Hi guys, thanks for joining me today. My name is Christa and I’m from MomTalks with Christa and today I’m so excited about our guest because this has been a long-awaited topic. We are talking about high-risk pregnancy and preemie care. This is something that we hear in our group all the time we want people to talk about. So I’m so excited to welcome Parijat to the show and to answer all of our questions, so welcome. 

Parijat: Thank you so much. 

Christa: I’m so excited to have you here so just to get started, can you just tell us a little bit about you and what you do? And then we'll kind of go from there. 

Parijat: Absolutely, so I am a health strategist, an integrative health strategist for women going through a high-risk pregnancy specifically a high-risk pregnancy after second or third trimester loss or preterm delivery. And I got into this work because of my own personal experience of having gone through a very high risk pregnancy and an extremely preterm delivery and a lengthy NICU stay. And It was my personal experience that really opened my eyes to where the gaps are in our current system in terms of supporting women and specifically what I found is that there's no conversation about how to support the neurobiology of pregnancy in order to actually reduce the risk of pregnancy complications and help you stay pregnant. And so when I kind of dove into the research after my son came home and I was ready to kind of start working in on this, I found there's 70 years of research showing the impact of supporting neurobiology on actually extending pregnancy and reducing the risk of complications and I thought, how come nobody's talking about this? And so I made it my mission because I know what it's like to have gone through this personally and even with the most incredible medical team there are still gaps in that care and I really thought it was so important to bring this message into the world and to teach women exactly how they can support their bodies to improve pregnancy outcomes, improve maternal outcomes, fetal outcomes. And there's so much that we can still do even in a situation like that where it feels like everything's falling apart and I know that personally what that feels like and also there's so much we can do and I find there's a lot of hope in that so that's what kind of brought me to this work today. 

Christa: That's awesome, I think what you said about kind of losing hope and thinking kind of, it's out of your control at a time so it's awesome having you here and share your knowledge and experience so you kind of have the two sides of it because you can bring a lot of experience into this whole conversation. So kind of starting with premature babies so for those kinds of those listening that aren't too familiar, what's considered a premature baby and what are some of the reasons babies are born prematurely? 

Parijat: Technically a pre-term baby or a premature baby is a baby born before 37 weeks. Even though so due dates are calculated around 40 weeks and so there is kind of a three-week buffer, that baby might be born before a due date but it's not technically considered pre-term. What they're doing now in the last several years is we're considering a full-term baby after 39 weeks and then there's early term which is kind of 37, 38 weeks or so around that time and the reason for that distinction is technically it's a your you're delivering at term after 37 weeks but we're finding that there are some additional developmental benefits of delivering after 38 weeks ideally around the 39-40 week mark regarding neurological development, lung development for baby but it's not. So early, where you start to see kind of longer-term complications between the 37, 38-week mark as opposed to some a baby born before 37 weeks. So long story short pre-term baby is born before 37 weeks and there's a number of reasons why a baby can be born preterm and they're kind of split by complications that impact mom versus impacting babies so maternal complications can be any number of pregnancy complications that either impact the pregnancy, impact the woman's health, or the birthing person's health and require that the baby be born early to save or support mom's health or there can be fetal complications. For example, fetal growth restriction, intrauterine growth restriction, issues with blood flow to baby, issues with baby's heart rate. For example, certain complications regarding any number of body systems during the pregnancy for baby that you sometimes can find with in more detailed testing, detailed ultrasounds, or more invasive testing that the providers at that point decide it's actually more beneficial for baby to be born so we can intervene in a way that we can't help the baby in utero for example. And then there's also reasons such as drug abuse, sometimes alcohol use, recreational drug use, things like that sometimes it has to do with some blunt force trauma. For example, if a mom falls down the stairs and you know falls in a certain way or gets into a car accident so sometimes it has nothing to do with the health of either one but for some reason it's just the solution is to deliver whether that decision is made by the medical team or made by the body for many any number of reasons there could be the reason to deliver pre-term. 

