As doctors, what are the top 5 actions you would encourage newly pregnant women to make in keeping their pregnancies in the low risk category?
As there are personal or behavioral liabilities that contribute to high risk pregnancy I would include the five actions below. Remember that even under perfect circumstances, sometimes pregnancy can become high risk.
- Keep your weight under 180 pounds prior to pregnancy and 200 pounds while pregnant. There have been studies showing that patients starting pregnancy at higher weights show increased rates of cesarean section (Nuthalapaty, Rouse, & Owen, 2004). This is true whether the patient is induced or goes into labor naturally. There are many compounding factors in this dilemma that range from proper nutrition to exercise and what patients feel they can or cannot do. You are not really eating for two when you are pregnant and you must still be very observant of what goes into your mouth. Many patients also believe that they have to gain weight during pregnancy and nothing could be farther from the truth. If you are already overweight beginning the pregnancy then it might be beneficial if you lost weight. Those patients with 30-40 pounds of extra fat might lose ten pounds if they start eating right with the increased metabolic demands of pregnancy.
- Control any medical problems prior to becoming pregnant. If you are a patient with diabetes or high blood pressure, prior to pregnancy make sure those medical issues are within normal prior to becoming pregnant. The same would hold true for any other metabolic disorders like thyroid disease. If you can normalize these processes prior to pregnancy then the risks are seriously minimized.
- Educate yourself. It has been shown that women who participate in some sort of prenatal education class have lower rates of complications and better pain control. This is not to say that even those women who are ultimately prepared do not need some sort of assistance with pain medication or epidural, but preparation is always the best medicine. Many times having he support of other women in your life can be a great support system to not only aid you during the labor process, but during the postpartum period as well. Is it necessary for you to have a laminated birth plan, no. It is simply better to read, attend classes, or gain knowledge of the labor process from those who have done it before you. Obviously, there will be those family members and friends that have negative labor stories and they are only more than happy to share them with you. Remember that your birth is yours and try to surround yourself with positive people and thoughts.
- Stretch and Meditate. This may be the hardest thing to fit into your busy life, but yoga, meditation, or some sort of relaxation technique is a good way to clear your mind and strengthen your body. Getting the mind and body together for this journey is an integral part towards becoming an effective parent. Yoga can help strengthen your pelvic floor making the second stage of labor and subsequent recovery easier and faster. The relaxation of meditative or contemplative thought can help you focus during contractions and gives you time to simply be in the safety of yourself.
- Age matters. Since the question is blatant towards keeping the pregnancy low risk then it should be noted that there are higher risks when the pregnant woman is at the far ends of the age spectrum. Teen pregnancies and women of advanced maternal age (> 40 years old) have higher risks of infants with low birth weight, chromosomal anomalies, and the mother’s themselves are at higher risks for miscarriage. There is no perfect age, and this is not to say that women at the ends of the age spectrum should not become pregnant, it is simply know that these pregnancies are slightly higher risk.
Many of the things you can do to keep your pregnancy low risk are common sense everyday things that most women already do in their lives. Occasionally, a high risk pregnancy will develop even though you have done everything correctly and that is why regular antepartum care is the best thing you can do to keep you and your baby safe.