Episode Transcript
[00:00:00] Speaker A: From Riverside Health System. This is the Healthy youy Podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
All right. I'm really excited to have with me in the Healthy Youth Studio today Frances Harris. Frances is a registered nurse. She's a high risk pregnancy manager at Riverside Maternal Fetal Medicine. Hi.
[00:00:43] Speaker B: Hello.
[00:00:44] Speaker A: Welcome. I'm so excited to have you.
[00:00:47] Speaker B: Thank you. Frankie. I'm excited to join you in this discussion with you today.
[00:00:52] Speaker A: Absolutely, absolutely. We are going to be talking about the high risk pregnancies insights and maternal fetal medicine, which I know a lot about from my years of experience personally with childbirth and getting pregnant and those issues.
So tell me a little bit about yourself and how you ended up in this line of nursing.
[00:01:16] Speaker B: Well, at Riverside Maternal Fetal Medicine, my role is to ensure that high risk pregnancies receive the attention and the ongoing care that they need for the best possible outcomes for both mom and baby. I help coordinate the care by supporting the plan that the patients and their providers discuss and I work behind the scenes on quality improvements.
So I make sure that we're following best practice.
And also I collaborate with local community organizations that help support healthy pregnancies.
But my work focuses on making sure that patients and their families are a part of that decision making process. That's very important. So I just closely work with their providers and also other specialists in their pregnancy.
[00:02:09] Speaker A: Well, thank you. Thank you for your commitment. This is such an important space for women.
So just for some definitions for our viewers when we talk about maternal fetal, explain what that encompass.
[00:02:27] Speaker B: So maternal fetal medicine, which we also refer to as mfm, is a subspecialty of obstetrics.
And so the pregnancies may involve health complications for mom, baby or both.
And the specialists, we sometimes refer to them as perinatologists. So you may have referred to that during your pregnancy, but they work closely with the primary OB doctors and they some of their work involves special imaging, monitoring moms closely and also treatments. And so your OB may refer you to maternal Fetal Medicine clinic if they feel like additional support is needed. And then so you know, you may have a chronic condition like hypertension, you might be expecting multiples or maybe something has come up in your pregnancy. You just got to discovered that you have placenta previa. So the goal is to achieve the Healthiest outcome for both mom and baby. And no matter how complicated the situation is.
[00:03:46] Speaker A: Okay, so we're going to be talking about some of those various conditions and you've mentioned a few and what treatments look like. What does that partnership look like with your obstetric? Right. Because it sounds like there's a multidisciplinary team approach to managing a high risk pregnancy.
And, you know, just your thoughts around that.
[00:04:11] Speaker B: So, you know, it's a lot of coordination of care. So you come to MFM probably because you've, you know, had a request for a consult.
[00:04:22] Speaker A: Okay.
[00:04:23] Speaker B: And so you're coming to them and they are able to go over your whole history and kind of lay out this plan.
So they are, because they're the specialists, they are able to determine if you need additional testing. Do we need to do lab work every trimester, do we need to do additional complete scans for your baby? So when you're coming there, they're laying out that plan. You have an idea of what's ahead, but also coordination with the primary obgyn.
[00:05:01] Speaker A: Okay.
[00:05:01] Speaker B: Okay.
[00:05:02] Speaker A: Excellent. Excellent.
I myself have dealt with challenges with.
I could get pregnant, but I had an incompetent cervix. So I spent a lot of time with a perinatologist and had to go on bed rest for a long period of time. And my age played a factor in that as well because I also got pregnant later after 35 years of age. So would you talk about some of those various conditions that put women in that high risk category you mentioned high blood pressure, placenta previa. Age. Right.
[00:05:41] Speaker B: Age.
Yeah. So over 35.
Then you will be offered additional testing and genetics just so to gather understanding of what this means in pregnancy. But also, you know, maybe some additional, what we call nst, which is the non stress test. So moms are placed on the monitor and we can monitor your baby's heart rate and contractions.
But there are women who come into pregnancy with maybe a previous known complication. So if you've had a loss prior to this pregnancy or if you have a chronic health condition like a heart condition, diabetes.
[00:06:31] Speaker A: Yes.
[00:06:31] Speaker B: So we have type 1 diabetes, type 2, and also gestational. So because of the growing placenta and hormones, you may develop gestational diabetes despite trying your best and having a good diet.
[00:06:50] Speaker A: My Grandbaby, who's now 2, was born 10 pounds, and so my daughter had gestational diabetes and then also had issues after delivery with her blood pressure.
We have a lot of diabetes that runs in our family. And then even on her father's side. So I don't know if that plays a part in it having a family history.
[00:07:15] Speaker B: And so that's why it's important to identify some of those risk factors.
Family history is another one.
And it can also be your socioeconomic background. And so it's important to understand that when we ask those questions in the office that we're assessing maybe your need for some early intervention. And, you know, intervention doesn't mean that we're going to steer your pregnancy into a certain direction or require you to do tests that you're not comfortable with. But just the monitoring can prevent some of those disparities in care and also prevent the maternal morbidity and mortality rates that we're seeing.
