Special Deliveries

UNM Hospital Experts Can Help You Manage a High-Risk Pregnancy During the Pandemic

Pregnancy can be an exciting time. There's a lot to do, from setting up the nursery to picking out names. Amid the excitement, getting regular pregnancy care should be a top priority.

That's especially true for patients with high-risk pregnancies-and it's even more important during the COVID-19 pandemic.

In a high-risk pregnancy, there is a greater chance of problems such as premature birth, complicated delivery or stillbirth. High-risk pregnancies may include any of the following:

• Developmental or genetic concerns for the baby
• Carrying twins or more
• Concerns for the mother's health.

These may include:

• Age younger than 18 or older than 40
• Previous high-risk pregnancy
• Pre-existing health problems, such as diabetes, high blood pressure or heart issues
• New health problems, such as gestational diabetes, preeclampsia or an infection

Having COVID-19 is also a high-risk factor. Pregnant women don't seem to be at greater risk for catching coronavirus than anyone else. But we still don't know how it might affect mothers and babies in the long run, so we're not taking any chances. At UNM Hospital, we've set up COVID-19 OB/GYN safety protocols to keep our pregnant patients safe.

Pandemic or no, women with high-risk pregnancies need more doctor visits than the average pregnant woman. UNM Hospital is the only Level 4 maternity hospital in New Mexico, and one of the few centers in the state that can provide care for the most complex pregnancies.

We believe every mother and baby deserves the best pregnancy care, so we formed a Special Delivery team to help pregnant women get the care they need.

Who is most likely to have a high-risk pregnancy?

It can happen to any mom, but it's more common among women facing obstacles such as low income and limited access to prenatal care. Patients with concerns like these are also more likely to have chronic conditions - asthma, diabetes and high blood pressure. These diseases can cause pregnancy and delivery problems and are linked to worse outcomes with respiratory infections like COVID-19.

Another major concern is premature birth - when a baby is born too soon. Premature babies usually stay in the neonatal intensive care unit (NICU) for help with breathing, eating and health complications. Sometimes we recommend patients move closer to a hospital with a NICU or schedule induction of labor or cesarean delivery (C-section) for a certain day. That way, mom can plan to be at the hospital when labor begins.

If you have a high-risk pregnancy, your doctor will talk with you about these and other risks during prenatal visits at the hospital.

Are high-risk patients safe at the hospital during the pandemic?

Yes. All patients and visitors who come to the hospital are screened for COVID-19. We carefully separate patients who have coronavirus from those who don't in all areas of the hospital.

The American College of Obstetricians and Gynecologists says hospitals and accredited birth centers are the safest places for women to give birth - even during the pandemic.

This is especially true if you have a high-risk pregnancy. Complications can develop quickly. Being in the hospital is your best chance for a positive outcome.

What will the provider do during my high-risk visit?

Care for expecting moms

At the hospital or high-risk pregnancy clinic, we'll monitor and treat new or chronic conditions such as:

• Gestational diabetes - Diabetes may develop during pregnancy, and it can lead to nutritional problems for moms and poor or too much growth of the baby - which can lead to increased chances for C-section delivery and longer NICU stays.
• Preeclampsia - High blood pressure can develop suddenly in pregnancy. Moms need emergency care to reduce serious health risks, including seizures, kidney and liver damage - or even death.
• Infection - Certain viral infections like the flu, Zika virus, measles and COVID-19 can pose health risks to mom and cause developmental issues in the baby.
• Heart conditions: Whether it is a condition you had before pregnancy or a newly diagnosed issue, it's very important to monitor heart problems carefully, as they are one of the biggest causes of serious complications during or after pregnancy.

Depending on your situation, you might need to come to the hospital or clinic more often. If we find a concern, we will make sure you understand the issue. Together, we will discuss options and help you plan next steps.

Checking baby's development and well-being

Women with high-risk pregnancies undergo many ultrasounds. In addition to the standard dating ultrasound and a careful assessment of the baby's anatomy in mid-pregnancy, we often perform a growth ultrasound and biophysical profile - an ultrasound exam that assesses the baby's well-being by measuring its breathing, heart rate, movement and muscle tone and amniotic fluid level.

Unusual ultrasound findings could signify a problem such as:

• Developmental issues - There could be a problem with the baby's organs or limbs. Or there might be signs of Down syndrome or other health issues.
• Growth restriction - Sometimes the baby doesn't grow to normal weight before birth. This is common in high-risk pregnancies.
• Placenta problems - The placenta is an organ that grows in the uterus to give the baby blood and nutrients. If it is not working properly, the baby can't get what it needs.

How does the Special Delivery team help high-risk moms?

UNM Hospital created the Special Delivery team to help pregnant moms navigate travel and health care challenges. Our team includes many providers with different skills, including:

• Case workers
• Family medicine doctors
• General obstetrician/gynecologists
• Maternal-fetal medicine doctors
• Neonatologists (doctors who treat newborns)
• Pediatric cardiologists
• Pediatric surgeons
• Perinatal coordinator

The Special Delivery team meets each week to plan for complex cases. They also work to help patients find needed services and help.

Do high-risk moms need special care after delivery?

Mothers who have high-risk pregnancies are more likely to have health problems later in life, including heart disease, kidney disease and future complex pregnancies. Postpartum care can help reduce these risks.

We ask new moms to visit us in the clinic between two weeks and six weeks after delivery. While some visits can be done through telehealth, we ask our high-risk patients to come to the hospital for physical exams and testing.

During checkups, we'll discuss:

• Birth control options, if desired
• Chronic conditions, such as high blood pressure or diabetes
• Emotional wellness, including screening for postpartum depression
• Healing, such as stitches for a C-section incision
• New symptoms, such as pelvic pain or too much bleeding

Along with postpartum care, research shows that breastfeeding can help lower the risk of long-term health issues. UNM Hospital is baby-friendly, so all our new moms can get tips and support from breastfeeding experts in person or by phone.

After the six-week visit, we help new moms connect with a primary care provider (PCP) in their community. While you might still need to come to UNM Hospital for certain checkups, your PCP can help you manage chronic conditions.

It is safe to come to the hospital during the pandemic. Getting advanced care gives you the best chance at a healthy pregnancy. And we're excited to help bring your little one into the world.