Pregnancy-related complications are high in the U.S., but doctors say women can help themselves
Obesity brings increased risk of gestational diabetes, preterm birth, need for a cesarean section, toxemia and having a large baby. An obese woman is more likely to have traumatic delivery. C-section is much more complicated. Blood clots, postpartum hemorrhage and preterm labor are also more likely, said Porter. It even makes an ultrasound more difficult. Obesity can mask birth defects that might otherwise be detected. It makes normal symptoms, like back pain, worse.
"Any complication in pregnancy is more common in women who are obese, and it's more difficult to treat. Prenatal diagnosis is very difficult," Porter said.
Like Althaus, Porter believes getting as close to an ideal weight as possible, maintaining a good exercise routine and eating healthy are vital.
Things you can't see
Erin Martineau knows you can't control all complications, but "you can control how you get educated and what you know." The Liberty, Mo., mom developed peripartum cardiomyopathy in her second pregnancy, while carrying twins. She, too, had trouble getting the symptoms taken seriously at first. She struggled with the condition afterward for more than a year, but recovered. She and the twins, now 7, are healthy. Some women recover fully, some struggle long-term with symptoms. Some die, usually from delayed diagnosis and treatment, she said.
"With knowledge, you can advocate for your health," said Martineau, who got a second opinion and diagnosis. "If you're prepared and knowledgeable, you don't have to fear. You can go to bat for yourself. I am a big proponent of getting educated."
Peripartum cardiomyopathy is very rare, says Dr. Ernie Graham, maternal-fetal heart specialist at Johns Hopkins. Most cases are idiopathic, meaning no known cause. High blood pressure or a virus are sometimes associated with the condition. Often, though, the women are very healthy. It's a diagnosis of exclusion, without known history of heart disease.
Often, women recover and a subsequent pregnancy may not pose significant increased risk. That happened for Garcia, who has a 3-year-old son, Alex. She did her research after recovery and met with a perinatologist before becoming pregnant. A cardiologist monitored her pregnancy, too. She got her heart in shape and adopted an impeccable, pregnancy-friendly diet. Knowledge became her power.
Progress for babies
Great progress has been made for babies in complicated pregnancies, said Dr. Linda Burke-Galloway, a clinical informatics specialist and author of "The Smart Mother's Guide to a Better Pregnancy." She cites a cooling blanket that helps reduce brain damage for babies born with very low Apgar scores, which assess the health of an infant right after birth. Many technological successes allow babies to survive and thrive.
Success has been more elusive on the maternal-complication side, said Burke-Galloway, of Orlando, Fla. "I don't think obstetricians do enough referring to maternal-fetal specialists when a woman needs to be referred."
General OBs can handle many things, but she thinks women who are older than 35, obese or who have sleep apnea, for instance, should be screened by a maternal-fetal specialist "just to make sure we're not missing something." They don't deliver babies, but look for potential complications.
Women don't always know what to look for or that it's OK to get a second opinion or ask whether something's normal, she said. If a woman has severe back pain, it's worth ruling out premature labor. If the baby doesn't move for 30 minutes, moms need to drink something sweet (not soda). If the baby still doesn't move, she needs to be checked.
Bleeding is also on her don't-ignore list. After leaving the hospital, baby in tow, she said moms should be examined if they have persistent headache or blood pressure greater than 130/88. Women who had pre-eclampsia are sometimes sent home too soon, since treatment is delivery. Seizures are possible for up to 96 hours. If that bottom number tops 90, seek help, she said.
Gaining a lot of weight right after delivering isn't normal. If depression develops, she recommends taking an Edinburgh postnatal depression test, available online.
"I strongly encourage women to trust their instincts," Burke-Galloway said. "I cannot emphasize that enough. We do have an internal barometer that speaks to us, but quite often we ignore it or we let people talk us out of it."
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