Over 40 and Pregnant

The most common problem associated with high risk pregnancy is that the baby could be born with Down Syndrome or another chromosomal defect. My high risk physician mentioned Trisomy 18.

There are other complications that more commonly arise in women over 35 during pregnancy such as gestational diabetes and high blood pressure. These complications can also happen to moms of any age.

Photo appears courtesy of anarchosyn on flickr via Creative Commons.

Normally, your doctor will order an ultrasound around 16 weeks to determine the due date (and the sex of the baby if you so choose!)

Other reasons that would indicate the need for an ultrasound may be after abnormal bleeding, or you may not have felt the baby move, or your doctor wants to rule out complications. Also, if you elect to have prenatal genetic screening performed, an ultrasound is a necessary part of the screening, as explained in detail below.

In high risk cases such as mine, you may have an ultrasound more often to check for problems.

My high risk doctor scheduled an ultrasound to measure the back of the fetal neck, called Nuchal Translucency (NT) to be done between 11 through 13 weeks. I thought I was just going in for another ultrasound and I was confused and worried. The doctor, nurse, and healthcare technicians may refer to this as the first-trimester screening.

After this ultrasound is complete, they take the NT measurement results, the results of your blood test, your age, and your ethnic background and come up with this "number," which is your personal risk estimate. The number tells you how likely it is that your fetus may have Down Syndrome or Trisomy 18.

This test is a screen only and does not tell you definitively whether there is a fetal abnormality. It simply determines the chances that your fetus has Down syndrome or Trisomy 18, and reveals whether those risks are high or low. The results are usually complete within 1 week.

As predicted by my doctor, my number showed my fetus was at "high risk." Looking back on this, if I understood what prenatal genetic screening was (I guess it just wouldn't sink in), I would never have had the screening. We had no doubt that we would not get an amnio because we did not want to take the risk (see the numbers below) .

Photo appears courtesy of geneticnutrition.info via Creative Commons.

During an amniocentesis, a needle is inserted into the uterus to extract amniotic fluid. A lab can then determine with 98%-99% accuracy if the baby has a genetic abnormality or disease. An amnio can also determine paternity and lung development.

The downside of having an amnio is that (according to the Mayo Clinic) the risk of miscarriage ranges from 1 in 400 to 1 in 200. In facilities where amniocentesis is performed regularly, the rates are closer to 1 in 400.

Why should you have one? To find out that your baby is fine, which will give you peace of mind. If you find out that your baby does have a disorder, this can give you time to prepare to care for a special needs child, or you many decide to terminate the pregnancy. You can terminate the pregnancy up to 24 weeks. This is a personal decision.

The Fetal Non-Stress test is a simple, non-invasive test performed in pregnancies over 28 weeks. The test is called the Non-Stress Test (NST) because no stress is placed upon the baby during the test. The nurse attaches one belt to the mother's abdomen to measure fetal heart rate and another belt to measure contractions.

For about 30 minutes, movement and heart rate are measured. Every time the baby moves, you press a button. If the baby does not move, it does not necessarily indicate that there is a problem; the baby could just be asleep.

My Ob/Gyn ordered this test at my weekly visit from week 36 to the end of my pregnancy. As I laid back and stared at the computer and machine that perform the NST test, I started to formulate questions. First, "Why am I taking this test; what are they looking for?" My doctor answered that I had to take this test because I'm a high risk pregnancy.

Other reasons for the testing may be that you sense no movement from the baby, or you are overdue. They are checking to make sure that the baby's oxygen levels are normal.

Also, "What do the results mean? Will there have to be further testing?" A reactive non-stress result indicates that blood flow (and oxygen) to the fetus is adequate. A nonreactive non-stress result requires additional testing to find out why the baby is not responding as it should. Low oxygen levels can often be caused by problems with the placenta or umbilical cord, or other types of fetal distress.

Two weeks before my baby was to be born, my doctor advised me that I should be induced, and wanted to send me straight to the hospital that day, which was a Monday. Since I wanted to see if the baby would just come on her own, he said we could wait only until Thursday night, and he would have to insert a tampon-like suppository into the vagina, since my cervix was not favorable (meaning it was not fully dilated).

This is called a prostaglandin gel or suppository. I looked into this after feeling that I dropped the ball on the prenatal genetic screening. If the gel doesn't work, in order to further induce pregnancy, the doctor would break your water or use Pitocin, which is an artificial hormone. Thank God the suppository worked on me, because my last encounter with Pitocin was not pleasant.

I was also not ready for what the prostaglandin would do to me. Three hours after the insertion, contractions came hard and fast, one right on top of the other, for about 8 hours. At that point, I was still only two cm dilated. Then, the doctor gave me the epidural I was begging for (I didn't have one with my first baby, but the contractions were nothing like this!). As soon as the epidural was performed, I jumped to 7 cm.

From there, it was about 2 hours before I was fully dilated and the baby would finally arrive. During that time, I had a hard time breathing and I was spent from the overlapping contractions. I was asking for my mommy, so my husband called her and she had the great joy of seeing one of her grandchildren born for the first time, Camille being her 10th grandchild, who was just perfect!