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Anthony Ziccardi
Kelly Whitehead and her children. Photo: Anthony Ziccardi
You don't want to know every possible sad thing. You do want to be a key member of your team and know what to ask. —Kelly Whitehead

During her first pregnancy, Kelly Whitehead had the excitement, the dreams and some of the clothes and supplies a baby will need. What she didn't have, at its end, was a baby. Her son, Ashton, never made it to term, dying in the 23rd week after she went into early labor.

The scariest thing Whitehead ever did was get pregnant a second time, she says. She was afraid over the whole course of the pregnancy and, because of that, she missed out on much of the joy of the journey through the baby's development.

As she carried Madison, who not only survived but arrived as a robust 9-pounder, she fretted and fussed, unable to let go and just embrace the changes to her body, the baby she was nurturing and faith the infant had a future. She was confined to bed for much of that time, where she was fairly miserable. Madison is now 6.

The third pregnancy, with Drew, now 2, was very different for Whitehead, a research microbiologist and author of "High-Risk Pregnancy — Why Me?" a guide to surviving high-risk pregnancy that she wrote in collaboration with Dr. Vincenzo Berghella, a fetal-maternal specialist at Thomas Jefferson University Hospital in Philadelphia and a professor at its affiliated university. Madison's birth bolstered her courage and this time, she was filled with anticipation and hope, instead of terror.

Of sorrow and hope

The numbers are both sobering and encouraging. There's been an increase, though not dramatic, in pregnancy complications, says Dr. Bob Silver, a professor of obstetrics and gynecology at the University of Utah. He believes that fact is likely a combination of an increase in obesity among American women, the choice some women make to get pregnant later than they did in past decades and an increase in the number of women carrying twins and triplets.

But here's the encouraging part: Even with perceived high risk and pregnancy complications, most women will have a healthy pregnancy and deliver a healthy baby at the end of it. Belonging to one of the risk categories calls for mindfulness and a discussion with your doctor to see if you need to consult someone who specializes in difficult pregnancies and their potential complications, he notes. But it doesn't necessarily portend coming sorrow.

What to do about perceived risks depends in part on the expert you consult. While there are a number of guides to surviving and even enjoying enforced bed rest, for instance, including Whitehead's, Silver said it's not scientifically clear whether bed rest makes a major difference. "They are theoretical benefits, although it's often prescribed," he says.

Regardless, nearly a million women with high-risk pregnancies spend a portion of the pregnancy on bed rest to protect their developing babies. Also nationwide, more than 500,000 newborns (about 12 percent) arrive too early, according to the Centers for Disease Control and Prevention.

Identifiable risks

Sometimes, it's not clear what prompted a complication. Some things, though, clearly pose potential complications and risks to a healthy pregnancy. The National Institute of Child Health and Human Development says they include young or old maternal age, being overweight or underweight, previous pregnancy complications and certain existing health conditions, such as high blood pressure, diabetes and HIV. Changes can occur during the pregnancy that create risk, as well, including pre-eclampsia and eclampsia, gestational diabetes, HIV/AIDS, preterm labor and infections. It's important, NIH notes, to begin prenatal care early, go to all the appointments and follow the advice.

The American Pregnancy Association and The March of Dimes note issues that can lead to too-early births and stillbirth, including problems with the placenta, birth defects, growth restrictions and more rare complications. Malnutrition, smoking and alcohol and drug abuse pose significant risks. Medline Plus adds heart disease, kidney problems, sexually transmitted diseases and cancer to the list.

Savoring the experience

Whitehead hopes that her book will infuse women in high-risk pregnancies with a desire to live the pregnancy fully, regardless of previous complications or worries.

"I feel like I really missed out," Whitehead says of her second pregnancy. Do "the normal stuff" as much as possible, even if you're confined to bed, as she was the second time. She tells people to shop online if you can't go out, enjoy the baby's kicks, savor the body changes. "A lot of us women who think we could lose the baby or have lost one distance ourselves from our baby. It doesn't protect us. Enjoy it." It's also important to find ways to feel connected and bolster intimacy with your spouse.

She warns women to "educate yourself about your condition only." Whitehead is a doula, providing assistance during pregnancy and childbirth. She admits that she was obsessed with Ashton's death and immersed herself in unhappy "what ifs." "You don't want to know every possible sad thing. You do want to be a key member of your team and know what to ask." That includes side effects of medicines, what to expect, what the options are.

"If you're struggling and you find yourself depressed and at odds, reach out," she says — to a friend, to someone who's been there, to someone who will just let you unload worries. "Freak out, scream, cry, get it out of your system and move on."

Isolation and a deep sense of being alone are among the risks of a complicated pregnancy. Women who are assigned bed rest, for instance, complain that time stands still for them, while it moves at the same speed for others.

"People don't know what to do with it. Don't hold it against them. Tell them what you need," says Whitehead, who lists that among the things she learned to do differently while pregnant with Drew. With Madison, "I pushed people away and felt like a burden."

Relationships in a challenging pregnancy can be tough. Experts say men seem to fall into two camps: those who talk about it well and those who withdraw and bottle it up. Lots of couples don't survive intact, while others are brought closer together. Whitehead says her husband came to terms with Ashton's death in his own way and it took them a long time to regain their footing.

Better treatments

Both Silver and Whitehead note that treatments are getting better. The use of a particular progesterone drug, called Progesterone 17, for instance, can often reduce the chance of preterm birth. Not all doctors know about that.

There's no shortage of information on aspects of pregnancy and managing complications is no exception. There's an exercise DVD available on exercising while on bed rest. There are blogs and guides with suggestions from inviting a friend to share a day of your bed rest — bring a movie and do each other's makeup or ask your hairdresser to stop by — to a guide to blogging the time away.

Going online for information is generally a very good thing, says Silver, as long as the individual knows that not all the information out there is trustworthy. But a woman who is engaged enough to seek as much knowledge as she can get about what's happening in her pregnancy is a good patient. It opens the door to discuss issues pertinent to the actual pregnancy that's unfolding.

Seven years after Ashton's death, Whitehead says she still gets emotional about it sometimes. "It's not something you will ever get over, but it does get better," Whitehead says.

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