This is a guest article by Silvio Aladjem M,D.

“Ruth just had a beautiful 7 lbs. baby boy”

“Dana delivered a premature baby. I believe the baby has some malformation.”

What is wrong with these two statements?

Actually, nothing, except for the fact that rarely, if ever, you will hear the second statement.

Complications of pregnancy occur anywhere between 10% and 90% of pregnancies, depending on your definition of “complication”. Such a spread indicates that we really do not know what the real number is, that we do not agree on the definition, or both. What most people seem to agree upon, tacitly however, is that complications of pregnancy are not a subject to be discussed openly. We seldom talk about them. You hear about the next door neighbor having a baby, but rarely that she had a miscarriage, or anything else for that matter. Books on normal pregnancy abound, but there are no books, for the Public, dealing with complications of pregnancy. Should a woman ask her doctor or midwife about potential complications, chances are that her doctor or midwife would want to know why she asks, since her pregnancy appears to be normal.

I would like to touch upon the subject of “Complications of Pregnancy” and demystify the topic. Historically, women have been carrying the burden of reproduction pretty much alone. In some cultures, when a girl is born instead of a male, it’s the woman’s fault since she cannot give her husband a boy. Never mind that it is the man’s sperm, and not the woman’s egg, that determines the sex of the baby. Kingdoms have been lost because of that. If a baby dies before birth, it is the woman’s fault since she cannot carry the child to term. Thus, not having a normal pregnancy has become some sort of a social stigma. Women today are still facing the unspoken burden of an abnormal pregnancy.

Our unwillingness to openly talk about such problems benefits no one. This attitude is unique to pregnancy. We speak freely about Cancer, Heart disease, HIV, Diabetes, or any other health problem. Yet, we are quite cavalier when it comes to pregnancy. Technological advances of the last twenty to thirty years, have been interpreted by the public at large as “medicalization” of pregnancy.

Why is it that this state of affair exists, and what is conspiring against a change in the denial that complications do occur, or that if they do occur, it will not happen to me. There is an unacknowledged superstition, going back to times immemorial, that by not talking about a potential bad outcome we will be able to avoid it. But worldwide, some 500,000 women die in childbirth each year. In spite of concerted efforts, about 400 women still die each year in childbirth in the United States. Health care professionals, be these family physicians, obstetricians or midwives, perpetuate this unwillingness to openly discuss complications of pregnancy, primarily because they do not want to upset or frighten their patients.

Are we to perpetuate this state of affairs or should we make a concerted effort to change the status quo? To answer this question, we need to look at some hard facts. A cursory look at available statistics shows that, prior to pregnancy even being detected, 50% to 70% of all conceptions may be lost, and a woman will never know since the bleeding that follows is interpreted as menses. Once pregnancy is confirmed, about 10-15% will miscarry. One out of 8 pregnancies will end in preterm births, i.e. before 37 week’s gestation, with infants at a greater risk of death in the first few days of life. Very young survivors are prone to a variety of complications, long term disabilities or intellectual and learning disabilities later in life. Early or Premature Rupture of Membranes prior to term may occur in 8% of all pregnancies. Early labor and/or infection may follow with potential serious consequences for both mother and infant. Hypertensive disorders occur in 5% to 10% of pregnancies. Serious infection of the kidneys occurs in 1% to 2% of pregnancies. Diabetes in Pregnancy (Gestational Diabetes) is diagnosed anywhere between 2% and 10% of pregnant women. Three to 5% of all newborns are born with congenital anomalies.

The first to suffer from this lack of information, is the patient and her family. When something unexpected happens, patients and their families are unprepared, frightened and at a loss to understand what is going on since they fully expected a “normal pregnancy”.

We must start by acknowledging the fact that while pregnancy is a normal occurrence essential to our very existence as a species, it is not always benign in its course or outcome. It is our duty, as physicians, to make such information available in a responsible way. Knowledge is not frightening. On the contrary, it does away with the fear of the unknown and allows for preventive measures to be taken, whenever possible.

In future blogs, I will continue to discuss the many aspects associated with pregnancy complications.

By Silvio Aladjem MD

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SILVIO ALADJE MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. He can be reached through his website, www.drsilvio.com

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