“I had 29 ultrasounds,” says Callista Puchmeyer, a Westlake mother of five children, referring to her sixth pregnancy, which took place in 2018. “Additionally, our baby needed three in-utero blood transfusions (meaning my baby needed blood while I was still pregnant with her). I was at my maternal-fetal medicine doctor’s office weekly, sometimes biweekly.”
She says decisions had to be made about an earlier delivery because she was the told the baby was safer outside of her than inside. Their daughter, Vincenza, was born in November 2018 and was able to come home after a month-long hospital stay.
Puchmeyer and her family — her husband, Jason, and their daughters Annabella, 11; Lucia, 9; Cecelia, 8; and Francesca, 3 — had to make preparations for the long hospital stay
“It was completely different than my non-high-risk, full-term babies,” she says.
The Punchmeyers, however, had experienced a high-risk pregnancy before, when Grace, 17 weeks into the pregnancy, passed away in April 2014.
Pregnancy often is accompanied with visions of a blissful 40 weeks with occasional doctor’s visits and long awaited ultrasound pictures to frame as “baby’s first photo.”
When a pregnant mom learns she is high-risk, like Puchmeyer did, 40 weeks of pregnancy take on a different meaning. Dr. Melissa Mancuso, chair of maternal-fetal medicine (MFM) and director of the Akron Children’s Hospital Fetal Treatment Center, answers what pregnancy can mean for high-risk parents.
What does it mean to have a high-risk pregnancy?
The term high-risk relates to baby, mom or both.
“In my mind, ‘high-risk’ means needing the expertise of someone who is trained to diagnose, manage and treat the complications of pregnancy for mom and/or baby,” Mancuso says. “High risk can mean many different things, like delivering preterm (before 37 weeks gestation), or experiencing a complication needing a procedure like cerclage, or medication like insulin.
“For example, a mom who has high blood pressure is at higher risk for complications for herself and baby due to worsening blood pressure during pregnancy,” she says. “A mom with diabetes is high risk for complications in the baby, if not well controlled, and for issues herself like high blood pressure. A mom who is 35 years old or older is at higher risk for chromosomal abnormalities in the baby, but statistically most pregnancies in moms considered ‘advanced maternal age’ are still healthy.”
Being pregnant with multiples (twins, triplets, or more) requires expert care, especially if the babies share resources like one placenta or grow in the same amniotic sac throughout the pregnancy.
How does care change throughout a high-risk pregnancy?
Mothers experiencing a high-risk pregnancy may need additional monitoring and visits throughout the pregnancy related to the condition identifying her pregnancy as high-risk.
Some high-risk moms worry about being seen by a MFM specialist for a variety of reasons, like feeling more comfortable with their regular obstetrician (OB).
“These moms can continue their care with their regular OB; nevertheless, we strongly encourage high-risk moms to visit a MFM specialist for consultation and, if needed, advanced diagnostic ultrasounds,” Mancuso says. “This diagnostic tool is an invaluable way to identify conditions and issues otherwise undetectable, and more importantly to create a plan for the best birth.”
How does being high-risk affect care during pregnancy?
The Society for Maternal-Fetal Medicine states that a high-risk pregnancy may require more frequent prenatal appointments in order to be closely monitored. MFM physicians are specially trained to care for mothers experiencing a high-risk pregnancy.
The exact care needed for mother and baby depends on particular circumstances of the high-risk pregnancy.
In Puchmeyer’s case, her blood type was incompatible with her baby’s blood type, a condition called Rh negative. The RhoGAM shot prevents the Rh-negative mother from making harmful antibodies, but this shot proved ineffective for Puchmeyer. This condition resulted in the loss of Grace in 2014.
Following her daughter’s passing and for Puchmeyer’s subsequent pregnancies, she was in the care of Dr. Mancuso (driving an hour each way to her appointments). During her last two pregnancies, she says she underwent “tough treatments to keep the babies alive from around 10 weeks and beyond.”
“My concerns were always to keep my baby alive and have her be born alive,” she says. “After losing a baby, something changes you, or at least it did for me. I had so much anxiety over the baby being born alive because I knew all the bad things that could happen. I also was hopeful our babies could be born without life-long problems.”
How does being high-risk affect labor?
If you have a high-risk pregnancy, prepare yourself for the idea “that the birth you have may not be the birth you’d choose,” according to the Society for Maternal-Fetal Medicine. High-risk pregnancies require a hospital birth, as a home birth or birthing center are not safe options. It’s best to give birth in a hospital where baby and mom can be monitored closely and specialist care is available before, during and after delivery.
The American College of Obstetricians and Gynecologists (ACOG) states, “preterm birth (defined as birth before 37 weeks of gestation) is the most common problem of multiple pregnancies. More than 50 percent of twins and more than 90 percent of triplets are born preterm. The number of weeks at which you are likely to give birth decreases with each additional baby.”
Depending on the situation, a high-risk pregnancy may need labor induced to prevent or reduce health problems for mom and baby. There may also be reasons why a vaginal birth isn’t possible and a c-section is the safest delivery.
Talk to your provider about what to expect during labor in order to best prepare.
What are the long-term effects on the mother and/or baby following a high-risk pregnancy?
Mancuso says, “The verdict is still out on this for some conditions; however, moms who develop gestational diabetes are at 50 percent risk of developing diabetes throughout their lifetime. In addition, women who develop high blood pressure during pregnancy are at higher risk of hypertension in the future.”
According to ACOG, preterm babies are more likely to have health problems than babies born at term (39 weeks to 40 weeks and 6 days), like breathing, eating and staying warm because they may not have finished growing and developing.
How can mothers prepare for pregnancy if they know they may experience a high-risk pregnancy?
“The best preparation begins during preconception, or before getting pregnant,” Mancuso says. “The best thing a mom can do is get into the best physical shape prior to conception. I advise moms to start prenatal vitamins a few months before trying to get pregnant. Moreover, try to optimize the medication regimen for conditions. Get on the fewest medications at the lowest doses to control a condition. This does not mean stopping all medications as soon as you find out that you are pregnant. Sometimes, that is more harmful than the medication itself.
“Protect unborn babies by ensuring a future mom is rubella immune (German measles) by getting vaccinated before getting pregnant (vaccination during pregnancy is not recommended),” she continues. “Preconception actions carry the most weight and have the greatest impact on healthy outcomes for mom and baby (or babies).”
Moreover, outcomes are most improved in high-risk pregnancies when the mom seeks a preconception visit with a MFM specialist. For example, getting blood pressure and diabetes under control prior to conception improves the outcomes for all.
To best prepare for a high-risk pregnancy, Puchmeyer advises, “First and foremost, educate yourself. You are your baby’s advocate. So ask questions, speak up if you don’t like something. An excellent doctor will never take this offensively, but it will help you be an active participant in your baby’s care and also reduce your stress if you have knowledge.
“Second, find a MFM you like and can trust,” she adds. “If you have a high-risk pregnancy, you will be spending a lot of your time in their office and with the staff, so interview, get opinions and find one that can work with you.”