Christa: And is there ever a reason like that a doctor would know like early on in the pregnancy? Like oh, this is going to be a premature birth or is that something that doesn't always have a plan? Like kind of can kind of just happen or is there times where a doctor might know early on? 

Parijat: It could go either way which is very frustrating because you kind of at least if I’m going to have a preemie just tell me and I can prepare because it is kind of the thought process at least certainly that's what I thought of as well. For example, in my case or cases like mine there are multiple complications that are adding up over time and so by that point you're kind of thinking, I remember when I was in the hospital around 23 weeks we had kind of changed the target date from my due date to 28 weeks. We're like, let's just make it to 20th so you know it does adjust based on what's going on in the pregnancy for sure. Oftentimes like the women that I work with privately, they already experienced a second or third trimester loss or preterm delivery which automatically makes the next pregnancy high risk for preterm delivery and sometimes there is spontaneous preterm labor and spontaneous preterm delivery where there is very little notice and something just happens without a lot of lead time and before you know, a baby is born early and that that can happen. When we take a neurobiological approach to on trying to understand spontaneous preterm delivery and preterm birth, there is a little bit more answers than we often get from our medical providers in terms of how the nervous system the endocrine system which is tied to hormones and the immune system, which is often tied to inflammation, how they kind of work together that are sometimes giving us clues ahead of time that usually the medical system can't find. That's kind of going orange flag, this might happen but things like if you have a complication called an incompetent cervix or cervical insufficiency meaning your cervix is shortening. There is data that shows if it shortens by a certain amount, by a certain point in the pregnancy, your risk of delivering preterm does increase. So there are some complications where you kind of have an idea and there are others where you maybe don't even have a complication and all of a sudden before you know a baby's born early. 

Christa: Oh wow, and so I know with premature babies there can be a lot of different health risks. So what are some of the short-term versus long-term health risks that can occur? 

Parijat: A baby born before 37 weeks it really varies depending on how early they are. So for example, my son was born at 24 weeks in five days so what he faced in the NICU at that point is very different than usually what a say the 35 weaker will face and everything in between. So it really depends on how early the baby is but typically what the short term concerns are can they breathe on their own? Can they regulate their temperature? Can they regulate their blood glucose levels? And can they stay warm? It's essentially can they regulate and can they actually be without intervention. Now again, you can imagine the earlier the babies are the more interventions are required and the longer it takes to get there but that's essentially what you're looking at kind of short term and again the earlier they are also there are various other factors that could be complicating their development and their health including complications to any number of body systems so you might notice in the NICU they do an ultrasound of the brain, they might they do echo cardiograms for the heart frequently, they're checking their lungs frequently, kidneys, livers I mean everything they're looking at to see if everything's okay. Another complication that could happen for pre-term babies and again, this is more often for the earlier babies a problem with the gut and the intestines and so any number of systems can be affected. At the time of birth the closer you are to 37 weeks the less likely that is. That's not to say that it doesn't happen but it's just far less likely. As we kind of come out of the NICU, going forward, the longer term complications can be really varied depending on what the health of the baby was before genetic factors, lifestyle factors at home, and just so many different factors but there's a higher risk for preemies to have developmental delays, gross motor fine motor delays, speech delays, or any some kind of issues with speech, feeding, sensory issues, learning disabilities, things like that not to say that it happens to everybody but there is an increased risk. 

Christa: When it comes to evaluating or checking your baby for different risks do you recommend parents like take them to specialists right away? Or kind of as they get older and grow to kind of have their doctor check different you know milestones and that kind of thing? 

