Be Proactive, not Fearful, when Pregnancy Issues Arise

SIOUX FALLS, S.D. (June 1, 2007) - "High risk" are two little words capable of causing big worries for expectant mothers. Yet through technology and today's highly specialized medicine, much can be done to address the different risk factors of pregnancy.

Dr. Les Heddleston, perinatologist with the Avera Maternal-Fetal Medicine program, said it's often more helpful to think in terms of risk factors, rather than in black-and-white terms of "high risk" or "low risk." Worry and anxiety aren't as productive as a healthy, proactive concern. "If you're worried and do nothing, you waste energy. If you're concerned, you take time to become educated about your medical problems with your provider," he said.

Among risk factors are a history of pre-term labor or delivery, a history of pregnancy loss, an incompetent cervix, high blood pressure, diabetes and medical conditions such as thyroid disease or blood clotting disorders.
Previous problems in pregnancy, such as placenta previa, shoulder dystocia or otherwise difficult deliveries indicate a woman might have similar problems again. And even situations like twins or triplets on the way, being over the age of 35 or weight issues can present risks during pregnancy.

Maternal-Fetal Medicine is a sub-specialty of obstetrics/gynecology dealing with high-risk pregnancy. Perinatologists have two to three years of additional training past their OB/GYN residency, which focuses only on high-risk pregnancy.

In trying to conceive, Jasele Brue of Sioux Falls had surgery and treatment to overcome infertility. When she actually did become pregnant, her OB/GYN physician suspected she might be at risk for complications. This proved to be the case, when perinatologist Dr. Naomi Wahl of Avera Maternal-Fetal Medicine detected a birth defect at 17 weeks. Brue's condition was closely monitored throughout her pregnancy. When she went into preterm labor, she was put on bed rest for five weeks and ended up having an emergency C-section to bring her son Preston safely into the world.

"With our second child, we had another whole scope of problems," Brue said, including preeclampsia and bleeding due to placenta previa. "Dr. Wahl joked with me that I had experienced about every pregnancy complication there is." That baby, Pierce, was born seven weeks early.

While carrying her third child, Palmer, now 3 months old, Brue experienced pre-term labor at 25 weeks. After contractions were controlled through bed rest and medication, Brue carried the baby to 38 weeks. "We were so lucky to have excellent care for all three children. With the preterm labor or preeclampsia, I could have had a baby way too early," she said.

 Perinatologists work in cooperation with a patient's regular obstetrician or family practitioner, as well as other sub-specialists. "There are cases in which we can make a dramatic impact," Heddleston said, cases in which the baby would not survive without immediate intervention.

Other times, the work of a perinatologist is a matter of waiting and watching for the best time to deliver - late enough for the baby's development, and early enough for the health of the mother. Heddleston recommends that patients find a physician they are comfortable with, and then follow their physician's advice. "It's always good for patients to be proactive in understanding their risk factors," he said.

Brue and her husband, Scott, now have three boys, Preston, 4; Pierce, 2; and Palmer. "I was so grateful to be able to be a mother, because there was a point when it looked like it might not happen for us," Brue said. Excited to even become pregnant, Brue handled the complications as they came along, reassured by the sense that she and her physician were doing everything that could be done to ensure the best outcome. "You just have to deal with whatever comes your way. Anything and everything you have to go through is worth it - and then some," she said. "We have been blessed with three amazing and wonderful little boys."