Finding a High-Risk Obstetrician

QUESTION

Dear Experts,
I am thinking about getting pregnant, but my last two pregnancies have been very complicated. My first daughter came at 26 weeks and had to stay in the NICU for 4 months following her birth. She weighed 1 pound 13 ounces.

I became pregnant again with my son a year later and he was born at 24 weeks. When I went to my five month checkup, I was informed by my doctor that I had dilated 2 cm and immediately had a stitch placed on the remaining cervix that I had left. The stitch was not helpful at this point because he still came early. Unfortunately, he didn't make it. He was just too early.

My question for you is what do you think my next approach should be on how to find a provider that specializes in complicated pregnancy in my area and how to concieve and have a full term, healthy baby? Do you think that there is anything I should take or do on my part to help my situation?

ANSWER

You've been through a lot -- your daughter's premature birth and we are so sorry that your precious baby son died. Our hearts go out to you.

After experiencing these difficulties and sorrows, it is normal for you to feel vulnerable and worry about what your future holds. And medically, you would be wise to seek a high-risk pregnancy specialist. Look for a qualified perinatologist, a high-risk obstetrician who specializes in complicated pregnancies. Your regular and trusted health care providers should be able to help you with referrals to qualified professionals. Ask your general practitioner, midwife, regular obstetrician, or your daughter's neonatologist or pediatrician. If you have medical insurance, you can also request a list of perinatologists from your insurance company. Even if there are no perinatologists in your area (more likely if you live in a small town or rural area), you can still enlist the consultation services of a perinatologist. This specialist can work closely with your local obstetrician, and you can make appointments as needed that supplement your regular prenatal care.

When you contact a perinatologist, request a phone consultation or an appointment in which you can discuss your history and see if the two of you are a good fit for each other. During this initial visit, evaluate whether this doctor:

  • Is respectful and responsive to your worries and fears,
  • Listens and responds to your concerns,
  • Takes the time to answer all your questions,
  • Communicates clearly and sensitively,
  • Shares information freely,
  • Offers ideas for monitoring your pregnancy and prevention of preterm birth,
  • Teaches patients to monitor themselves for signs of preterm labor,
  • Encourages patients to call the office anytime they have any concern about the pregnancy or the baby
  • (The practice) offers medical attention 24 hours a day, 7 days a week,
  • Gives you hope -- is realistic but optimistic, reassuring without being patronizing,
  • Is someone with whom you feel you'll work well together toward your goal of carrying your baby to term, and
  • Is someone you simply feel "comfortable" with.

When you find a doctor you want to work with, ask him or her for specific recommendations tailored to your situation that can increase your chances of having a full term, healthy baby.Of course, nobody can give you guarantees, but by asking questions and gathering information, you can make informed decisions for your pregnancy. Learning about risk factors and signs of complications and, when possible, finding out the reasons behind your babies' premature deliveries can give you a sense of mastery and competence. (By the way, we don't like the unfortunate medical term "incompetent cervix," as it adds insult to injury for mothers struggling with the normal feelings of guilt, failure, and body betrayal. You are competent, and you just happen to have a cervix that has been unstable.) You couldn't control what happened, but you can try to understand it. And if you have hopes for a future pregnancy, working with a sensitive, responsive doctor can help you hold on to some optimism that what caused the problems the first time can be prevented or at least mitigated in a subsequent pregnancy.

We wish you the best.-- Debbie and Mara
The Crisis Pregnancy Expert Team

Davis and Stein

Deborah L. Davis, Ph.D. and Mara Tesler Stein, Psy.D. are the authors of Parenting Your Premature Baby and Child: The Emotional Journey, a 2004 National Parenting Publications Awards "Gold Award" winner. They also collaborated on Parent: You and Your Baby in the NICU (2002), as part of the nationwide March of Dimes NICU Project. They.ve been invited to regularly contribute to Advances in Neonatal Care, a neonatal nursing journal; their first article appears in Spring 2005. They are the founding members of Partners in Perinatal and Pediatric Consulting, which promotes developmentally supportive care for babies and parents, as well as collaboration between families and health care professionals.

Dr. Stein is a clinical psychologist in private practice, specializing in the emotional aspects of coping with crisis and adjustment around pregnancy and parenting. She is regularly invited to lecture and give workshops on these issues throughout the country to conferences of physician and nursing groups, doulas, and lactation consultants. Since 1997, she has been consulting with organizations and providing training to health care providers, guiding their efforts to improve the level of psychological support and developmentally supportive care to families during and subsequent to perinatal crisis.

Dr. Davis is a developmental psychologist, researcher, and writer who specializes in perinatal and neonatal crisis, medical ethics, parental bereavement, parent education, and child development. Dr. Davis is the author of four books for bereaved parents, Empty Cradle, Broken Heart (Fulcrum, 1991; 1996), Loving and Letting Go (Centering, 1993; 2002), Fly Away Home (Centering, 2000) and Stillbirth, Yet Still Born (PILC, 2000). She is also on the Board of the Pregnancy Loss and Infant Death Alliance (PLIDA.org) and is regularly invited to write articles for professional periodicals and parent support materials.