Laura Aimone’s pregnancy was progressing along normally, although she did feel tired in her second trimester, which she didn’t expect. “I just kind of figured that’s what me being pregnant was,” she says. Her baby was measuring small, but doctors at University Physicians for Women at Northridge were monitoring it.
Headaches: A Warning Sign
Due on August 28, 2013, Aimone began experiencing bad headaches in July. “I didn’t know that was a sign of anything,” she says. Headaches can, in fact, indicate preeclampsia, a serious pregnancy-related condition characterized by high blood pressure. It can cause poor growth, placental abruption (separation of the placenta from the uterus) and damage to the mother’s organs.
Preeclampsia is diagnosed by testing for protein in the urine. But when Aimone next went to her doctor, a test didn’t find any protein. While her blood pressure was elevated to 130/95, her baby looked fine during an NST (non-stress test), which measures a baby’s heart rate and movements. Aimone was ordered to take it easy, but she admits she didn’t understand what that meant. She took a yoga class that night that which left her with a horrible headache; when she called UVA’s Labor and Delivery Department, the staff had her come in.
Aimone’s blood pressure was high but it went down after resting and there still wasn’t any protein in her urine. Tests again showed the baby was in good condition. “They said, “We’re not going to deliver the baby tonight. I think my husband and I said, ‘Well, no, we’re not going to deliver the baby tonight! We have six weeks to go and I’m going to be late because first pregnancies are late.’”
Aimone was scheduled to do a 24-hour urine test, which more accurately measures the amount of protein in the urine, but without those results doctors still weren’t prepared to officially diagnose her. Still, at this point she learned what taking it easy really meant when doctors told her she could get out of bed to use the bathroom.
What is a High-Risk Pregnancy?
Aimone’s pregnancy had quickly progressed from normal to high-risk. A high-risk pregnancy means there are complications that could affect the mother, the fetus or both.
Women with a high-risk pregnancy often see a maternal-fetal medicine specialist (MFM). Other names for this type of doctor, who has specialized training in treating high-risk pregnancies, are:
- High-risk obstetrician
“Fortunately, the vast majority of pregnancies proceed along fairly normally and don’t really need to be seen by someone who’s a high-risk obstetrician. Most women are low risk,” says Donald Dudley, MD, division director of the Division of Maternal-Fetal Medicine at the University of Virginia. “But for moms-to-be who are high risk, at UVA, we have a team of maternal-fetal medicine specialists who treat women at our Maternal and Fetal Medicine Clinic at the new Battle Building.“
Women with high-risk pregnancies usually spend more time with the doctor and are seen as often as twice a week throughout their pregnancy. They also need additional blood tests, ultrasounds and possibly specialist visits. For women for whom these additional visits become a hard to manage, UVA doctors often set up programs with local care providers and use the telemedicine program, making appointments less of a burden.
Diagnosis of Preeclampsia
After her visit to Labor and Delivery, Aimone had a scheduled appointment for a special ultrasound called a biophysical profile, which is used in high-risk pregnancies to measure the baby’s breathing, movement, amniotic fluid, muscle tone and heart rate. It showed the baby was in great condition. The results of the 24-hour urine test were in, though, and they showed Aimone did have preeclampsia, so Megan Bray, MD, sent Aimone back to Labor and Delivery for an assessment.
“She was very direct,” Aimone says. “She said, ‘At the point where your health risks outweigh the baby’s health risks, that’s when we deliver the baby, because that’s how we fix your preeclampsia.’ I wanted to make it to 37 weeks, but she said it wouldn’t be any longer than that. I was kind of bummed about that. I really wanted to go into labor naturally.”
After bedrest, more headaches and another trip to Labor and Delivery, Aimone’s water broke at 35 weeks, 5 days. She delivered her daughter Waverly, who weighed 3 lbs, 15 oz, on July 29. Waverly spent 10 days in UVA’s NICU (neonatal intensive care unit). Aimone’s doula assisted at the birth and Aimone had the opportunity to hold her daughter before she went to the NICU. Waverly is now a healthy, happy little girl who keeps her mom and dad Ben busy.