Parijat: I definitely recommend finding a pediatrician who is familiar with working with babies born at the gestational age where your baby was born. So I remember when I was getting ready, my son was getting ready to be discharged and we were starting to do research on pediatricians ourselves, there were a lot of pediatricians who were like we work with preemies all the time but when I asked how early were they born oh 33,34,35-weeks usually something like that. A baby born- we just talked about the baby born that late in the pregnancy has very different concerns and has had a very different path up until now than a baby born as early as my son was. And so that was a question that I thought was really important to really clarify, who has had experience with? What are called micro preemies? For example, that super super tiny really really really early ones because it's a very different path and with that then, we were able to have a lot of reassurance that our pediatrician was watching out. And at the time of discharge, we were certainly already seeing specialists. Some of them were from the hospital that we just saw outside of the hospital, some of them we had to find new because they didn't transfer, they didn't do provide care outside of the hospital. And so at the time of discharge often you'll know which specialists you need to follow up with and for the babies that are born closer to that 37 week mark, there may not be anybody. And so if you have a pediatrician that is really good at being proactive and looking for those you know, orange or yellow flags before they even become red flags, that's often a really good sign that you might be able to catch something sooner before it becomes a huge issue and then if your state allows it and you're able to, I think it's always a great idea to enroll in early intervention and just have some of those specialists checking just keeping an eye out. Best case, everybody keeps telling you everything's great, no issues and you can rest assured that you have enough eyes looking at the health and development of your baby and worst case somebody catches something with enough time and notice for you to actually intervene and do what's necessary to support your child's development. 

Christa: I know you've already shared so many amazing like tips for moms that are have premature babies. So but, what would you say is one of the most important things for moms to know that you know- because we get questions all the time, some premature babies in the group and wanting to know about health and how to take care of them and so what would you say is something a really important tip for them to know? 

Parijat: Oh gosh can I say two? Yes, absolutely. So the first I would say is think remember that when your baby is born, their whole life and their whole journey is not mapped out for them. We still have a lot to learn about who they are and how prematurity is going to affect them. One of the best pieces of advice I received from a NICU nurse I had was two babies can be born at the exact same gestational age and have completely different outcomes completely, different outcomes and I actually have a friend who's who has a son born at the exact same gestational age as my son. They could not be more different what my son struggles with he doesn't and what he struggles with my son doesn't. It's so varying and so because of that, I realize that it can bring up a lot of overwhelm because that means you don't know and sometimes, we just want to know. And I encourage you to think about your child's development really on a micro level, how are they doing, especially when they're infants in the first like year or two, you're looking at kind of week by week oftentimes and then you can extend to you know, like quarter by quarter or half year by half year then by year by year how are they doing and trust that they are going to show you when they need support and where they need it. And our job, only our job is to just notice those flags and then we find the people who can help us, right? And I think that that's really important because we do try to and I did this, absolutely did this myself but just tell me, but just tell me what's going to happen and then I’ll do all the things to prepare myself for it now. And there's a lot of anxiety about is this the appointment where we find out there's a delay? Is this the appointment where we find out there's something wrong with his heart? Or his kidneys? Or something. And we don't know is truly the answer and if you can take your attention from what everybody's telling you and focus entirely on your child, they will tell you what they need and where they need that support. So trust that it's going to unveil itself in the time that it unveils itself. And again, I fully recognize that it's much easier said than done and also I find that it takes a lot of the overwhelm out because now we're not trying to predict three years in the future because that's this child who you have now is going to be a very different person three years from now for example. And then I think the second thing is which is I think is tied to this is you were on a marathon, you are on a marathon, running a marathon, don't try to sprint it. So, in taking such good care of your child please don't forget about yourself, do what you need to do and I’m not talking necessarily about bubble baths and you know rose scented whatever. They do that if you love that totally, but I’m really talking about don't neglect your basics, your day-to-day, take your showers, make sure that you're meeting with friends at least on zoom until we can meet again in person, exercise. Don't feel guilty about going to work like you have to fulfill yourself because this is a long road. And especially for those of parents who have children where no matter how preterm they are, who they know have long-term complications or health issues that they're going to be dealing with, please remember not to sprint this marathon because it's it will catch up with you and I know that that's not- we don't want that for ourselves or our children so just a little gentle reminder there which I also wished I’d had earlier as well. 

Christa: Wow, and I think that's amazing advice. I think so quickly we want to like figure everything out and it's so easy to neglect ourselves. One of the things I keep hearing from moms too in similar situations is one of the hardest parts is leaving the hospital without your baby if they're staying in the NICU. So what tips, advice anything do you have to share with those moms you know, kind of going through that rough period of okay I’m going to, you know, I’m going home, I’m kind of feeling like I’m missing something and I’m not where I should be, so what would you say to them? 

