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Pregnancy is usually expected to be a safe and healthy
process. Seeing a medical provider regularly throughout the pregnancy
helps to ensure potential problems can be dealt with promptly
before they become serious for the woman or the fetus. Women who
have certain chronic diseases like diabetes or high blood pressure
have better chances of successful pregnancies if their illness
is under control before pregnancy occurs. It is best to do everything
possible to be sure you are in good health before getting
pregnant. When pregnancy is suspected, it is important to have
it confirmed as early as possible and to set up a schedule for
regular medical check ups.
Pregnancy Risks
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The risk of having complications of pregnancy varies
depending on many factors. A medical expert can help make
sense of this complicated health evaluation. Some factors
to consider are:
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| • the woman's general state of health
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| • her age |
| • the stage of her pregnancy (risk goes up as the
pregnancy progresses) |
| • illnesses |
| • past surgeries |
| • family history |
| • Previous pregnancy history (number, spacing, and
outcome) |
| • medications currently used or potential exposures
to any toxic substances |
| • any problems identified in the current pregnancy
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Most times, pregnancy complications can be managed
so there is no lasting effect on health. Some complications will
result in serious risk to health. Pregnancy related deaths are
rare events. In Alaska, a woman's risk of dying from complications
of pregnancy or childbirth is very low, about 7.4 deaths per 100,000
live births. This may be compared to the U.S. rate of 11.5 per
100,000 live births. There were 8 pregnancy related deaths in
Alaska in the 10 years between 1990 and 1999. High blood pressure,
heavy bleeding, and blood clots were responsible for these 8 deaths.
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The most common possible complications of
pregnancy include:
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• Ectopic
pregnancy – This is a pregnancy that has
implanted somewhere outside of the uterus. A frequent
location is in one of the woman's fallopian tubes. There
is no room in the tube for a fetus to develop. Ectopic
pregnancy can become a medical emergency that can lead
to death. |
• High blood pressure
– A woman who has high blood pressure before her
pregnancy is at higher risk of pregnancy complications.
A woman who has never had high blood pressure can develop
high blood pressure during pregnancy.
A woman's blood pressure may rise dramatically in pregnancy
and cause problems such as impaired functioning of the
liver, kidneys or blood clotting system. Fetal growth
may be slowed and the placenta damaged. If blood pressure
increases out of control, with or without treatment, maternal
or fetal death can occur. In late pregnancy the likelihood
of high blood pressure increases. The stress of labor
and delivery can send the woman with high blood pressure
into crisis with seizures, kidney failure, and extreme
danger to the fetus. An emergency cesarean section may
be needed to save both mother and fetus. These conditions
are known as Pregnancy-Induced
Hypertension, Pre-eclampsia,
Eclampsia, and HELLP
Syndrome. (See glossary
for definitions). |
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• Infection, especially genital
or urinary infections – Bacterial and viral
infections of the genital or urinary tract can contribute
to premature rupture of membranes, premature labor, or
infection of the fetus or mother.
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• Diabetes –
A woman with known diabetes before pregnancy can reduce
the risk of her fetus having birth defects if her blood
sugars are in good control. Some women (about 3-5%) develop
diabetes as their pregnancy advances. Too high blood glucose
content can contribute to causing high blood pressure
and its complications as described above. Another common
result of diabetes in pregnancy is a larger than average
fetus, which may result in a difficult vaginal birth or
the need for a cesarean section delivery.
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• Premature labor – Premature labor is defined as labor starting after
the 20th week of pregnancy but before the full term of
pregnancy (37 weeks). Sometimes premature labor can be
stopped by medical treatment. If a premature birth results,
there is a greater chance of the infant's death due to
immature organ systems, particularly the respiratory system.
The chances of survival of the infant improve the closer
the pregnancy is to the due date.
