Veronica Peterson’s baby Brendan is seven months old. Her pregnancy was normal, except for the morning sickness.
"The morning sickness was unreal," she said, "so I was, I was in a way, and the first one was, too. But this one, it was kind of like, rough, yeah. I had some stuff going on with my mouth. It was just all these bodily things that were happening. And again, thankfully, it wasn't my very first pregnancy, but still, you feel those things, and that's tough."
She was new to Springfield – she and her husband had relocated to the city so he could take a job as a coach for the Missouri State University men’s basketball team, and she had to find a new OB/GYN. By the time she got there, it was later than she would have gotten in otherwise, and there was confusion about the due date. And, while all was well in the end and she had a healthy baby, there were a couple of minor worries before Brendan was born.
"It's all about patience, the whole maturation process of having a baby growing inside you," she said. "It's all about patience. And when you're a mom and you can't control the morning sickness, and you can't control when the baby's coming or how they're coming or any of those things, you have to be patient. And so, his birth and the pregnancy was all about patience for me and learning to just go with what happened."
Importance of prenatal care
Getting the recommended health care during and after pregnancy and having a trusted healthcare provider is vital to having the best possible health outcomes for mom and baby.
While Peterson didn’t have any significant health issues during her pregnancy and birth experience, many women do.
"I think prenatal care is absolutely critical to having a healthy mom and baby," said Dr. Jennifer Brooks, an OB/GYN at Mercy Springfield. "It's designed to find and detect and manage issues early on, such as gestational diabetes, high blood pressure, if there's anything abnormal with the placenta, then we can manage those and get them, get our patients who need higher care with our maternal fetal medicine doctors the appropriate care earlier."
Brooks said preeclampsia – or pregnancy-induced high blood pressure – has been on the rise in recent years. So has gestational diabetes – diabetes that occurs during pregnancy. It’s important to diagnose those and address them early since they can lead to stillbirth.
According to Brooks, typically those conditions go away after a baby is born. But women are at increased risk for diabetes outside of pregnancy if they experienced it during.
"So that's why we screen at the six-week postpartum visit for women, and we do glucose tolerance tests at that time as well as high blood pressure in pregnancy. That typically does go away," she said. "But those women are also at increased risk for having high blood pressure outside of pregnancy as well."
Preconception care
Brooks encourages women thinking about trying to become pregnant to schedule a preconception appointment.
"A lot of women don't know that we offer these services, but it is an appointment with a provider, like an OB/GYN, where we can optimize your health," she said. "So, we can talk about weight loss, get you on prenatal vitamins, get you on folic acid months in advance before you get pregnant because those are actually important to have on board before you find out you're pregnant. So, if we can reduce some of the risks ahead of time of getting pregnant, we can have a healthier pregnancy and better outcome."
Dr. Courtney Barnes is a physician at the University of Missouri and an associate professor of clinical OB/GYN who’s been practicing for 17 years.
"About 10% of pregnancies are affected by hypertensive disorders," said Barnes. "So, a lot of hypertension, a lot of obesity, a lot of depression, anxiety. Those things are quite common."
Mental health and pregnancy
Mental health disorders can also arise during pregnancy or be present before, according to Barnes. She said doctors are watching for those as well as physical health disorders.
"You can tell a lot just from listening to people, talking to them about how it's going. And you get to know people so well during their pregnancies," she said. "And I also tend to be somebody who is pretty vulnerable and open with my own experience. And so, I like to think that that helps patients be open and honest and willing to share their own experience, and then just talking about all the resources we have. I mean, we have psychiatrists, we have psychologists, we have therapists, we have group prenatal care, which is incredibly helpful for mental health, so...we have a lot of resources now for women, and there's really no reason for women to go through pregnancy or even just their everyday health without having appropriate treatment for mental health disorders."
According to Barnes, 60% of maternal deaths in Missouri are related to substance use and mental health disorders.
She said there’s a statewide program that provides help for both moms and providers. The Maternal Health Access Project is overseen by the Mizzou School of Medicine’s Center for Child Well Being.
"If you have somebody who's been on multiple medications, she's complex, she has side effects. She has comorbidities that really affect what you're going to prescribe. And, you know, as an OB/GYN, that's not my area of expertise," she said. "So, I can actually call and within an hour be on the phone with a psychiatrist who will go through that patient's history and help me make recommendations. They can also set up services for the patient: Counseling services, virtual health psychiatry visits, and it's all a free program for patients, so, it's a really important step to helping our maternal mortality crisis."
Brooks said moms who are dealing with depression and anxiety during and after pregnancy shouldn’t be afraid to ask about taking antidepressants during pregnancy. Most of the medication they prescribe has not been shown to cause harm to the baby, she said.
Another cause of maternal mortality is cardiovascular disease or cardiomyopathy, according to Barnes.
"We're seeing more and more women with those conditions," she said, "so those are really complex medical conditions that require a multidisciplinary group to treat."
As far as access to abortion care is concerned, a media relations professional at MU Health told OPB they can only provide a statement to the media about the topic. Barnes says, even though as a state institution, they’ve never been able to offer those services, access to family planning services, whether it be contraception or abortion, is important to women’s health. Brooks said Mercy can do medically-necessary abortions, but she hasn’t yet had a patient who has needed one.
Teaching future doctors
As a professor, Barnes is working to make sure future doctors are attuned to women’s concerns.
"I think the biggest thing is teaching people how to listen. Women are so smart and intuitive about their bodies and their health. And yes, we have the clinical expertise, but really, it's the patient that helps you make good changes," she said. "So, I think it's really about listening. And a lot of that has to do with like cultural humility as well, learning how to listen to perhaps people who come from a different culture, a different socioeconomic base. So, I think probably the most helpful thing is just teaching people to listen to the moms, which is a hard skill to learn."
She said it’s important for pregnant women to have an advocate – whether it be a doula, a friend or a family member. When that support is there, outcomes are better.
"Continuous labor support, whether it's in the form of a doula or it's in the form of a family member who really cares about you, we know it improves outcomes, said Barnes. "We know that it decreases epidural rate, decreases C-section rate, decreases birth trauma, helps breastfeeding outcomes."
She said having someone there to make sure everyone is on the same page, communicating with the patient and understanding one another, can make a big difference in the mother’s experience.
