heard the heartbeat yet. They tried to find it. They said, “We don’t hear it, but that doesn’t mean anything. Sometimes we just can’t find it, so we have to do an ultrasound.”

And then the woman giving the ultrasound said, “I’m sorry.” And in my head, I think, “So sorry about what?”

Then the doctor comes in and gives me a hug. “I’m really sorry; sometimes this happens.  The fetus stopped growing at 8 weeks.” And then it hit, and I just bawled, and she hugged me.

I am tearing up just thinking about it. I didn’t think I would.

After the Miscarriage

My husband came rushing over. He told me, “If we can survive this, we can survive anything.” He really helped me. So I had to have a D&E, so I had to sit with it all weekend and just deal with it.

After the D&E, I developed an infection. I woke up a few days later, shivering and so sick. I called. They had left tissue inside; I had to have another procedure. During that entire process, I wanted to move on but couldn’t. I was pretty depressed.

My husband said really good things to me. He is my life support. He let me cry, he never judged me, he had lunch with me every single day to check on me. He would give me silly tasks to do, tell me, “The car needs an oil change, can you do me a favor and go do it?” Things like that to get me out of the house. Which was really good.

My sister in law had a baby a couple days before my miscarriage, so I didn’t want my family to come down. It was really hard to be around a friend of mine who was pregnant and had a healthy baby. I didn’t want my friends to visit. I was a mess.

After a couple weeks, I was still really depressed. My husband said, “I don’t want this to define you. This is not who you are. You are very happy. You always see the good in everything. This happened, and it’s sad, and we can be sad about it. But this cannot define you. I want you to live your life.” He really pulled me out of depression. I’m so thankful for that.

Getting Pregnant Again

I worried I wouldn’t get pregnant again. My husband said, “It will happen when your body is ready. Don’t stress about this. We know you can get pregnant.” We ended up getting pregnant five months later; it turned out my body was ready.

Throughout the pregnancy, I was a nervous wreck. I had kidney stones from five weeks until I delivered, so I would see blood and was so terrified. We didn’t tell anyone, and then only close friends and family. We did not post anything on Facebook. We didn’t plan on having a baby shower – we’re Jewish so we don’t have baby showers anyway; it’s bad luck. We were not acknowledging him until we held him in our arms.

After a miscarriage, Stacy had her son, Remi.

New Hope

My son was born early, at 32 weeks, in the UVA NICU. It was one year since the miscarriage.

We named him Remi, a name we picked flipping through the channels when I was about six months along. Remi was the name of a French contestant on American Ninja Warrior, which created a spark in us, since we had traveled to Paris between the miscarriage and this pregnancy. Little did we know that name would be so fitting for Remi, who had to fight to live right from the start. At 21 months now, he is no longer my little nugget, but a precocious toddler who is succeeding in numerous ways.

A lot of people are asking if I’m going to have a second child, but mentally I’m not there, because I’m terrified of having another miscarriage, and I’m terrified of having a micropreemie.

I will tell you I had the most amazing experience at UVA with Dr. James, who will be delivering any future children of mine, as she was wonderful and made the whole situation, which was scary at times, better. Looking back, I think what a great experience it was.

Healing From Stigma and Blame

I think if more people talked about miscarriages, it would make a person going through it not feel as alone. I felt so alone. It seemed like nobody else had this experience, everyone got pregnant right away, and it was all so easy. If people could talk more about it there wouldn’t be this stigma.

My mom gave me advice. She actually had a baby, born at 28 weeks, back in the 70s, and he lived for a couple of hours. When I had the miscarriage, she said, “I’m so sorry, Stacy; I’ve been in your situation. I understand. It is out of your control. You did nothing wrong. You can’t control it. As women, we like to control things. But there’s nothing you could have done differently.”

As horrible as the miscarriage was, if I hadn’t had that, I would not have had Remi. He’s the best thing that ever happened to me.

Share Your Story

Have you had a miscarriage? Let us know in the comments below what helped you heal. 