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The process of birth includes labor and
delivery. The possible risks and complications of labor
and delivery include:
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• Blood clot (embolus)
– Blood clots can become dislodged and move to smaller
vessels where they block off blood flow. If blood flow
to a vital organ is blocked by an embolus, the woman's
death can occur very quickly.
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• Heavy bleeding
– There is always some bleeding with a birth. Heavy
bleeding is more likely with a difficult vaginal delivery,
the performance of a cesarean section, a large fetus,
or when medical complications like high blood pressure
are present. This could result in the need for a blood
transfusion with its associated risks.
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• Premature birth
– In Alaska, 1 in 10 births was premature in 2002.
Babies born before the full term of pregnancy have much
greater risk of immediate health problems. Many will catch
up with full term infants by the time they are one or
two years old. Some will not. Some will have lasting disabilities.
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• Infection –
Some infections of the birth canal can be passed to the
baby as it is born through the vagina. An important source
of infection of the mother is infection that travels up
into the uterus after birth has occurred. Bacteria can
directly enter blood vessels and spread throughout the
body very quickly causing high fevers and chills. These
infections can progress to shock and death without prompt
medical care.
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• Injuries to the vagina,
rectum or bladder – When the fetus passes
through the birth canal, excessive stretching can cause
damage to the vagina, rectum, or bladder.
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• Cesarean section
– Cesarean section is the surgical delivery of a
fetus through an incision made in the woman's abdomen
and uterus. Approximately 1 in 5 (21%) births in Alaska
is by Cesarean section. Commonly called "C-section",
the procedure is done to relieve dangerous conditions
of stress on the fetus or the woman, when the fetus is
too large to pass through the birth canal, when the woman's
labor is not progressing normally, and various other reasons.
Any surgery poses some level of risk for problems with
anesthesia, injury to the woman or fetus, bleeding or
infection.
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| • Rh factor incompatibility –
Protein material found on the surface of red blood cells
is known as the Rh factor. If a woman and her fetus have
different Rh factors, the woman must receive medication
to prevent the development of antibodies that would endanger
future pregnancies. |
FETAL EXPOSURE TO HARMFUL EFFECTS
OF
DRUGS OR ALCOHOL
Smoking during pregnancy
Cigarette smoke contains chemicals that are harmful
to a developing fetus. Smoking nearly doubles a woman's risk of
having a low-birthweight baby. This can occur because of a slower
growth rate of the fetus and because smoking can contribute to
an increased risk of preterm delivery. Smaller babies have higher
risk of health problems during the newborn period and of chronic
problems like learning disabilities, cerebral palsy, and mental
retardation. The American Academy of Pediatrics policy statement
on smoking says, "Pregnant women who smoke should be aware
of increased risks to their offspring, including spontaneous abortion
(miscarriage), low birth weight, sudden infant death syndrome,
and long-term cognitive and behavioral problems including lower
intelligence and attention deficit disorder with or without hyperactivity."
Alcohol use during pregnancy
There is no safe amount of alcohol consumption during
pregnancy. Alcohol can damage a fetus at any stage of pregnancy.
Alcohol use in pregnancy can cause permanent, life-long physical
and mental birth defects. Physical defects include smaller brain
size; defects in internal organs, especially the heart; and changes
in facial features. However, these features can be subtle and
difficult to diagnose. Alcohol use during pregnancy can result
in lifelong learning disabilities. The effects of alcohol consumption
during pregnancy are entirely preventable. For more information
on fetal alcohol spectrum disorders (FASD), go to http://www.eed.state.ak.us/tls/fasd/whatis.html.
Cocaine use during pregnancy
Cocaine use during the early months of pregnancy
may increase the risk of miscarriage. It may also cause problems
for the fetus such as heart attack, serious birth defects, and
stroke. Cocaine use in later pregnancy can result in premature
labor by causing the placenta to detach from the uterus too soon.
Any of these conditions may lead to brain damage or death of the
woman or fetus or both.
