How to Deal with a High Risk Pregnancy

Eils Hewitt: For many women pregnancy is a time of unparallel joy and expectation but for others, especially those with medical conditions, pregnancy can be time of fear and uncertainty. Dr. Susan Bewley is a Consultant Obstetrician at Guy's and St. Thomas' Hospital in London specializing in High Risk Pregnancy. Thanks very much for coming in today. Firstly let's just clarify what we mean by High Risk Pregnancy. Dr. Susan Bewley: Well, anything can go wrong in any Pregnancy, but there are women for whom we know the chances are that if there is something wrong with the baby or threats to the mother's health is little bit higher. Obviously there isn't just low and high risk, there's a whole degrees of risk but I look after women with medical complication, that we already know about. Eils Hewitt: So, firstly then in the initial stage of pregnancy or before pregnancy is there anything that a woman should do before she gets pregnant? Dr. Susan Bewley: Well, all doctors say that you shouldn't smoke and we don't recommend that women who are thinking of getting pregnant smoke, we would like women to quit drinking alcohol or taking illegal drugs. There's a vitamin called Folic acid that we allow the women to be taking if they know they are trying to get pregnant for the first three months, because that prevents Spina Bifida. But if a woman has got a medical condition or is on medication, for many of them, that's fine it doesn't affect the pregnancy, mild asthma isn't a problem but there are women who are on medication for epilepsy or things like that, you might want to talk to the doctor before hand or a midwife and so the preparation, if you know you might have a problem, that's something is worth looking in to. For most women just have to be sensible. Eils Hewitt: So how do women know once they are pregnant that the baby is alright particularly, if they got some certain medical condition or what have you? Dr. Susan Bewley: Well there's no guarantee any baby is alright, certainly we can look at the baby, we can look at anatomy of the baby at the usually 5 months scan for women who have got a high risk of having chromosome problem that's the things like Down Syndrome, there are blood tests and scan, that might give risks and some women will get offered test where you put a needle in the tummy to actually check that out. There are some women who are late in pregnancy have problems with the baby's growth, placenta might not be feeding the baby very well and we pick that up through the routine checks, seeing if the baby is not growing well, but for most women seeing the baby on the scan is mostly reassuring and then in the late pregnancy knowing the baby's moving well is a way of knowing the baby is alright but many things don't show until after birth of the child, so there's no guarantees. Eils Hewitt: I know certainly when I went for my scan, I have got 5 month old baby, it was just amazing to see, you know, see the scan and to see him actually you know moving and to find that all the basics were in the right place, so it certainly gives you peace of mind, doesn't it? Dr. Susan Bewley: It does but it's a medical test, and it's got its fallibilities and some things don't show. Eils Hewitt: So, who's more likely to have an abnormal baby then, are there certain types of women? Dr. Susan Bewley: Well, there are some women who've got a diseases that are genetic, they may know they've got a problem that they can pass on to their children, they may not know. For example, many black women carry something called Sickle cell that's fine but if their partner also carries it, then there's a one in four chance their child would have Sickle cell In a wide population, cist fibrosis can come in a child and there are some people if their cousins have a slightly higher chance of inheriting genetic disorders and we can look for those things more specially. Certain drugs cause abnormalities and some of those things can be picked up on scans. Older women can have more things like Down Syndrome. So you can have an abnormal baby through something you already know about but most of it, just happens to women who are totally normal. Eils Hewitt: What are the common risks in pregnancy then? Dr. Susan Bewley: Well, the common things are problems of development, it's very complicated to make a human being and particularly, for example Spina Bifida or the head closing, that can be quite common. A lot of babies have heart diseases, some -- because the heart is very complex organ, little holes in the heart may not matter, big problems with the chambers might matter. So any system can have a problem going wrong but most things are minor that babies are born with little tags, shortening or extra fingers, or toes that sort of things. So again anything can go wrong anywhere because we are too complex to make. Eils Hewitt: I have got a friend who's baby was born basically the wrong way around, but they were 8 months before that was picked up and they I think had a cold that got serious. The whole legs and all sorts of things