Coping with complications

Coping with complications

Morning sickness is an equal opportunity employer. It doesn’t care whether a woman lives quietly in a Maine town or is an international celebrity. Just ask Shauna Thomas of Gray, or Kate Middleton, the Duchess of Cambridge, whose bout with an acute form of the common pregnancy complaint made front-page news.

Unlike Middleton, Thomas, who is 36 and pregnant with her second child, did not experience morning sickness the first time around.

“My first pregnancy was a breeze and I barely had any symptoms at all,” said Thomas. “I didn’t find out I was pregnant this time until 12 weeks. Morning sickness had kicked in and alerted me to the fact that I was probably pregnant.”

Morning sickness is not the only problem that can arise as a result of pregnancy. Anemia, hypertension, gestational diabetes, and post-partum depression are just a few of the complications that women can face.

But there is no need to panic. Although each pregnancy is unique, there are some common steps women can take to reduce or alleviate issues that may crop up. And there are resources out there to help.

Leah Deragon is a founding director of Birth Roots, a resource center in Portland for pregnancy, both pre- and post-natal. The nonprofit offers non-clinical, community-based education and support throughout pregnancy and the first year of parenting. Birth Roots also publishes a free local resource guide each year.

Deragon has found that reduction of stress can alter the course of a pregnancy.

“Stress is toxic to pregnancy. Developing coping skills, working with a team, finding useful resources all helps reduce it. Take hold of the pregnancy and any issues right away to avoid them becoming major. Pregnancy often is approached as a disease, but it’s not. The sooner a woman takes responsibility for her health, the better,” said Deragon. “Your own influence determines a lot as you find your way through the spectrum of choices, all of which are individual. There is not a single path for women to take.”

Dr. Anne Rainville of Women’s Wellness Comprehensive Care in Portland is a fellow of the American College of Obstetrics and Gynecology and a board-certified obstetrician/gynecologist. Rainville, who is also a surgeon, has been practicing in the Portland area for more than 22 years and is experienced in pregnancy care. She agrees with Deragon about the importance of women taking an active role in their own health.

“Pregnancy and thinking about becoming pregnant is a very exciting time in a woman’s life; however sometimes pregnancy and the postpartum period are not always the way that one might envision it,” said Rainville. “Early pregnancy can be especially challenging with unexpected body changes, as well as the dreaded morning sickness. During pregnancy, sometimes complications arise that can be very concerning for the health of both the mother and the baby. This might all seem overwhelming, but there are some things that a woman can do to help prepare herself to be better able to avoid or alleviate some of these problems.”

Thomas learned of her pregnancy just two weeks after her husband left to start a new job in North Dakota while she stayed in Maine to manage the household and care for the couple’s 3-year-old son. She goes about her day-to-day life doing her best to cope with the nausea that often accompanies morning sickness.

“Not having my spouse here to help me with trigger situations has been a huge challenge. Obviously, it’s not a situation we could change, so I had to learn to push through my symptoms to deal with situations, even if it ended with me getting sick,” said Thomas. “Smells are a huge trigger for me, especially things like handling trash bags, dealing with pet odors and issues, and even the smells of certain foods.”

Movement is another trigger for Thomas.

“My symptoms almost always kicked in on days when I was rushing to get out the door,” said Thomas. “I do think calling it morning sickness is a little bit of a misnomer. For me, symptoms could happen at any time of day without warning. The good news is we’ll be joining my husband in North Dakota soon and he’s more than happy to help.”

Rainville said the most important thing a woman contemplating pregnancy can do is to ensure that she is as healthy as possible before she becomes pregnant, including maintaining an appropriate weight.

“Not only is this important for the woman so that she does not put herself at risk with excessive weight, but there is increasing evidence that excessive weight gain before and during pregnancy is hazardous for the baby as well,” said Rainville. “Having a healthy and varied diet before becoming pregnant sets you up for continuing that good diet when you’re pregnant.”

But having a healthy diet can prove challenging especially if morning sickness makes it difficult to even think about eating. That is why Rainville suggests women consider taking prenatal vitamins for a few months before they become pregnant.

“If you’re used to taking your prenatal vitamins, and can continue to take them, then diet is actually not that crucial in the first trimester. Babies are extremely efficient and getting what they need from you in this early part of pregnancy, other than folic acid. Taking your prenatal vitamins assures that they get this important nutrient,” said Rainville.