Newborns that have been exposed to cocaine may start life with
serious health problems such as low birthweight, mental retardation,
coordination problems (such as cerebral palsy), and attention
and learning problems. The effects of cocaine exposure are entirely
preventable.
Other drugs
Many drugs, legal and illegal, can cause unwanted
fetal effects. Some addictive drugs, like heroin can cause the
fetus to become dependent on the drug and lead to very serious
health consequences and fragile newborns.
Medications
Some medications, like commonly used seizure medications,
warfarin (commonly known as Coumadin) a blood thinning medication;
isotretinoin (commonly known as Accutane) to reduce acne; and
some antibiotics, can also harm the fetus. Women using any medications,
whether prescription or non-prescription, should tell their health
care provider as soon as pregnancy is suspected.
THE EMOTIONAL SIDE OF PREGNANCY
AND BIRTH
Having a baby can be one of the biggest and happiest
events in a woman's life. Each pregnancy and birth brings new
and different feelings and experiences. Some of the most intense
feelings of contentment and fulfillment may mingle with feelings
of anxiety, fear, sadness or depression. If depression is left
untreated during pregnancy, it can result in complications.
Immediately after a birth there is often fatigue and a period
of rapid physical change. Variations in hormones can cause moodiness.
Postpartum depression is a term used to describe a wide range
of emotional changes that can occur after having a baby. About
sixty percent of Alaskan mothers of newborns surveyed in 2000
indicated they were somewhat depressed in the months after their
delivery. Nearly 6% said they were "very depressed".
Postpartum depression can be treated, but it must first be recognized.
Depression can occur within days after delivery and may be only
mild and last only a short time. This kind of depression may not
need treatment. Sometimes having a supportive partner, friend,
or other new mothers to talk things over with is helpful.
If feelings of sadness or anxiety do not go away or if they get
worse and begin to interfere with daily activities or the ability
to care for a new baby, professional help is definitely needed.
In rare circumstances women with depression have harmed themselves
or their baby.
THE IMPORTANCE OF ESTABLISHING PATERNITY
Establishing paternity can help provide emotional,
social and economic ties between a father and his child, and can
ensure that the child receives the same rights and privileges
as all children. These include inheritance rights, access to the
father's medical and life insurance benefits and to Social Security
and veterans' benefits. The child also has a chance to develop
a relationship with the father, and to develop a sense of identity
and connection to the father's family. It also may be important
for the child's health for doctors to know the father's medical
history, especially if there is a history of medical conditions
in the father's family. Alaska law does not allow a father to
be named on a birth certificate if the mother is not married at
conception, during the pregnancy, or at birth, unless an affidavit
of paternity is completed by the parents or paternity is determined
by a court. If a father is not named on the birth certificate,
the father of the child cannot obtain a copy of the child's birth
certificate.
How can a father or a mother establish
paternity?
Either the mother or the father may complete a voluntary
affidavit of paternity. These forms are available at all hospitals
in Alaska and are usually given to the mother (if she is unmarried)
at the time of birth. Additional forms are available at the Bureau
of Vital Statistics. The Bureau has walk-in offices in Anchorage,
Juneau, and Fairbanks. The Bureau's web site (http://www.vitalrecords.alaska.gov)
has the address and a map showing the location of each office.
Affidavit of paternity forms may also be requested by calling
(907) 465-3162. If a parent has questions about how to complete
the form, they may call the Bureau of Vital Statistics at (907)
465-3162 for assistance. A voluntary affidavit of paternity needs
to be filled out and then signed by both parents. IMPORTANT:
The affidavit of paternity form must be signed by both the mother
and the father in the presence of a notary, a postmaster, or witness.
Once the form is completed and signed, it needs to be mailed to
the Bureau. The address is on the form.
If the father is not willing to sign a voluntary affidavit of
paternity or the mother is married but the husband is not the
biological father, the mother should contact the Bureau at the
number above for additional assistance.
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