Who Has a High-Risk Pregnancy?
Anyone who gets pregnant can have a high-risk pregnancy, but most women won’t, says Dudley. A lot of rare conditions can cause high-risk pregnancies, but some of the most common risk factors include:
- Multiples (twins, triplets or higher)
- Previous history of diabetes
- Blood pressure issues, such as pre-eclampsia
- Fetuses with birth defects
- Previous history of preterm birth
- Women at risk for preterm birth for any number of reasons, including, cervical insufficiency
Make An Appointment
Make an appointment with a maternal-fetal medicine specialist at UVA.
In many cases, these risk factors mean there’s a risk for preterm labor and/or preterm birth. Dudley says preterm birth is a significant problem in the U.S and the leading cause of neonatal infant mortality worldwide. “Having babies in the NICU is really what we want to avoid. We want to have babies go home with the mom right away. That’s the optimal outcome.”
Other factors that put a pregnancy in the high-risk category: Going past the due date and the mother having late-onset high blood pressure are examples.
What About Gestational Diabetes?
Having gestational diabetes doesn’t mean you necessarily need to see a maternal-fetal medicine specialist. Dudley says it depends on the comfort level of your provider. Gestational diabetes is a common pregnancy condition that affects many women. If you’re seeing a midwife or a nurse practitioner, you should see a high-risk doctor, he says. “Most good general obstetricians can manage you, but most of them would want you seen by a high-risk obstetrician to confirm the management plan and to have that kind of insurance.”
Preventing a High-Risk Pregnancy
It’s not always possible to prevent a high-risk pregnancy, especially if you already have an underlying health condition or you’re pregnant with multiples. But here are a few steps you should take:
Before you get pregnant:
- Eat a healthy diet
- Don’t be overweight
- Maintain a healthy lifestyle
- Exercise regularly
- Take prenatal vitamins containing folic acid
- Stop smoking and taking drugs unless prescribed
Once you’re pregnant:
- Get early prenatal care
- Continue prenatal vitamins
- Continue a healthy diet with green, leafy vegetables and include extra calcium and extra protein
- Do some aerobic exercise (check with your doctor first!)
- Minimize chemical and drug exposures
- Don’t smoke, take drugs or drink alcohol
Worried About the Risks?
If you have underlying health conditions, you may want to consider preconception counseling. Dudley says MFM doctors prefer women with high-risk conditions like lupus, complex high blood pressure, kidney disease, diabetes, seizure disorders and other conditions see a high-risk doctor for preconception counseling.
“We can go over a plan for what we’re going to do when they achieve pregnancy, make sure they’re on medications that are safe for pregnancy as best we can, and that way when they’re pregnant they’re already in an optimal condition,” he says. Women with lupus have a higher risk of preeclampsia, fetal death and other problems; however, if they have their babies while in remission and on medication they usually have good outcomes, Dudley says.
Preconception counseling isn’t the norm because at least half of all pregnancies are surprises. But ideally, a woman with a serious health condition will call an MFM first, Dudley says. This is critical, because maternal mortality rates in the U.S. are increasing. “It’s driven a lot by women who have underlying heart conditions achieving pregnancy and then having problems toward the end of their pregnancy.
“We love to do preconception counseling. It helps us provide a strategy that hopefully will ensure the best possible outcome from the very beginning.”
Choosing a Hospital to Minimize Risk
Worried about a high-risk pregnancy, though you don’t have underlying conditions? Choosing a hospital with a NICU might be your best bet.
“Mainly you need a NICU if there’s going to be some need for specialized care. The main one is preterm birth, but if you have a baby that is delivered at term that has a heart defect or spina bifida or some other problem, you would still need a NICU,” says Dudley.