[00:08:06] Speaker A: Are there some things or programs? I know there are programs to help women who are struggling with some of those. I call them social determinants of health, one of which is socioeconomics.
[00:08:19] Speaker B: Yes.
[00:08:21] Speaker A: Can you talk a little bit about that? Do you link them to various resources?
[00:08:25] Speaker B: Absolutely.
And programs, this position that I am in here at Riverside, you know, fortunately, the people, the powers that be here realize that, you know, we need to address the whole patient.
[00:08:42] Speaker A: Right.
[00:08:43] Speaker B: And we need that coordination of care. And if prenatal visits are so important, but we have problems with transportation, then we can't get those services to the patients that need them the most.
[00:08:59] Speaker A: Absolutely.
[00:09:00] Speaker B: And so, yes, I do a lot of care coordination with the patients, you know, and it sometimes it's just a phone call, you know, and saying, hi, I'm here to help you.
[00:09:13] Speaker A: Absolutely.
[00:09:14] Speaker B: And I'm here for you during your pregnancy and also afterwards. So you're going to look for me to, you know, come find if you are, you know, if you had your postpartum visit, you know, or how's your mood, but those things. And also just connecting with the community.
I've been able to connect patients with community resources, and sometimes it's just being with other women who are experiencing the same thing that you are during those times.
[00:09:44] Speaker A: So, I mean, I've heard of instances where. Where the woman shows up and presents ready to deliver and has had no prenatal care at all. And so very high risk and sometimes can be a negative outcome for both the mother and the baby.
I would think that it would have to be a lack of understanding of how important that is, or to your point, you know, challenges with transportation and information.
And so.
[00:10:17] Speaker B: So it starts here. So if you're listening to this podcast, you know, it's important if you're not in childbearing age and Then if you're women who nurture other women to share that information, because prenatal care is so important. And even women who's had children previously, you know, this is my fourth baby and you know, things like the routine, I know the routine and all they do, they just listen to my heartbeat for just a couple minutes or something like that. Every pregnancy is its own.
And your body, pregnancy takes a toll on your body.
And so it's important that we get you into cardiology. It's important that you follow up with your primary care physician. So connecting women to that is important.
[00:11:09] Speaker A: Yes.
Another piece is a misconception about the financial woes of those visits. We do have programs and things to help support them or can link them to resources, insurance resources and things that are available to them. I think sometimes there's a misunderstanding that I don't have the money to go and be seen.
[00:11:37] Speaker B: Absolutely. So because of the CARE act, we now have coverage for women in pregnancy. And that's new. And some people may not realize that.
And so we're not pregnant every day of the last few years. So it just may be that it wasn't available before.
So you can come for care and, and we can help you get insurance and those things. And you know, it's important to get in early and it's important not to delay. And so if you don't have insurance and you think you're pregnant, reach out because we can connect you with those resources. And like you said, they're out there.
And we're also doing a lot within Riverside to help support women's health so that that care is there. And we have a lot of new ways to get you to where you need to be. And so we offer group prenatal care as well as another option to your pregnancy. So it really does put you in touch with other women that are going through what you're going through and for those high risk pregnancies. And that's always been kind of controversial whether or not a high risk pregnancy can only be seen in a certain space. But we do see it all. You did mention that women sometimes come and they, you know, they're delivering and it's their first time.
[00:13:12] Speaker A: Right.
[00:13:12] Speaker B: But we have a really good Brentwood OBGYN here who sees high risk patients in our high risk clinic at the maternal fetal medicine office.
So those doctors will be able to see you and care for you in the best way, you know, at that very high level.
[00:13:36] Speaker A: Very good. So how long would someone stay under the MFM care?
[00:13:44] Speaker B: Yeah, some people Come just for that consult that we talked about. And some people come and they just need kind of that initial care coordination, and then they will follow up as needed. Others require kind of a lot of appointments that, you know, could happen weekly or bi weekly. If you have diabetes, you may continue to come in. Exactly. So it's very comprehensive.
[00:14:16] Speaker A: Okay. All right. And something that's. I told you, my daughter experienced this. As we talk about these conditions, is post, after the baby, things that come up and develop after you've delivered the baby. And sometimes there's a misconception that, you know, I'm out of that trouble zone.
[00:14:39] Speaker B: Absolutely. So preeclampsia, which is a condition of high blood pressures and can develop after birth.
And so it's important to understand those warning signs, the headaches, blurred vision, the increased swelling, the nausea.
And so those things are important. Those signs are important. And it's important kind of to educate the entire community and your family to notice those things that are happening. Absolutely.
[00:15:18] Speaker A: So as it relates to lifestyle, are there things that a woman can do in preparation for, hey, I'm planning and I know I want to become pregnant? Yes. And then the bounce back.
[00:15:31] Speaker B: Yes.
[00:15:32] Speaker A: Post.
[00:15:33] Speaker B: Yeah.