but it's unusual, I find it unusual that even when your baby is born even afterwards that there are not more tests on your baby to check that everything is normal. Dr. Susan Bewley: Well it's partly because those things don't show, and because the heart does different work to do before you are born and when you're younger when you're growing up, many childhood diseases only show as babies are growing. Cerebral palsy won't show when babies are born. So I think in an era of technology, we have very high expectations of the tests that are reliable but actually human nature and evolution has made us what we are and we can't pick everything up. Eils Hewitt: So there are certain things that, we can do as a woman I suppose. So for example, with being underweight or overweight, and we should be of certain desirable weight before we get pregnant. Dr. Susan Bewley: It's certainly easier to get your weight right before you're pregnant than when you're pregnant and again doctors like to see people with what's called a body mass index between something called 20 and 35 but the slim, and there's a little bit overweight and that's fine, that's all within the normal range but women who are very thin, women who have got things like anorexia do have more problems with babies being born early and with breaking waters, with growth problems and sometimes even a strain on their hearts. Women who are very overweight, obese or more bigly obese have more risks of clots on the leg, they have more risks of blood pressure problems, if they end up with cesareans, they have more problems with the wound and getting mobile again and being very overweight can be associated with very serious complication. So yes doctors like women to be in that normal range and just you know put on a reasonable amount of weight but I don't think, you can be too obsessive in dieting in pregnancy rather staying the weight you are, is probably a best thing. Eils Hewitt: What about psychologically as well, I mean are there any effects if you're kind of depressive or anxious, how does that effect the pregnancy? Dr. Susan Bewley: Well, that's the little less worked out. We know that it's not a good thing but more really for the mother, it's not good for her to be anxious or depressed. Women who are anxious and depressed are more likely to get postnatal depression afterwards and being very tensed and not being able to enjoy her pregnancy is not a good thing, it may have a little effect on growth, it may have little effect on the relationships afterward. So it's very important for mothers to look after themselves and most medications that are used, most talking treatments that are used, are perfectly safe in pregnancy. But some women have very anxiety, failed pregnancies because they haven't got supportive relationships or even violent relationships and when it's very abusive, that has much more serious effects on the baby in terms of miscarriages, premature labor things like that. So, again it depends slightly on the level of the anxiety and depression, but if women are worried they should find someone to talk to, midwives and doctors, confidential and then people can advice what can be done. But it's very important to tell people how you're feeling in pregnancy because of the serious problems of postnatal depression afterwards. Eils Hewitt: So what are the kind of common complications then during pregnancy? Dr. Susan Bewley: Well the commonest complication is that the pregnancy doesn't carry on, lot of people don't realize that actually one in four pregnancies miscarries in the first three months, having got passed the first three months, the serious complications can be led to miscarriage or premature labor which about 3-5 in a 100 women have baby too early. The common things where mothers can be bleeding in pregnancy, blood pressure disease called Preeclampsia and then just the difficulties of giving birth that lots of women have, help with assistance with Forceps or cesarean things like that but most women do absolutely fine. Eils Hewitt: And obviously, Preeclampsia is tested before as well isn't it during your pregnancy. Dr. Susan Bewley: The main reason, we introduced Antenatal Care free long before the health service was set up was to get women iron tablets to avoid anemia and to get a blood pressure and urine checked to look for this disease Preeclampsia. So the routine of going to a midwife or doctors to look for those particular diseases. Eils Hewitt: And as a pregnant mom, what signs would you look for -- are there any worrying signs? You know for example, excessive bleeding or anything that you should look out for. Dr. Susan Bewley: Yeah, the most worrying thing obviously is abdominal pain, although actually there are a lot of funny new feelings and pains that are normal in pregnancy, bleeding from the vagina is quite serious but again most women even when that's happening the baby is alright. Certainly things like Preeclampsia can cause headaches and pain in the tummy, the problem is that a lot of the feelings of pregnancy, short of breath or feeling bit headache