"I was told I needed to stay home and as still as possible," Polidaks says. "I felt stressed because everyone had to run around to take care of me, but this was the way my body reacted and there was nothing I could do about it."
It can be terrifying to have your pregnancy labeled "high-risk." But remember, it's a broad term applied to any woman who faces a higher-than-average risk of complications during pregnancy or delivering a baby with health concerns. It doesn't mean your pregnancy won't progress normally or your baby won't arrive healthy though.
Earning the "High-Risk" Label
Expect your pregnancy to be labeled high risk if you have a chronic medical condition (like high blood pressure or diabetes) that could affect the pregnancy and health of your baby. Obesity, a sedentary lifestyle or using alcohol or illegal drugs directly affect an unborn baby's health, development and growth and could also land you in the high-risk camp. According to the U.S. Department of Health and Human Services, smoking during or after pregnancy has been linked to one in 10 infant deaths.
Sometimes otherwise healthy women find themselves holding the same title. If you're under 17 or over 35, overweight or carrying twins, you have a greater than average chance of developing problems. Women who develop gestational diabetes, high blood pressure (preeclampsia) and placenta previa (placenta covering the cervix) as well as those with a history of pregnancy-related complications like preterm delivery run higher than average risks during pregnancy and delivery. The good news is that even with so much to worry about, less than one quarter of women labeled high-risk develop a complication that requires intervention.
Peter Bernstein, M.D., medical director of obstetrics and gynecology at Montefiore Medical Center in New York, counsels patients to zero in on what the diagnosis means specifically to them. "A common blood test taken at 15 weeks gestation may indicate your baby's chance of having Down syndrome has increased from one in 250 to one in 100," he says. "That's still not a high risk. You still have 99 chances in 100 of having a normal baby – but further testing will tell you for sure. It's important to be as specific as possible, quantify the risk and find out its significance to you."
Juan Arias, M.D., a high-risk pregnancy expert at the Center for Maternal and Fetal Medicine, Methodist Dallas Medical Center, says, "We don't have a crystal ball, but we try to be clear about the risk and alleviate anxieties while being realistic."
For some health issues, diagnosis and treatment is a welcome relief – validation that your symptoms aren't in your imagination. During pregnancy though, the only advice and medical treatment you might receive is "wait and see," making diagnosis a mixed blessing. In some situations, medical intervention – like bed rest – lowers the risk. But if the purpose of further testing is not clear, ask questions until you're satisfied. In most cases, health-care providers closely monitor red flags so they don't develop into life-threatening situations.
Getting the Information You Need
If your doctor labels you high-risk, other than freaking out, what can you do? First, many experts say, don't be intimidated by the label. Ultimately, it's your life, your pregnancy and your baby. Find out why you've been placed in this category, the risk factors and what you can do.
"Knowledge is power in this situation and the more accurate information you have, the better decisions you can make," Dr. Bernstein says.
If your health-care provider isn't forthcoming, it may be time to look for a new one – one who listens, as well as offers information and advice.
When it comes to doing your own research, go online and research reputable medical sites, like the American College of Obstetricians and Gynecologists (www.ACOG.org). Be sure to review your findings with your doctor at your next visit. Knowing concrete facts (instead of focusing on the "what-ifs") will give you the power to be involved, as well as peace of mind.
Barbara Lopez-Lucio delivered her first baby six weeks early and suffered a miscarriage at four months during her second pregnancy. When she began her third pregnancy, her doctor instructed her to stay as still as possible during the day.
"I was a little worried I would miscarry or deliver early, but the pregnancy went full-term," Lopez-Lucio says. "The doctors wouldn't say why I had problems. I think that made it tougher somehow, not knowing why."
Keys to Coping
In some high-risk pregnancies, it's not unusual to be ordered on to bed rest or even a mandatory hospital stay. Keeping your routine as normal as possible will go a long way in reducing your overall stress level. While staying in the hospital is sometimes unavoidable, research proves that bed rest at home is less stressful and often a better alternative. Home-care nurses can help organize appointments, find resources and provide prenatal education.
If a hospital stay is required, be your own advocate and ask for daily reports so you know what's happening and why. Keep your spirits up by bathing daily, wearing your street clothes (if possible) and spending time enjoying quiet activities.
For some women, stress during pregnancy can be a positive motivator. A high-risk label can lead to finally finding a good enough reason to start paying attention to poor lifestyle or health-care choices.
Being ordered to stay in bed, watch movies and generally lie around all day may sound like a dream – until you've done it for three months with another three ahead of you.
Researchers at the University of Calgary in Canada studied how women with high-risk pregnancies cope and reported that many of the women felt frustrated in their isolation. The bottom line for most moms-to-be is that bed rest is boring, but it can also be a direct route to an even bigger pregnancy risk: depression.
"Because we have been so tuned to diagnose depression after pregnancy, we often missed signs that it was happening earlier," says Dr Shaila Misri, author of Pregnancy Blues. "Depression is the most frequently encountered medical condition, yet prenatal classes will tell you about placental bleeding and hypertension, which are not as common."
Fortunately, once identified, depression is a highly treatable illness, Dr. Misri adds. "You will get through this."
If you're concerned you may be depressed, talk to someone you trust and get the help you need. Depression isn't something you can control, but it's something your doctor can help you overcome.
While being over-the-moon happy about your pregnancy, health issues can quickly transform bliss into nine long months of constant worry. Unfortunately, no one can promise you a perfect pregnancy, or a perfect baby, no matter how "normal" your pregnancy. Remember, the high-risk label isn't a self-fulfilling prophecy, and it doesn't take away your ability to stay informed, make healthy choices and seek adequate prenatal care. It's easy to let your imagination run wild, but staying grounded and doing everything in your power will give your baby – and you – the very best odds of a successful pregnancy outcome.
Julia Rosien is a freelancer who frequently writes on pregnancy and women's health for a wide variety of newspapers, magazines and Web sites.
Maria Polidaks struggled to remain calm as her blood pressure climbed to a dangerous level near the end of her first pregnancy. Twenty-two days before her due date, her blood pressure spiked; her doctor induced her and she delivered a healthy baby that day. Her second pregnancy, automatically labeled "high risk," took an alarming turn when her blood pressure surged dangerously high again – this time at only two months gestation. She had a stressful job, a busy toddler and a health condition that threatened her life, as well as her unborn baby's.