We have a couple of resources within our maternal fetal medicine. We have genetic counseling, so we can do preconception counseling for women.
We also have a dietician, and so they are able to see non pregnant women as well. So maybe it is that you're trying to optimize your health for. For pregnancy. I think we all could use that. And so maybe you're underweight or overweight, or maybe you've just been struggling to find that optimization of your health. Right. Making the right food choices. And so we can specialize those things for you and you can follow up as needed. Maybe you need to come back in a couple months and you need to tweak things a little bit. Absolutely. Exercise, Exercise is very important.
And so, you know, and also there were some habits that we may have had prior to pregnancy, so it's important to address those as well.
And, you know, eliminating alcohol and smoking is important.
[00:16:51] Speaker A: Okay.
All right. And then, you know, this weight, you know, what is the target number? What is the magic number? You know, some of us grew up in the era where, hey, you're pregnant, you eat whatever you want, there is no weight gain limit.
[00:17:10] Speaker B: So the dietitian will be very specific with you. It's very specific towards the weight that you started out pre pregnancy, the baseline.
[00:17:18] Speaker A: Okay, okay.
[00:17:19] Speaker B: And so we will. That's part of prenatal care, is Coming in and evaluating your pre pregnancy weight maybe is you might need to gain a little more than some women. And also how many babies you're having, how many calories you need. We're not eating for two, we're never eating for two. But you know, you may need to double those in calories. You know, you may need, say, 300 calories early in pregnancy with one, one baby, but maybe you need to, you know, you have two. So it's important to understand that dynamic and get the specialized care for yours for you.
[00:18:04] Speaker A: It sounds like a true team approach to managing pregnancy and ensuring that you have a healthy, a healthy, healthy baby.
[00:18:15] Speaker B: Teamwork is the key. Teamwork is the key. And we're able to do that because we're sharing the same patient chart and we're able to have that good communication between your primary OB and your maternal fetal medicine. It really is a synergy of that specialized care.
[00:18:40] Speaker A: All right, and then the post pregnancy, you know, what would that look like?
[00:18:48] Speaker B: So post pregnancy, if you are a patient with maternal fetal medicine, you will normally follow back up with your primary OB in the post pregnancy.
And there are a number of visits that we could require. So it's not just that six week postpartum visit.
We'd like to see you back within the first two, two or three weeks to check on you and to see how your mood is.
[00:19:18] Speaker A: And we don't talk a lot about that. That postpartum depression.
[00:19:22] Speaker B: Yeah. And so it's very important to take care of yourself and to acknowledge those changes that's happening in our bodies.
[00:19:32] Speaker A: All right. All right.
So this is so inspiring and so informative. Thank you for your commitment and all the work that your team do. Thank you in your clinic. Before we wrap up, what would you say to an expectant mother who might be feeling nervous or overwhelmed about being referred to maternal fetal medicine?
[00:19:55] Speaker B: I would say that when you, if the time comes and you have to be referred to maternal fetal medicine, to look at it as that we are giving you the most comprehensive care. We are going to address your needs and your baby's needs and that we're a team. And I would just encourage you to ask questions, be a part of that care planning and trust that we are here for you and to support you and what you envision for your pregnancy.
[00:20:34] Speaker A: Right. I know that to be true. I still remember the staff and the nurses and the physicians that supported me along my journey. I've been pregnant six times. I only have two left births and the babies that are lost were 20 to 24 weeks.
So yeah. But I have a good story because I do have two children and they supported me and kept me encouraged.
So thank you. Thank you for what you do come back anytime soon.
[00:21:05] Speaker B: Well, thank you for sharing as always.
[00:21:06] Speaker A: Welcome.
[00:21:07] Speaker B: Thank you for having me.
[00:21:08] Speaker A: Thank you so much. This has been so insightful, this conversation and to our listeners. If you or someone you know is navigating high risk pregnancy, remember there is a team of experts that can help and support you. And if you want, you can let our viewers know how they can reach your clinic, even though most often they come through referral. But if someone wants to just follow up and get more information so you.
[00:21:34] Speaker B: Can find your care at Riverside Partners in Women's Health or Riverside Brentwood Clinic.
And that's how you will get the referral to maternal fetal medicine. And you know, it's important just to say this is my first pregnancy, but I have concerns that I would like to follow up on or this is not my first pregnancy and I would like to get into the specialist and you know, once you're there, I will be available to you.
And so ask, ask for Frances because you know, I am here. I do spend a lot of time in the background kind of thumbing through your chart and making sure that we're following the care that the plan that you have discussed with your provider. But I'm here for you. And so some patients and I we mychart message.
[00:22:27] Speaker A: Yes, yes.
[00:22:29] Speaker B: Like we're girlfriends, like we're texting. So you do have extra support. So please know that that's comforting. Absolutely.
[00:22:39] Speaker A: As a part of our mini series on pregnancy, this episode builds on previous discussions about pre pregnancy planning and healthy pregnancies. Be sure to check out those episodes as well. Thank you.
Thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
