6 Tricky Pregnancy Topics You Should Discuss With Your Ob-Gyn

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If you're pregnant or trying to conceive, then you're likely inundated with pregnancy related content. Think: social media ads for cute baby products, gestating influencers in your newsfeeds, and unsolicited advice texts from friends and family.

Maternity advice and guidance are everywhere and that can make it hard to know what information to trust. Yet it doesn't have to be. In my field of work, I've heard it all and witnessed so much. And because of that, I wanted to share what I wish more people knew before they got pregnant.

1. Pregnancy is one of the most dangerous things you can do with your body

...but nobody likes phrasing it that way. In the United States, the maternal mortality rate for 2019 was about 20 deaths per 100,000 live births, or 754 women. This rate is highest for Black women: 44 deaths per 100,000 births, which reflects systemic racism in health care, not an innate difference in race.

The reason pregnancy and childbirth are so dangerous is because of events like postpartum hemorrhage, preeclampsia (a condition that can cause elevated blood pressure, seizure, stroke, preterm birth, and more), infection, and life-threatening blood clots (pulmonary embolism). Celebrities like Serena Williams and Beyoncé, and the Olympian Allyson Felix have helped shine light on these risks in recent years by sharing their own harrowing birth stories.

While these outcomes may seem rare, they aren't rare enough. Preeclampsia happens in about one in 25 pregnancies in the U.S. and about 5% of patients will experience a postpartum hemorrhage. Luckily, organizations like the American College of Obstetricians and Gynecologist and the Society of Maternal and Fetal Medicine have prioritized decreasing these rates through sweeping education and policy initiatives.

As part of your prenatal care, it's a great idea to talk with your provider about your personal risk of conditions like preeclampsia and what precautions you can take to lower these risks.

2. Some everyday illnesses can be more serious if you get them while pregnant.

There are viruses around that you may not even notice as an otherwise healthy adult but that could be harmful to a fetus, or even cause birth defects. One example that is uniquely concerning in pregnancy is CMV, or cytomegalovirus. This is a super common virus that the majority of reproductive-age people have already been infected with, but that rarely causes any symptoms beyond that of a common cold. When passed to a fetus, however, CMV can cause serious neurodevelopmental issues, including hearing loss. Only 2-3% of pregnant people are known to become infected with CMV while pregnant, but it's just one example of why it's definitely worth asking your doctor about your exposure to — and protection from — viruses in general, and how they might impact your pregnancy.

3. Spacing your pregnancies is super important to consider.

While the idea of two babies born within a year may sound cute and cuddly — or like a way to get the no-sleep, all-diapers phase over with in one go — it's also potentially risky.

In recent years, new data has emerged that shows if you want to decrease your risk of preterm birth with your second child, it's best to wait at least 18 months after delivering your first before getting pregnant again. On the opposite end of the spectrum, that same data also shows that spacing out pregnancies by five to 10 years may also be associated with increased risk of adverse outcomes.

Not to mention, while getting the exhausting-infants phase over with all at once might work for some, it's important to not feel rushed. We're all operating on our own schedules. If you can, do what's best for your body and life, instead of focusing on external pressures and assumptions.

4. There are more benefits to an epidural than just keeping contractions in check.

I'm constantly fascinated with the varying views on epidurals. Whether you're pro epidural or not, my advice to you is this: consider what will happen before and after the birth and have a conversation with your provider about it. If you end up with a vaginal birth, the placenta needs to come out and in about 3% of deliveries, it can get stuck and require a manual removal. A manual placenta removal is where we ob-gyns insert our entire hand and arm deep into the uterus to take out the placenta. If it's not coming out that way, it's being pushed out the same way as the baby — and it's not small.

It's also incredibly common to have tearing that requires stitches after a vaginal birth, especially if it's your first time. Depending on the extent of the tear, this can take anywhere from a few minutes to over an hour to repair, and locally applied lidocaine only goes so far for this type of pain relief. There's a lot to talk about when it comes to epidurals and the process of laboring, too, so this should be high on your list for a chat with your healthcare providers.

5. Breastfeeding is not always as easy as social media makes it look.

Like I tell my patients in the clinic, there's a reason there have been wet nurses since the beginning of time. Some people can breastfeed effortlessly, but many people have challenges. All of it is okay and while breast milk absolutely is the best source of nutrients for a newborn, the stigma surrounding the "breast is best" message that we often hear can actually be quite damaging for parents and babies alike.

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When we hear messages that exclusive breastfeeding is both easy and the only accepted way to feed your baby, the real message we receive is that anything short of this is wrong. Some people can't breastfeed or chestfeed due to medical or surgical conditions. Some people choose to exclusively pump or formula feed, or do a combination of all of these things. The breastfeeding-or-else messaging ignores those parents, and can also lead to real medical concerns for newborns — namely, excessive weight loss, which increases the risk for things like jaundice and dehydration.

The best approach to breastfeeding is to realize that it comes with challenges, and they are nothing to be ashamed of. Anticipate these challenges ahead of time and make a plan: talk with your OB provider, research lactation consultants and have their phone numbers handy, order a breast pump (covered by insurance as part of the Affordable Care Act), and be kind to yourself if things don't go exactly as planned.

6. Your vagina will change.

And that's okay. Back in the day, doctors considered conditions like urinary incontinence and vaginal prolapse more common after birthing larger babies, having multiple deliveries, or forceps delivery. In reality, the act of carrying a pregnancy in general (regardless of how the baby comes out) is the biggest risk factor for pelvic floor trauma.

For the entire length of a pregnancy, the uterus puts constant pressure on certain  muscles and nerves — it's not uncommon for pregnant people to pee themselves when they sneeze or cough. (This is actually way more common than you think in people who haven't been pregnant yet, too.)

Strengthening your pelvic floor is absolutely possible at all stages of pregnancy and the postpartum period, especially with the help of specialized pelvic floor physical therapists. Unfortunately, this isn't a universal service for most new parents in the U.S. and insurance rarely covers the expense. Excellent online resources and exercise programs exist, though, and you can absolutely start strengthening your pelvic floor early in pregnancy or even before you conceive. Two of my favorite prep and recovery recommendations include: The Power Pregnancy and Pelvic Health Program and Every Mother. These are fantastic (and realistic) approaches to addressing this issue proactively, and from the privacy of your own home.

The other big change here is with sex. There may absolutely be changes with the way things feel, especially in the beginning, but that is normal and can also improve with pelvic floor physical therapy and good communication with your partner. The biggest takeaway I try to communicate with patients is that your body (and mind!) will never quite be the same as before in a variety of ways and that is okay.