Sometimes, it’s actually care for the mother that’s just as important, if not more so. “There are high-risk maternal conditions where the baby will do fine. For example, the baby’s at term and the mother develops severe preeclampsia. Then the mother needs to be in a place with high-risk maternal care and adult care, but the baby doesn’t always need anything special. You really want a hospital that has comparable levels of care for the mom and the baby. It’s the combination of the two.”
Even without the risks that could affect their pregnancy, some women choose the safety net of a hospital with a NICU to avoid last-minute emergencies.
Aimone expected to have a normal pregnancy and did until the very end. She planned to have her baby at UVA in part because of convenience, but also because of the care UVA provides. UVA is right around the corner from her house. “God forbid anything happen, we wanted to be at UVA. Everyone was like, ‘Oh nothing will happen. It’ll be fine.’ But it did.”
Make an Appointment
Make an appointment with a maternal-fetal medicine specialist at UVA.
Cancer touches all of us. Despite our greatest scientific achievements, far too many lives are cut short by this disease. But there is reason to hope. For the first time, we’re unlocking mysteries of how cancer develops, grows and spreads at the molecular and cellular levels — insights unknown even five years ago.
Here, we’re united by a common goal — not another life devastated by this disease.
Join us for a free education series to learn how our Cancer Center researchers and physicians are defeating “the emperor that is cancer” through clinical trials, nanotechnology and targeted treatments.
When: Thursday, April 9, 7 p.m.
Where: The Paramount Theater
Hear UVA Cancer Center director Thomas P. Loughran talk about this valuable event on Caring Beyond Cancer with Joe Thomas in the Morning.
WVPT Public Television will record the presentation and produce a television special to be broadcast in late June.
Also, don’t miss the upcoming film premiere, ”Cancer: The Emperor of All Maladies.” This free screening is Monday, March 30 at 6:30 p.m. at The Paramount Theater
It’s a common story, about miscarriage — that there is no story. People don’t talk about it, and yet it can be a truly traumatic loss.
It’s also a fairly common one; studies show that anywhere from 8 to 25 percent of all known pregnancies end in miscarriage. Despite the silence around miscarriage, many women have experienced it.
That’s certainly what Stacy Lynn found to be true. The more she broke the silence, the more she discovered other women who had had miscarriages. She told me her story to help others know they are not alone
Getting the Bad News
I hadn’t heard the heartbeat yet. They tried to find it. They said, “We don’t hear it, but that doesn’t mean anything. Sometimes we just can’t find it, so we have to do an ultrasound.”
And then the woman giving the ultrasound said, “I’m sorry.” And in my head, I think, “So sorry about what?”
Then the doctor comes in and gives me a hug. “I’m really sorry; sometimes this happens. The fetus stopped growing at 8 weeks.” And then it hit, and I just bawled, and she hugged me.
I am tearing up just thinking about it. I didn’t think I would.
After the Miscarriage
My husband came rushing over. He told me, “If we can survive this, we can survive anything.” He really helped me. So I had to have a D&E, so I had to sit with it all weekend and just deal with it.
After the D&E, I developed an infection. I woke up a few days later, shivering and so sick. I called. They had left tissue inside; I had to have another procedure. During that entire process, I wanted to move on but couldn’t. I was pretty depressed.
My husband said really good things to me. He is my life support. He let me cry, he never judged me, he had lunch with me every single day to check on me. He would give me silly tasks to do, tell me, “The car needs an oil change, can you do me a favor and go do it?” Things like that to get me out of the house. Which was really good.
My sister in law had a baby a couple days before my miscarriage, so I didn’t want my family to come down. It was really hard to be around a friend of mine who was pregnant and had a healthy baby. I didn’t want my friends to visit. I was a mess.
After a couple weeks, I was still really depressed. My husband said, “I don’t want this to define you. This is not who you are. You are very happy. You always see the good in everything. This happened, and it’s sad, and we can be sad about it. But this cannot define you. I want you to live your life.” He really pulled me out of depression. I’m so thankful for that.
