There are a number of medical conditions in pregnancy that will determine whether a woman is deemed “high risk”. Here in Canada, women who are low risk have no underlying medical conditions and have the option of being cared for by a midwife, general practitioner (GP,) or obstetrician (OB.) Women who are high risk require specialized care, almost always with an OB. That said, some midwives and OBs work together and offer women a “shared care” model. If you’re unclear about your options, speak with your family doctor when you first become pregnant.
Pre-existing medical conditions
Women will be aware of their own specific health issues when they become pregnant. Depending on condition’s implications for pregnancy, women may be referred to a high-risk OB. Maternal-Fetal Medicine (MFM) doctors are trained to deal specifically with high-risk patients. Examples of pre-existing conditions could include Type 1 diabetes, a heart condition, or epilepsy.
Obesity
Obese women are defined as having a Body Mass Index (BMI) ≥30 mg/k2. Pregnant obese women are generally treated as high-risk patients, and assigned to an obstetrician for care. They will be counseled on diet and lifestyle modifications, and may be advised to meet with an anesthesiologist prior to labour to discuss complications relating to pain medications and surgery. Guidelines for obese pregnant women are vague, and perpetuate bias towards larger women. BMI does not take into account health status, and many women who fall into the “obese” category are in fact healthy and at a low risk for pregnancy complications. Pregnant women labeled as obese will need to advocate for positive care in their pregnancy. Consider a birth doula for non-judgmental support, and consult with a midwife to discuss shared-care with an OB.
Maternal Age
The average age of motherhood is rising in Canada, and more women are becoming pregnant and giving birth over the age of 35. Research has suggested women at advanced (≥35 years) or late (≥40 years) maternal age, are at a greater risk for pregnancy complications and stillbirth. However, clinical guidelines do not treat maternal age as the sole factor for “high risk” status, and many women can continue to be cared for by a GP or midwife.
Multiples
Women having twins, triplets (or more!) will sometimes require the care of an OB. This is because multiples can present certain challenges for mothers, and there is a greater risk for medical conditions (such as preeclampsia) to develop. That said, some mothers expecting twins can continue to receive care from a GP or midwife if nothing comes up during the pregnancy or birth. Shared care may also be an option for women expecting twins.
If you are labeled “high risk” it’s important to ask a lot of questions, and be clear on policies and procedures that relate to your care. High-risk pregnant women can really benefit from the caring support of a birth doula who will be there to answer questions and provide emotional support. Taking a comprehensive prenatal class will also help women and their partners to learn about medical decision making and informed consent.
I had a high risk pregnancy due to obesity but had no complications. I was very worried at first, especially after reading terrible stories of women, their complications and poor levels of care. I was seen by the High Risk Unit at the Civic and have to say their team was wonderful! My first appointment was the only one we talked about weight and they never made me feel upset or embarrassed. They explained the risks but with a “if it happened, we will deal with it. We have likely seen it before” attitude. A little ‘perk’ to high risk care is a I had many ultrasounds, every appointment, so I really got to see him grow and understand what going on in there!