 
 

Maternity Monday: Miscarriage, A Common Taboo

On March 16, 2015 | At 9:48 am

I thought a quick scan through a Google search about miscarriage would reveal more information than I could fit into this blog post.

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I was wrong. In fact, my quick scan turned into a lengthy search, and the very large gap of information underscored a sentiment that seems pervasive:

You don’t talk about miscarriage.

But why? I wanted to know. Everyone online and the women I talked to for this story expressed the same thing: There’s silence around miscarriage. And it needs to be broken, because this taboo makes it a lonely, isolating experience, on top of the already-difficult physical and emotional loss.

The closest thing I could find for an answer was that the lack of medical reasons for miscarriage—and there’s more often than not no clear reason for it—leaves the why of what happened a blank. As Diane Rozycki, MD, told me, “Miscarriages can happen due to a variety of reasons. They can also be unexplained, with chromosomally and structurally normal fetuses in apparently healthy women.”

As with most mysteries humans face, we tend to fill in the gaps. Women who have miscarriages often feel responsible, at fault and ashamed; the pregnancy “fails,” and they feel they have failed, too.

Miscarriage Risk Factors

But even when a cause is implicated, most of the risk factors for miscarriage aren’t something a woman can control, like:

  • Maternal age: Risk increases with age
  • Maternal disease, acute infection as well as endocrine disorders (uncontrolled diabetes and thyroid disease, for example)
  • Structural abnormalities of the uterus
  • Fetal chromosomal abnormalities or congenital anomalies

Two risk factors, a woman being extremely overweight or exposed to certain medications and substances, can, in some cases, be controlled, but they certainly are not predictors of miscarriage.

Miscarriages Are Common

And the thing is, miscarriages happen more frequently than generally assumed. Rozycki again: “Miscarriage in early pregnancy is common. Studies show that about 8 to 20 percent of women who know they are pregnant have a miscarriage some time before 20 weeks of pregnancy; 80 percent of these occur in the first 12 weeks. Loss of unrecognized or subclinical pregnancies is higher.” (That is, you can have a miscarriage without even knowing you’re pregnant. You might experience symptoms, like pain and/or bleeding, but not necessarily.)

The situation seems like a catch-22: No one knows how common miscarriages are because we don’t talk about them, and we don’t talk about them because we don’t know how common they are. It doesn’t help that in the US, cultural convention tells us to hide pregnancy until after the first trimester, the time when most miscarriages happen. So paradoxically, the time when women arguably need the most support, feel the most tired and nauseaus as well as the most worried, is exactly when they are supposed to hide their pregnancy and, should it happen, their miscarriage.

One article talking about the misconceptions people have about miscarriage reported:

The survey of more than 1,000 women and men found 65 percent believe miscarriage is rare, when in reality it occurs in one in four pregnancies. While knowledge of miscarriage rates was low, respondents accurately assessed that it is traumatic, with 66 percent believing the emotional impact is severe and potentially equivalent to the loss of a child. Research shows understanding the cause of miscarriage can reduce feelings of guilt or blame; however, currently the origin is only identified in 19 percent of patients.

Life After Miscarriage

The good news about miscarriage is, it may be beyond your control, but it doesn’t mean you’re beyond hope for having a baby.

“If you have had a prior miscarriage, you can be at increased risk for another,” Rozycki says. “But it does not mean you are infertile. Even women with recurrent pregnancy loss (three consecutive miscarriages) have a good chance of eventually having a successful pregnancy.” She does advise that women wait for two to three months before getting pregnant again.

And, whatever the taboo or misperceptions, you are not alone. As one woman told me, “It’s still painful right now, looking back at it, but I have to say time decreases the intensity of what happened. Do whatever self-care works for you. Give yourself time, and reach out for support.”

Odds are, when you do, you’ll find someone who knows exactly what you’re going through.

Next Monday, we’ll hear a personal story about the mix of emotions that can occur with a miscarriage.

Worried About Miscarriage?

