Pregnancy can be complicated. There are many reasons women may be referred to a maternal-fetal specialist—also called perinatology or high-risk obstetrics. For many, it’s not because they’re high-risk. It’s because their doctor wants them to get a higher level of screening or additional information about their pregnancy. If they are higher-risk, it means they may need closer surveillance and intervention if their health status changes. At Providence Cedars-Sinai Tarzana Medical Center, we help our patients feel supported throughout their pregnancies.
Health Matters asked Tania Esakoff, MD, an OB-GYN and maternal-fetal medicine doctor at Providence Cedars-Sinai Tarzana, to explain what patients need to know.
What is maternal-fetal medicine?
For expectant moms who are being managed for high-risk conditions or complications with their pregnancies, there is maternal-fetal care that begins in pregnancy and ends with the baby’s birth. These medical conditions vary, as do complications the baby might experience before it’s time for delivery.
What makes a patient higher-risk?
Some women have diabetes, hypertension or autoimmune diseases such as lupus. Or maybe they had an organ transplant in the past or were born with a congenital heart defect that was repaired. We also follow patients because of their fetal complications: For example, if you are having multiple babies, it automatically makes you a little bit higher-risk.
What are the other reasons people visit a maternal-fetal medicine specialist?
We may see patients in their first trimester for their nuchal translucency (an ultrasound that measures the fluid behind a baby’s neck to screen for potential abnormalities). In the second trimester, it might be for the fetal anatomic survey, to make sure the pregnancy is developing normally, and, if women desire, more diagnostic procedures.
How do you determine if a woman should be an outpatient or inpatient?
Most women are outpatients, as long as their maternal status is stable and their fetus is doing well. If a woman’s disease worsens, or there are any signs she’s developing a new condition—such as preeclampsia—depending on the severity and how far along the woman is in her pregnancy, she may require admission to the hospital. The same is true for the fetus: If there are issues with the fetal heart rate, the placenta or amniotic fluid volume, that might prompt hospitalization well before it’s time to deliver.
What are important questions for patients to ask?
One of the most important things to find out is whether the pregnancy is healthy and if there are single or multiple babies. It’s important to ask what sort of testing an expecting mother might consider. Every person is different. Some people want to do less, but I think being educated about the options is important for everybody.
Confidence in Choosing an OB
The right doctor puts you and your baby’s health first.
Childbirth is a critical moment in life. Whether you have a high-risk pregnancy or want to deliver without pain medication, make sure your obstetrician respects your expectations and values. An OB who makes decisions with you and walks you through your options can help you feel confident before, during and after birth. Here are a few questions to get you started.
How would the OB describe their role in your care? How long have they been practicing? How many C-sections have they performed in the past year? And do they take your insurance?
Before and during your pregnancy, you’ll need ongoing support and personalized care. Ask how often you’ll see the doctor, how they’ll handle your questions between visits and whether they’ll still be your doctor if your pregnancy becomes high-risk. Will they help you create a birth plan?
Labor and delivery:
During this stage, it’s vital to have an OB who respects your choices and avoids unnecessary interventions that can lead to complications. Ask who will deliver if your doctor is unavailable, what their thoughts are about inducing labor and what choices they offer for pain management.
Your OB can help both you and your baby thrive after delivery. Ask if your baby can sleep in the same room with you, if your partner can stay over as well, and what kind of breastfeeding help you will receive.
Now ask the most important person: yourself.
Do the OB’s values align with mine? Do I trust their judgment? Do I like the way they communicate? And do they make me feel respected, confident and safe?
Remember, it’s your pregnancy. Let Providence be your partner. Find out more at providence.org/locations/socal/tarzana-medical-center/obstetrics.