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

Although this seems to be a simple question, in reality it is not. The World Health Organization defines normal term for delivery as between 37 weeks and 42 weeks of pregnancy, but does not define “normal pregnancy”. “Williams Obstetrics”, the standard textbook of obstetrics does not define “normal pregnancy”. Other textbooks do not define “normal pregnancy” either.

Some people define a “normal pregnancy” as one that ends up in a vaginal delivery, as opposed to a cesarean section. This is a totally misguided concept. Cesarean section is a “method” or “mode” of delivery as opposed to “vaginal” or “spontaneous” delivery. Neither of these “modes of delivery” makes the pregnancy normal or abnormal. For example, a woman whose pregnancy develops preeclampsia but delivers vaginally did not have a normal pregnancy. Equally, a pregnancy that was normal and the patient, who had a cesarean section in a prior pregnancy, chooses to have a repeat cesarean section rather than a VBAC (vaginal delivery after cesarean section), did not have an abnormal pregnancy. Understanding these concepts is important.

What, then, is a “normal pregnancy?”?

Let us take a diabetic patient, for example, who has her diabetes under perfectly good control, delivers a normal infant that does not show any signs of having been affected by maternal diabetes, and the mother goes home with a normal child. Was that an abnormal pregnancy because the mother had diabetes? One can argue that the mere fact that the mother has diabetes makes it an abnormal pregnancy. I beg to differ. Having diabetes makes it a pregnancy at risk, or a “High risk pregnancy”, but the pregnancy was normal. In fact the whole idea of having a “high risk pregnancy” concept is for the purpose of receiving specialized care and to assure, as much as possible, that the mother will have a “normal pregnancy”.

In the last twenty to thirty years there has been a push, by well-meaning people, for non-intervention in pregnancy. Delivering in a hospital, monitoring and other technologies that allow the physicians to assess the course of labor, and the immediate availability of emergency services, when needed, for both mother and baby, made delivery safer. To return to the past, to the time of bed room delivery and physicians or midwives asking for hot water, is both foolish and dangerous. If anything, medical and technological advances have reduced maternal mortality, improved general care for mother, fetus and the newborn, and more and more pregnancies are “normal” as a result. The entire purpose of obstetrical care is to have a normal mother and a normal baby.

Unfortunately, the diagnosis, and therefore definition, of a normal pregnancy can only be retrospective in nature. We can say that the pregnancy was normal, when we look back and know that there were no complications during pregnancy and a healthy mother went home with a normal healthy baby. But we cannot look forward, at the beginning of pregnancy, and assure ourselves that the pregnancy will be normal. In the majority of cases, fortunately, it will, but we cannot predict it. Therefore, the diagnosis of a “normal pregnancy” can only be made retrospectively.

This inability to prospectively define pregnancy as normal or abnormal, leads us to an important concept. We should be talking about pregnancy only. The concept of High Risk Pregnancy implies that, medically, in some patients, we have detected a problem which needs specialized care for the purpose of attempting to have a “normal pregnancy” and end up with a healthy mother and baby. In the vast majority of cases we succeed. In some we may not, but that is part of life. Complications of pregnancy are not a curse and the mother is not at fault. Let us stop throwing under the rug “complications of pregnancy” and let us talk about them intelligently. Are we ever going to understand this? Sometimes I wonder.

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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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