Many of the problems discussed above do not cause serious health risks for the pregnant woman and her unborn baby. The problems discussed below may be associated with poor outcomes for the mother and/or baby.
“Risk” is a relative term when it comes to pregnancy. Any one condition may involve, maternal risk, fetal risk, both maternal and fetal risk, and temporary or long-term risk. Severity of potential risk is obviously an important factor, too. When discussing high-risk pregnancy it is important for a woman to understand all these aspects of her own particular risk. Discussions with one’s doctor or midwife are extremely important.
If your doctor or midwife identifies a risk factor in your personal history, family history, health status or pregnancy, you may want to explore the aspects of the particular risk. Here are some questions you may want answered:
- What is the physiologic basis of the risk? For example, if one has mitral valve prolapse, what is that and how is it related to a potentially poor outcome for the mother and/or baby?
- What it the chance that the risk actually produces or is involved with a poor outcome? For example, if one is a carrier of Herpes, what percentage or fraction of patients transmit the bacteria to the baby, and what percentage of the babies actually show signs of infection?
- What actions can be taken to decrease the risk?
- What are the complications to any treatment?
- What are the alternatives to any treatment?
Pregnancy and childbirth are inherently risky times in a woman’s life. It is often the first time that a healthy woman in a developed country comes close to the possibility of significant illness, and even death. It was not too long ago (your grandmother’s generation) that pregnancy was feared by most women due to the risk of death of both mother and baby. Today, in developed countries, maternal death is relatively rare…..about 1 maternal death for every 10,000 live births. But it happens in the very best of hospitals under the very best of care. It is one of those facts of life.
Risks to fetuses and newborns are significantly greater than risks to mothers. Pregnant women, by their very nature, are usually the youngest and fittest of society’s members. Babies, however, are society’s most fragile members. Pregnancy and birth-related factors account for a perinatal death rate of 1 in every 100 live births in the U.S., and this does not count miscarriages.
The single, most serious threat to an overwise healthy fetus is to be born prematurely (too early). Prematurity accounts for the largest piece of the pie when it comes to neonatal morbidity (illness) and mortality (death). A fetus does not use its developing lungs to oxygenate its body. Obviously, it is crucial that the lungs mature adequately before birth occurs. If a newborn cannot breathe and oxygenate the cells of the body, those cells become damaged and die……life on this planet revolves in and around oxygen. Most babies do not have adequately mature lungs until about 34-35 weeks gestation (about 5-6 weeks before an average due date)……even some babies born between 34 and 37 weeks have significant lung immaturity.
Lung maturity is not the only problem related to premature birth. Other “organ systems” may also be immature prior to a baby’s due date. A baby’s ability to fight infection is dependent on his/her immune system. Even babies born on their due date may have some immune system immaturity. The liver is another organ which needs to be significantly mature before a fetus leaves it mother. Also, a baby’s ability to keep warm and regulate body temperature is dependent on maturity.
Neonatal intensive care units have made remarkable strides in improving the health of premature newborns. In fact, almost all of the recent improvement in the health of babies born prematurely is due to the advances in neonatal medicine…..not in the prevention of premature births. In the U.S., the percentage of premature births has not decreased significantly in many decades.
It is important that a woman with significant risk factors in pregnancy be cared for in a system which can handle the worst-case scenario. If a woman is not of the “lowest risk” (but most women are of the lowest risk), she and her care provider should at least be in consultation with a board-certified obstetrician. About 10-20% of women are of significantly high risk to warrant receiving all of their care from an obstetrician. For the highest risk women, their obstetrician may be in consultation with a perinatalogist or other “sub-specialty” doctors.
Finally, women with a significant risk of premature delivery (prior to 34 weeks) should give birth in a hospital with a neonatal intensive care unit. In the U.S., these are called Level III centers (or tertiary-care centers).