Getting Pregnant Again
I worried I wouldn’t get pregnant again. My husband said, “It will happen when your body is ready. Don’t stress about this. We know you can get pregnant.” We ended up getting pregnant five months later; it turned out my body was ready.
Throughout the pregnancy, I was a nervous wreck. I had kidney stones from five weeks until I delivered, so I would see blood and was so terrified. We didn’t tell anyone, and then only close friends and family. We did not post anything on Facebook. We didn’t plan on having a baby shower – we’re Jewish so we don’t have baby showers anyway; it’s bad luck. We were not acknowledging him until we held him in our arms.
My son was born early, at 32 weeks, in the UVA NICU. It was one year since the miscarriage.
We named him Remi, a name we picked flipping through the channels when I was about six months along. Remi was the name of a French contestant on American Ninja Warrior, which created a spark in us, since we had traveled to Paris between the miscarriage and this pregnancy. Little did we know that name would be so fitting for Remi, who had to fight to live right from the start. At 21 months now, he is no longer my little nugget, but a precocious toddler who is succeeding in numerous ways.
A lot of people are asking if I’m going to have a second child, but mentally I’m not there, because I’m terrified of having another miscarriage, and I’m terrified of having a micropreemie.
I will tell you I had the most amazing experience at UVA with Dr. James, who will be delivering any future children of mine, as she was wonderful and made the whole situation, which was scary at times, better. Looking back, I think what a great experience it was.
Healing From Stigma and Blame
I think if more people talked about miscarriages, it would make a person going through it not feel as alone. I felt so alone. It seemed like nobody else had this experience, everyone got pregnant right away, and it was all so easy. If people could talk more about it there wouldn’t be this stigma.
My mom gave me advice. She actually had a baby, born at 28 weeks, back in the 70s, and he lived for a couple of hours. When I had the miscarriage, she said, “I’m so sorry, Stacy; I’ve been in your situation. I understand. It is out of your control. You did nothing wrong. You can’t control it. As women, we like to control things. But there’s nothing you could have done differently.”
As horrible as the miscarriage was, if I hadn’t had that, I would not have had Remi. He’s the best thing that ever happened to me.
Share Your Story
Have you had a miscarriage? Let us know in the comments below what helped you heal.
I thought a quick scan through a Google search about miscarriage would reveal more information than I could fit into this blog post.
I was wrong. In fact, my quick scan turned into a lengthy search, and the very large gap of information underscored a sentiment that seems pervasive:
You don’t talk about miscarriage.
But why? I wanted to know. Everyone online and the women I talked to for this story expressed the same thing: There’s silence around miscarriage. And it needs to be broken, because this taboo makes it a lonely, isolating experience, on top of the already-difficult physical and emotional loss.
The closest thing I could find for an answer was that the lack of medical reasons for miscarriage—and there’s more often than not no clear reason for it—leaves the why of what happened a blank. As Diane Rozycki, MD, told me, “Miscarriages can happen due to a variety of reasons. They can also be unexplained, with chromosomally and structurally normal fetuses in apparently healthy women.”
As with most mysteries humans face, we tend to fill in the gaps. Women who have miscarriages often feel responsible, at fault and ashamed; the pregnancy “fails,” and they feel they have failed, too.
Miscarriage Risk Factors
But even when a cause is implicated, most of the risk factors for miscarriage aren’t something a woman can control, like:
- Maternal age: Risk increases with age
- Maternal disease, acute infection as well as endocrine disorders (uncontrolled diabetes and thyroid disease, for example)
- Structural abnormalities of the uterus
- Fetal chromosomal abnormalities or congenital anomalies
Two risk factors, a woman being extremely overweight or exposed to certain medications and substances, can, in some cases, be controlled, but they certainly are not predictors of miscarriage.