are quite normal and that's what the specialists and midwife and doctors are trying to distinguish, what's pregnancy and what could be serious. But it's very important, it's the most important time of a woman's life and most important thing she does, so clearly any worries or any anxiety she must feel free to talk to people about, get it checked out. Eils Hewitt: Yes and obviously if your first pregnancy, yeah you're right your body is doing all sort of things, you're like what's going on. So often should people consult their doctors would you think? Dr. Susan Bewley: Well the main thing is to get there early so that gives us a clue as to how pregnant you're and to be able to schedule the time to be seen, quite often they are very anxious in the beginning because they haven't got that before, actually lots of midwifes worry more at the end, which is when things can go wrong. So but most people have schedules where people are seen a bit more frequently as the pregnancy goes on and can be seen anytime if they are worried or usually there are phone call numbers that people can phone if they are worried anytime 24 hours a day. But at the beginning sometimes people are seen for two months, at the end they might be seen every week. Eils Hewitt: So in terms of age affecting your pregnancy, can older women conceive just as easily as younger women? Dr. Susan Bewley: No, the difficulty in getting pregnant which 1 in 10 couples will experience goes up quite a lot from 35 and dramatically over 40 and interestingly a lot of women are putting off having their babies and drifting out of what we think is the best time to being over 35 or over 40 and then sometimes they need help getting pregnant and it doesn't work so well, when women are older. IVF fails 9 times out of 10 if you're over 40. So, it's probably better to start younger and then you've got time and room for maneuver. Eils Hewitt: Yeah it seems certainly I seem to, seem to think that it seems that ladies -- the age in which you're becoming pregnant is kind of polarized, it's either you know kind of 15, 16, 17 or as you say you know kind of mid 30s, so it seems peculiar that actually the safest time is that but in the middle. Dr. Susan Bewley: The best time biologically and medically is between about 20 and 35, obviously most teenagers are fine and most older women are fine but we see quite dramatic differences particularly as women go over 35. Eils Hewitt: So what common conditions then or what medical deconditions are common in older women. Dr. Susan Bewley: Well we've mentioned that women may have difficulty falling pregnant at all, miscarriages go up, things like Ectopic pregnancies those are pregnancies in the tube go up and we see that the diseases we've talked about bleeding, Preeclampsia, the placenta not working all go up and the risk to the mother of clots, complications, ending up on incentive care units or death, even death all go up as well. So as far as the baby is concerned, the risk of abnormalities goes up and the risk of growth problems goes up. It's not entirely doom or gloom but there isn't anything barring mothers being a little bit more mature and parenting in a slightly more mature way. There isn't anything that's a benefit from putting it or from the baby's point of view, it might be sensible if someone is waiting for the right man or Mr. Good Enough, it might be sensible from her career point of view but she is pitching her life choices against her reproductive choices which are running out with the time. Eils Hewitt: I mean generally how well do older ladies cope with pregnancy other than kind of medically? Dr. Susan Bewley: Well they mostly cope fine, they are a little bit more anxious than younger women, because I think they are aware of these issues and they might take a little longer to recover or but mostly they are fine because most people are still pretty fit. One of the other problems that can happen is that whilst most people are very fit at 20, by the time women are 35 or 40 a few more of have had things like arthritis or cancer or heart disease and that can very negatively affect the pregnancy. So a few unlucky people have actually developed long term illnesses and that can interfere with pregnancy in a much bigger way but we don't know that when we're young, who's going to be unlucky. Eils Hewitt: And in terms of the birth situation with an older person, are they more likely to need a Cesarean section would you say, or is that a myth? Dr. Susan Bewley: If a older mother who has had babies before, her omb or her uterus work very well and she is usually fine, a first time older mother, the uterus doesn't seem to contract so well and maybe because she has been more fearful but there's a slightly high chance of having a cesarean. On the other hand if you have one, there's also a higher chance of getting complication. So generally we say leave it up to nature and see if the baby will come and fit and get monitored as per usual. Eils Hewitt: Well, thank you very much for coming to chat with us today and certainly putting our minds at rest.