If pregnancy after loss is a mind game, a high-risk pregnancy after loss is a mind game on crack. When your pregnancy after loss becomes high-risk, you face a double-whammy of a loss of innocence and heightened anxiety and fear.
To put it simply, a high-risk pregnancy is one which requires extra measures to increase the likelihood of a positive and healthy birth outcome. This can range from chronic health conditions in the mother, multiple fetuses, a complicated past pregnancy history, a condition the baby has, or any other complication that requires extra care. While this label can feel scary, depending on the circumstance, it can be possible to have a healthy high-risk pregnancy.
Follow these 10 tips to help manage your high-risk pregnancy:
1. Start with a great team.
Request a referral to a high-risk doctor, otherwise known as a Maternal-Fetal Medicine Specialist (MFM). This doctor has had several years of additional, specialized training in obstetrics beyond what a regular OB/GYN has. If you have a great relationship with your OB/GYN, you should be able to see both your MFM and regular OB during your pregnancy. In fact, your MFM may prefer it. If you do not feel that your provider is taking your risks seriously, you should always seek a second opinion.
2. Get prenatal counseling.
If you think you are ready to try again, meet with your team to discuss what tests you may need to run, what statistics you need to be aware of, and any recommendations of what you should be doing prior to or during your season of trying to conceive and after conception. If you have a history of infertility or recurrent pregnancy loss, adding a reproductive endocrinologist to your team is a smart idea.
3. Bring your hospital records/nurses’ notes from your previous pregnancies.
You can request records from your hospital from your previous deliveries, surgeries related to pregnancy/fertility, etc, including the nurses’ notes. Bring these documents with you to your consultation with your MFM. This will be a substantial stack of paper, but you bringing it ensures that nothing will get lost over fax. (And if you’ve tried to have your records faxed before, you know there’s a special hole in the universe specifically for faxed medical records. You want to avoid that black hole.)
4. Create a game plan.
After you’ve assessed your specific risk factors with your team, it’s time to discuss your game plan. Ask for clarity on what early interventions are possible. Have them explain how often you need to be seen, and what tests you can expect them to run, and when they’ll run them. Decide if you are a good candidate for a c-section, vaginal birth or vaginal birth after cesarean, and what would change those delivery plans. Find out what preventative medical treatments are available if any. Be upfront about your fears and your questions. You may have suggestions on tests you’d like or options for your pregnancy based on your experiences, research or just your own peace of mind. That’s OK to bring up. A good doctor will listen and then weigh in with their own insight. Remember, you are a team, creating this game plan together in hopes of the best possible results.
5. Create contingency plans.
As you progress through your pregnancy, talk with your team about what to do if something changes. Having a backup plan for the most likely scenarios can allow you to feel even the slightest bit more in control. It also means that your voice is heard loud and clear before you’re in an emergency where you may have to make quick decisions. When it comes to your appointments, ask, ask and ask some more. Knowledge is your power to help you make decisions.
6. Advocate for yourself and your baby.
You are the specialist on your own body. You know what feels right and what doesn’t. Your doctor should be explicit about when to request extra monitoring, how to best contact them in case anything changes, and what signs and symptoms you need to be aware of which might indicate a problem. In order for any of that to work, though, you’ll need to advocate for yourself. Remember that any doctor would rather you come in and something not be wrong than to not go in and something be wrong. You are your own (and your baby’s) best advocate.
7. Decide on your hospital.
Your high-risk status may mean you need to be seen at a hospital with a neonatal intensive-care unit (NICU). It may mean you are free to deliver at your local hospital baring any further complications. Or it may mean you need to stay within a certain driving distance of a university hospital toward the time of your delivery. When choosing where to deliver, take into consideration how far away it is, what level of NICU the hospital has, who will deliver your baby there, the recommendations of your team, and the level of difficulty in visiting in case you are discharged from the hospital before your baby.
8. Get support. You are not meant to do this alone.
Besides your medical team, you need a community who will hold your hand during tests, bring you meals if on bedrest, help take care of living children during your million doctor’s appointments. You need people who will help meet your emotional, spiritual and physical needs during this very vulnerable time in your life. Online support is also helpful. I found having a secret Facebook group for my friends who wanted to remain updated on my pregnancy to be very comforting. I could share with only those who were ready to support me, without worrying about triggering people.
9. Hold on to hope.
A high-risk pregnancy does not necessarily mean an unhealthy pregnancy. It simply means that your condition, your baby’s condition or your medical history indicates you are at higher risk than the general population for complications. It is possible to begin a pregnancy high-risk, and later be demoted to normal-risk pregnancy (and vice-versa). But being high-risk can have its advantages. For those of us who may already deal with anxiety because of our previous losses, knowing that doctors are taking our pregnancy very seriously and offering above-average care and monitoring can also bring a little more peace of mind.
10. Take it day by day.
It is so hard not to rush a million-miles-an-hour down the “what if” highway when you have a high-risk pregnancy. But 40(ish) weeks is a very long time to be in a constant state of stress. When you start to feel overwhelmed, take a few deep breaths and remind yourself that at this moment, your baby is with you and you are okay. Sometimes, it’s too much to take a high-risk pregnancy month by month, or week by week. Sometimes, all you can do is take it one breath, one moment, at a time. If you find that no matter how hard you try, you cannot find a moment’s rest from the stress, please talk to your provider about options for further mental and emotional support.
Having a high-risk pregnancy with your rainbow baby can be so very hard emotionally and physically. But with a strong medical team, a clear game plan and practical support, it can be possible to have a healthy high-risk pregnancy. And no matter how your pregnancy ends, you can have some peace of mind that you and your team did absolutely everything possible to give you and your baby the best possible care.
Have you had or are having a high-risk pregnancy? What tips might you add to this list?