Miscarriages Are Common
And the thing is, miscarriages happen more frequently than generally assumed. Rozycki again: “Miscarriage in early pregnancy is common. Studies show that about 8 to 20 percent of women who know they are pregnant have a miscarriage some time before 20 weeks of pregnancy; 80 percent of these occur in the first 12 weeks. Loss of unrecognized or subclinical pregnancies is higher.” (That is, you can have a miscarriage without even knowing you’re pregnant. You might experience symptoms, like pain and/or bleeding, but not necessarily.)
The situation seems like a catch-22: No one knows how common miscarriages are because we don’t talk about them, and we don’t talk about them because we don’t know how common they are. It doesn’t help that in the US, cultural convention tells us to hide pregnancy until after the first trimester, the time when most miscarriages happen. So paradoxically, the time when women arguably need the most support, feel the most tired and nauseaus as well as the most worried, is exactly when they are supposed to hide their pregnancy and, should it happen, their miscarriage.
One article talking about the misconceptions people have about miscarriage reported:
The survey of more than 1,000 women and men found 65 percent believe miscarriage is rare, when in reality it occurs in one in four pregnancies. While knowledge of miscarriage rates was low, respondents accurately assessed that it is traumatic, with 66 percent believing the emotional impact is severe and potentially equivalent to the loss of a child. Research shows understanding the cause of miscarriage can reduce feelings of guilt or blame; however, currently the origin is only identified in 19 percent of patients.
Life After Miscarriage
The good news about miscarriage is, it may be beyond your control, but it doesn’t mean you’re beyond hope for having a baby.
“If you have had a prior miscarriage, you can be at increased risk for another,” Rozycki says. “But it does not mean you are infertile. Even women with recurrent pregnancy loss (three consecutive miscarriages) have a good chance of eventually having a successful pregnancy.” She does advise that women wait for two to three months before getting pregnant again.
And, whatever the taboo or misperceptions, you are not alone. As one woman told me, “It’s still painful right now, looking back at it, but I have to say time decreases the intensity of what happened. Do whatever self-care works for you. Give yourself time, and reach out for support.”
Odds are, when you do, you’ll find someone who knows exactly what you’re going through.
Next Monday, we’ll hear a personal story about the mix of emotions that can occur with a miscarriage.
Worried About Miscarriage?
The best bet: Talk to your doctor. Find a caring, expert OB/GYN:
Throughout its 4,000-year history, cancer has left doctors, scientists and patients with questions that the medical and science fields could not even start to address until recent decades. For centuries, the question has lingered: Will there be a time when we find a way to control or even cure this disease?
Today, in 2015, researchers and scientists finally understand on a cellular level what cancer actually is and how it spreads and have discovered many successful, targeted ways of treating it – surgically, medically and with radiation.
Almost daily, new discoveries about cancer are made, critical ones like the key to cancer’s spread.
How did we get to this momentous time in the history of cancer? Based on “The Emperor of All Maladies: A Biography of Cancer” and Cancer Progress’ timeline, here are some of the most noteworthy cancer-related achievements and failures.
- “Anesthesia,” the idea of making a patient unaware of pain, was first applied in surgery at Massachusetts General Hospital.
- After reading multiple similar reports, German researcher Rudolf Virchow published his report about a patient whose autopsy revealed massive amounts of white, milky cells above the red blood upon examination of blood specimens. He named the condition leukemia from the Greek word leukos, meaning white.
- Virchow discovered that cancer was, in its simplest form, the uncontrolled growth of cells, called hyperplasia. This led to the term neoplasia (neo meaning new), a term that is still used today to describe cancer.
- A Scottish surgeon named Joseph Lister recalled Louis Pasteur’s experiment, which found that meat exposed to air began to ferment. But the air was okay in a sterilized, sealed jar of meat broth. Lister realized bacteria would affect an open wound the same way, so he tried treating an open wound with an antibacterial agent and then closed it. It healed and resulted in another major discovery in the treatment of cancer: infection control.
- William Stewart Halsted started collecting data on a new procedure for breast cancer, hoping to prove radical mastectomies would prevent cancer recurrence.
