Coping with a high-risk pregnancy

As Piglet points out in Pooh's Little Instruction Book,
"It is hard to be brave when you're only a very small animal." And when
you are pregnant with a very small baby, and things go awry, it is even
harder to be brave.

Many mothers who have
gone through a high-risk pregnancy describe it as one of their worst
experiences. There are the logistics of coping with work and family
while trying to protect the life of their unborn child. There is
loneliness, as quite often "high-risk" translates into hospitalization
or bed rest. But most of all, there is fear. Often, the complications
of such a pregnancy are a matter of life or death, either for the
mother or the baby.

Some women go into pregnancy knowing they are in a high-risk category,
because of a pre-existing condition like diabetes, being pregnant with
multiples or complications with a previous pregnancy. But for many
other women, the experience is a surprise, as a seemingly healthy
pregnancy suddenly becomes precarious.

Darcy Carr, M.D., an assistant professor of obstetrics and gynecology
at the University of Washington, says the hypertensive disorders are
among the most serious. Learning of them is often upsetting for
patients. Severe preeclampsia, for instance, usually develops in late
pregnancy but sometimes occurs much earlier and may require a pre-term
delivery. Characterized by a rise in blood pressure, swelling and
kidney problems, preeclampsia requires hospitalization, "often for
several weeks, often away from family and friends," Carr says.

The logistical challenges

The severity of the condition dictates how each family must respond. If
hospitalization is necessary, a mother might face the immediate
challenge of child care for siblings. Is a spouse or other family
member able to care for children? If not, the scramble is on to find
hired help, whether an in-house sitter or a day-care center.

Pregnant moms placed on home bed rest may also need help caring for
other children. For a mother to truly limit her movement, chasing after
other kids is not realistic and could be dangerous for her and the
unborn baby.

For professional mothers, work often takes a sudden backseat to
immediate health issues. As with child care, the amount of
responsibility a mother continues to shoulder depends on the specific
health risk and how much activity the doctor will allow. Is working a
few hours a day sitting in front of a computer safe? Is any amount of
driving safe? Of course, different employers have different disability
policies. Any discussions a working mother has with supervisors and
human resources departments should include specifics of her doctor's
orders.

Finally, there is housework. Hospitalization means outsourcing that
work. But even home bed rest may force big changes. Family and friends
can often help with cleaning, shopping and errand running. Or, if money
allows, a mother may opt to hire out certain jobs. Many grocery stores,
dry cleaners and other stores do home delivery. And, a bedridden mother
with access to the Internet can expect to become a proficient online
shopper.

The health challenges

If not hospitalized, a mother may find herself responsible for home
monitoring of her condition. That might mean monitoring of uterine
contractions. Or, for the roughly 4 percent of pregnant women in the
U.S. that the American Diabetes Association says are diagnosed with
gestational diabetes, it can mean sampling one's own blood several
times a day and making dietary changes.

Carr encourages patients on bed rest to talk with their doctors and
nurses about physical therapy. "Instruction in resistance exercises for
arm and leg muscles might ward off potential side effects of bed rest,
such as blood clotting and muscle atrophy," Carr says.

The emotional
challenges

Moms may need to cope with feeling isolated. Email and phone calls with
friends can help. But often, even those meaning well do not truly
understand the fear, anger or guilt. To an outsider, the thought of bed
rest might sound a lot like a vacation.

Find a support system: The national support network, Sidelines, (see
Resources below) is one valuable resource for mothers dealing with
complicated pregnancies. Moms can be matched with a trained, local
volunteer who has been through a similar situation. There are regular
online chat sessions. And, the group's Web site and magazine also have
helpful information and poignant articles.

Melissa Papesh of Gig Harbor recently spent four weeks on home bed
rest. She remembers how vulnerable she felt emotionally. "When my
husband would come home from work, if he didn't say 'hello' to me right
away, I would just break down."

As difficult as this period was, Papesh says that her relationships
with family and friends deepened because she learned to lean on others.
By providing meals, running errands or helping care for her 3-year-old
daughter, "Everybody had to come together" she says. "Even when they
thought they were only helping a little bit."

And now that she can cradle her healthy baby son in her arms, "Grant is
the product of a lot of people's love," Papesh says.

Hilary Benson, a mother of three, lives in the Seattle area. Her work has appeared in ParentMap and Seattle Magazine and on KING-TV.

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