Controlling weight gain during pregnancy is another way women can reduce risks. Rainville notes that for women of average weight, gaining 25 to 30 pounds during pregnancy is the most recent recommendation.

But for Rainville, the most common and concerning complications of pregnancy are those associated with hypertension.

“The most serious is that of pre-eclampsia or toxemia pregnancy. Although we don’t know of any specific ways that this can be prevented in all women, it is important that a woman let her health-care provider know if there is a family history of this problem or if she herself has any underlying high blood pressure,” said Rainville. “In these specific instances, there are some things that can be done to help reduce the incidence of preeclampsia.”

Preeclampsia, characterized by high blood pressure and signs of damage to other organ systems, often the kidneys, is a complication that generally starts after week 20 of pregnancy.

Gestational diabetes is another common complication, according to Rainville.

“Again, we do not know of any specific ways to prevent this disorder; however this condition is very easily treated by dietary changes in most women,” said Rainville. “Undiagnosed and uncontrolled gestational diabetes can lead to significant complications for the baby, as well as the mother. If you have a family history of early diet controlled diabetes, of gestational diabetes, or if you are obese, then you might develop this condition earlier than expected. Because of that, it’s important to let your provider know so that you can be screened early, and treatment can be started early to help reduce the incidence of complications.”

But once the baby has arrived, everything goes back to normal, right? Well not exactly. For one thing, having a new baby can be overwhelming, not to mention exhausting, according to Rainville.

“Preconceived notions of how you feel the postpartum time should be, as well as expectations of family and friends, can leave you feeling blue. Things do not always go smoothly with what you expect should be simple, such as feeding your baby,” she said.

“It is common to have feelings of inadequacy when faced with this beautiful little person who is a complete mystery to you. The postpartum blues are a real thing. It is normal for women to have feelings of unexplained sadness and crying with mood swings in the first weeks after having a baby. These feelings should resolve approximately four weeks postpartum. If you find that these feelings linger, and are associated with excessive anxiety or sadness as well as difficulty sleeping, then you should let your healthcare provider know as soon as possible. These are signs of postpartum depression,” Rainville added.

Rainville said postpartum depression is easily treated safely and women should not hesitate to ask for help.

“It is important to involve your partner. Don’t overlook this resource for you and your baby. Encourage and allow your partner to take care of the baby as much as possible; that way you can perhaps take some time for yourself,” said Rainville. “The single most important factor for a happy baby is a happy mom. Remember this so that you can allow yourself and other people to help take care of you, as well as the baby.”

For Deragon, the key to a positive pregnancy and entering the world of parenthood is to acknowledge that it will be a transformative experience.

“The role of Birth Roots is to help women slow down, reframe their mindset, value pregnancy in the evolution as a person and parent,” said Deragon, “embracing the journey rather than being overwhelmed by complications. You don’t have control over labor but you do have control over the pregnancy.”

Thomas said that paying attention to her body has been effective in dealing with her morning sickness. She also talked with her obstetrician about it.

“Her recommendations were great. She suggested that I learn to slow down and ask for help if it’s available,” said Thomas. “She also told me that B vitamins are sometimes a big help for women with morning sickness. She reassured me that morning sickness usually passes for most women during the first half of their pregnancy. The main thing that has helped me was learning to slow down. If I started feeling symptoms, I would take a few minutes to remove myself from the situation, stop, and rest.”

Will Thomas and her husband have another baby?

“This is our second baby and I think we are done,” said Thomas, who added, “and not because of my experience with morning sickness, but because we think having two children will be the perfect number for us.”

Maine native Dr. Anne Rainville, after completing her medical school training in Vermont and residency in Washington, D.C., returned to practice in Maine. Rainville is also trained in acupuncture.Leah Deragon is a founding director of Birth Roots Perinatal Resource Center. Deragon and co-founder Emily Murray teach classes and share administrative tasks and long-range planning for Birth Roots, a nonprofit located in Portland.Birth Roots perinatal resource guide offers a collection of local resources from pregnancy to parenthood for women, men, couples and families. Courtesy photosAccording to complications of pregnancy can involve the mother’s health, the baby’s health, or both. Some women have health problems before they become pregnant that could lead to complications. Other problems arise during the pregnancy even in healthy women. The following chart, developed by the Office on Women’s Health at the U.S. Department of Health and Human Services, lists common pregnancy complications. For more information about the problems or symptoms listed here contact your medical care provider and follow their advice about treatment plans.

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