- A German lecturer discovered radiant energy that came to be known as X-ray.
- Marie Curie identified radium, named from Latin for light.
- The surgical community discovered that cancer recurrence was determined by whether the cancer had spread prior to a mastectomy, and how far, not by how invasive the surgery was.
- Radiation therapy exploded in the United States; the extensive side effects of radium surfaced among workers – both acute, including skin, bone and tooth necrosis, and long-term, including cancers of the blood and sarcomas.
- President Franklin D. Roosevelt approved the establishment of the National Cancer Institute (NCI).
- Sidney Farber, a pathologist turned clinician researched and tested chemicals (named chemotherapy) that showed promising results in treating childhood leukemia.
- A Greek pathologist named George Papanikolaou invented pap smear tests were invented to prevent cervical cancer.
- Cancer became highly publicized and politicized – finally a topic of international discussion, resulting in abundant funding for research.
- Farber raised more than $150,000 for his own treatment center for leukemia patients.
- Combination chemotherapy for leukemia showed promise but had limitations.
- The U.S. Senate authorized the NCI to initiate a coordinated effort on the research of chemotherapy drugs, called the Cancer Chemotherapy National Service Center (CCNSC).
- A four-drug regimen to treat leukemia showed grossly toxic effects in trial populations. However, it could put patients in remission if they survived the side effects.
- Results based on St. Jude’s and other research tests proved chemotherapy regimens could cure 80 percent of those treated.
- Based on numerous studies dating back to the early 1900s and data published by the American Cancer Society, the Surgeon General issued a report linking cigarette smoking to cancer.
- President Nixon signed the National Cancer Act and funds were poured into the trials of new chemicals for cancer treatment.
- The NCI designated 20 Comprehensive Cancer Centers, hospitals with dedicated cancer centers
- Radioactive seeds for internal radiation were used for prostate cancer and other cancers (Brachytherapy).
- Genes reemerged as the focus for researchers studying cancer.
- Researchers identified the roles of oncogenes and antibodies, and started using them as targeted cancer treatments.
- Advances in breast cancer research included the successful use of the hormonal drug Tamoxifen to achieve remission with little side effects.
- Doctors began initiating palliative care for many untreatable cancers, using opiates to reduce pain and anti-nausea drugs to relieve vomiting.
- Hospice care was established at hospitals around the world.
- H. pylori infection was found to be a cause of gastric cancer.
- Many hospitals began performing bone marrow transplants.
- Herceptin was proven a successful drug for breast cancer.
- Early detection and prevention showed promise, but data showed confusing and conflicting mortality rates both across ages and by cancer type. No conclusions could be determined except that there was a great deal still to be learned about cancer.
- Historical medicine and research paired with modern science started to show an impact in the mortality rates of cancer.
- 24 new cancer drugs were brought to market.
- Targeted therapies showed promise but were not reliable.
- Researchers shifted back to the focus on prevention and underlying causes of cancer.
- The Human Genome Project (sequencing of the normal human genome) was complete, allowing the sequencing of gene mutations for cancer types to be studied. By 2009, researchers revealed mutations in pancreatic, ovarian, and lung cancer and leukemia.
- Major strides have been made in the areas of immunology, metabolism, gene regulation, and cancer metastasis.
- Clinical trials for targeted cancer treatments are available worldwide and offer opportunity for patients to benefit and for researchers to forge ahead in finding a cure based on what proves to be effective.
- Procedures such as “image-guided intraoperative radiotherapy” (only available at UVA Cancer Center) allow patients with early stage breast cancer to have surgery and radiation in a single visit.
- The relatively new combination of imaging, radiology and surgery results in treatment options that are more convenient and effective and less expensive and invasive.
- Cancer survival rates have dramatically increased due to early detection through screening programs, preventative measures and advanced treatment options.
- There are now 68 NCI-designated cancer centers; UVA Cancer Center is one of them.