When Pregnancy Doesn't Go as Planned
The vast majority of pregnancies are eventful only in the excitement and joy of anticipating the birth of your baby. Most women work to optimize health and do “all the right things” to have a healthy pregnancy. But even the healthiest women will encounter unexpected outcomes, both major and minor. It is important to understand that we cannot control everything in our pregnancies, just as we cannot control whether the rain will fall or the sun will shine. Sometimes, the best we can do is roll with the punches and adapt to what life gives us.
Planning Ahead
First and foremost for a healthy pregnancy, plan ahead. Optimize your health, work toward an appropriate weight, stop smoking, and take a folic acid supplement. Schedule a basic checkup to see that you have normal blood pressure, thyroid function, blood count and immunity to German measles (rubella). If you have a
pre-existing medical condition, consider having a preconception consult with a maternal fetal medicine specialist to learn how your condition is impacted by pregnancy and which medications are the safest.
Prenatal Care
Partnering with a healthcare provider to help you maximize your health during pregnancy is what prenatal care is all about. Your monthly to weekly visits help confirm your and your baby’s health and provide you with information about staying healthy and preparing for childbirth.
Some Common Complications
- First Trimester Bleeding – 25 percent of women will experience some bleeding in the first 12 weeks. Usually, this is self-limiting and not harmful to the developing embryo. It may be a remnant of a hormonal signal to begin menstruation. It may be bleeding from the placental site where the growing embryo is “burrowing in” to the uterine blood lining. There may be mild cramping, red, pink, or brown blood when you wipe, or even a small blood clot. Severe cramping, heavy bleeding or spotting that persists for more than two days should be discussed with your healthcare provider.
- Early Pregnancy Loss – 20 percent of fertilized eggs fail to progress to a normal pregnancy. Most pass through our bodies without implanting in the uterus. We may not even realize we were pregnant. Some will begin to implant and fail; these are often recognized as early miscarriages. Still others will fully implant, develop for perhaps nine to 11 weeks and just stop growing. Miscarriage (the medical term for which is “spontaneous abortion”) may be complete or incomplete. A complete abortion is fully expelled by a woman’s body like an extremely heavy and painful period. An incomplete abortion requires medical or surgical treatment to complete.
Rarely, the pregnancy will implant in the Fallopian tube. This is called an ectopic pregnancy and can endanger a woman’s life. If you are diagnosed with an ectopic pregnancy, follow your provider’s instructions carefully until it is completely resolved.
If you have never had a baby and experience two miscarriages, consider consulting a specialist. It is important to remember that nothing you do causes miscarriage, which is a natural part of human development and rarely repeats itself.
- Gestational Diabetes – Pregnancy causes changes to a woman’s insulin/glucose regulation system, creating a mild level of resistance to insulin. This is nature’s way of keeping sugar in our blood longer so it can circulate to the new organ in town, the placenta. Three to five percent of women over-respond to this mechanism, and their blood sugar remains too high for too long; this is called gestational diabetes. If left unchecked, the baby gets too much sugar, secretes insulin at higher levels, and is in danger of growing excessively large and of having difficulties regulating his/her own blood sugar after delivery. This insulin resistance peaks at 24 to 28 weeks, which is when you should be tested. Gestational diabetes has no symptoms, so the glucose tolerance blood test is the only way to be diagnosed.
Most women can self-regulate their insulin resistance with diet and exercise. If you are able to maintain normal blood sugars for the rest of the pregnancy, there are no known harmful effects on the baby. If you cannot regulate your glucose with diet and exercise, you should begin medication to help; in such cases, special monitoring of your baby’s health is indicated.
- High Blood Pressure – One of life’s miracles is that a woman can grow a 5 to nine-pound baby inside her body with a two-pound placenta, increase her blood and body water by almost five quarts, and still maintain normal pulse and blood pressure. Think of the changes that occur in your body to allow this adaptation! Occasionally the body does not adapt and blood pressure rises toward the end of pregnancy. Even less often, preeclampsia, a condition characterized by pregnancy-induced high blood pressure, protein in the urine, and swelling due to fluid retention, develops.
Regular (monthly, then weekly) monitoring of your blood pressure will help diagnose these conditions early. Primary prevention (diet, exercise, lifestyle changes) can prevent or minimize gestational hypertension. Preeclampsia is more random and difficult to predict. If you develop preeclampsia, close monitoring and, sometimes, early delivery are essential to your and your baby’s health.
Assume the Best
Some women lose a lot of sleep in pregnancy, anxious about every possible thing that could go wrong. So much energy spent! Most women sail through pregnancy without any of the problems described here. It is important to keep perspective on what you can and cannot control. Do your best to stay healthy. Work with a midwife or doctor to help monitor your pregnancy. If a bump occurs along the road, take it in stride and go with the flow. If you find yourself focusing on the negative, consider partnering with a therapist or a skilled childbirth educator to learn breathing, relaxation, and visualization techniques that will help keep you centered throughout your pregnancy, birth and the exhilarating, challenging role of parenting ahead.