The best bet: Talk to your doctor. Find a caring, expert OB/GYN:

 
 

Maternity Monday: Prenatal Vitamins & Other First Trimester FAQs

On March 9, 2015 | At 10:15 am

Parenting books and baby blogs are great resources, but they can also supply an overwhelming amount of information for newly expectant mothers. I took a look at some common questions for the first trimester of pregnancy and caught up with Vanessa Gregg, MD, for the answers.

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Do I Need Prenatal Vitamins? 

Yes — prenatal vitamins are beneficial for both the mother’s changing body and the developing fetus. It’s ideal to begin taking prenatal vitamins before conception. Although most women get the nutrients they need via their diet, prenatal vitamins provide that extra boost.

Gregg warns moms that it may take some self-discipline to include all of the major food groups in the diet during pregnancy, especially when you have cravings, but it’s important to try.

What’s Important in Prenatal Vitamins? 

Dr. Gregg tells her patients that one important ingredient in prenatal vitamins is folic acid.

What is that and what are the benefits, you ask? Folic acid:

  • Is a type of B vitamin
  • Helps produce red blood cells to prevent anemia for mother and baby
  • Helps form the neural tube (the brain and spinal cord) to decrease the number of potential defects while the fetus is forming

Before conception, you should take about 400 micrograms of folic acid. Bump up the dose to 600 micrograms during pregnancy. “It’s one thing you can easily do to help have a better outcome,” says Gregg.

Prenatal vitamins also contain many other valuable ingredients, including iron, which many pregnant women need more than they would outside of pregnancy.

Should I Avoid Any Particular Food?

One important thing to be wary of is raw or undercooked food like meat, eggs and fish, as these foods can lead to food-borne illnesses. Some types of fish have higher concentrations of mercury, which has been linked to birth defects.

Prenatal vitamins contain folic acid and other nutrients for expectant moms and their babies.

Look for folic acid in your prenatal vitamin of choice.

Safe options for expectant moms are:

  • Shrimp
  • Salmon
  • Catfish
  • Pollock
  • White (albacore) tuna, limited to about six ounces a week

You should also be cautious of listeria infection, a food-borne illness caused by bacteria. Listeria infection can lead to miscarriage, stillbirth and premature delivery. As a precaution, women should avoid unpasteurized milk products, and heat lunch meats like hot dogs and cold cuts before eating.

Gregg also advises expectant mothers to peel all food skins themselves and thoroughly wash fruits and vegetables. She tells her patients, “If you’re in doubt, skip it and eat something else!”

Am I Really Eating for Two?

You may want to indulge all of your cravings, but there is no increased caloric need within the first trimester. Over the course of a pregnancy, the caloric intake will increase to about 300 extra calories per day — not an outrageous amount!

While it’s important to have a healthy weight gain during pregnancy, the expected weight gain for each mother varies depending upon her pre-pregnancy weight. The average weight gain for a single pregnancy in a woman of normal body weight is between 25 and 35 pounds. But, as Gregg reminds expectant mothers, gaining too little or too much weight can create pregnancy complications later on.  Your obstetrician or other prenatal care provider can advise you as to how much weight gain is appropriate for you.

What Bodily Changes Should I Expect?

There aren’t many changes that occur within the first trimester. Some women may notice a temporary thickening of the hair or hair growth in unexpected areas like their face, chest, abdomen and arms. However, it isn’t until the baby further develops and grows that changes like stretch marks and darkening areas of the skin may occur.

The most common experiences during first trimester are:

  • Fatigue
  • Breast tenderness
  • Morning sickness, the body’s way of processing new hormones

Is There Really Such a Thing as ‘Pregnancy Glow’?

While there isn’t necessarily a medical reason for the “glow,” Gregg certainly believes it exists. However, she attributes it to the rounding of the expectant mother’s face or the positive, excited attitude and outlook she exudes. In addition, hormonal changes of pregnancy may change the texture or oiliness of the skin, which can contribute to the “glow” of pregnancy.

“Pregnancy is an amazing time. It’s phenomenal, the changes the body goes through to accommodate a growing person,” says Gregg. She encourages all her patients to enjoy the experience and look forward to the joy of a new addition to the family.