Parijat: I would say grieve that loss. Give yourself the time and the space and all the support you need and really lean into it because I think what happens in the NICU is you have to kind of keep it together really quickly because you want to be there for your baby and you're trying to figure out what they need and how you can support them or your baby's starting to pump and there's just it's a busy time. And I find that there's often not a lot of space to acknowledge all the losses and all the things that are just really hard to really sit with them and acknowledge them because it is in sitting with them and acknowledging them that they don't actually bury into the body and encode his trauma. So I think the best thing I can say is yes. That day is awful and every night that you leave that NICU and you go home without your baby is awful. Give yourself the time and space to grieve that. 

Christa: That's definitely important. Kind of in general. I know you like there's so many different you were saying like every baby is different and that just and that goes for babies in general, people in general but what are some general kind of items that you know moms of preemie, have preemies have to do a little bit differently versus a full-term baby and like overall health or breastfeeding those kind of things that they should kind of look for? 

Parijat: I think it depends like we've talked about it, depends on what's going on for the preemie. So let's say, I’ve worked with women who've delivered at 35 weeks before and baby didn't need any NICU time and they went home just like every other family, maybe with a slightly tinier baby than otherwise but you from the outside, you couldn't tell, right? And so it's possible that at the time of birth and soon after birth things may not be very different, you might be able to breastfeed, you might be able to do everything, you thought that you wanted to do and the only difference is you delivered several weeks before your due date. There could be other times when you're in the NICU for a couple of weeks or a month and in those situations, you're certainly looking at probably pumping for some amount of time until baby is strong enough and ready to try breastfeeding if that's what you want. You might have to make some decisions for example around donor milk. If you're not able to produce milk quickly enough or enough for baby or you choose not to lactate which is entirely your decision and totally okay if you decide that. Sometimes depending on what's going on with the baby's growth, you might have to fortify. So even if you are producing or you really wanted to breastfeed for the health of the baby, you might have to make decisions about fortifying their feeds for example. And then again, it depends on how what's going on with the baby's health but after discharge, you may have specialists, pediatric specialists who you need to follow up with at any kind of intervals you might have. OT, PT, SLPS you might have cardiologists, nephrologists, neurologists I mean any number of things. Some preemies go home on monitors, so you might be taking your baby home on oxygen or they might need you to monitor heart rate at home or you might be going home on a ventilator something like that. There's a wide range of things. I think what I would say is as much as possible don't assume what your baby is going to need at discharge because even if you're in the NICU for a couple of weeks that baby is changing every single day. It's a brand-new baby every day and sometimes they just need time and at some point in their development. Things start clicking and they suddenly come off of oxygen or they're suddenly able to breastfeed when they were taking everything through the ng tube but up until that point. So take it really slow and as things are presented to you and your maybe your medical team's going no I think we're going to need to follow up with cardiology after discharge. Okay now we can add it to our plates and now let's open that door and investigate what does that mean and what questions do I ask and how often and things like that. So I would suggest because it is so unknown and so varied take it really slow and address what's presented to you right in front of you. As much as possible, stay focused there instead of thinking about all the other things that could happen. Which again from a personal level I totally get how hard that is and also if you can do that it will just save you so much energy as you are, like you said on this marathon. 

Christa: Awesome, I love that analogy about what being on a marathon. That's perfect. So I know we obviously also want to talk about high-risk pregnancies, a lot of times premature births are they tied into high-risk pregnancy or is that labeled completely separate? 

Parijat: It is possible to deliver pre-term with a low-risk pregnancy and oftentimes when that happens is there is spontaneous pre-term delivery, so nobody saw it coming and everything was totally fine and there were no other issues that were known at the time that would even indicate that you would deliver pre-term. That doesn't happen very often so anyone who's listening going oh my gosh is this going to happen to me, it probably won't but I think that's usually the case off when there's is when it's not tied to a high-risk pregnancy otherwise there's often some kind of- a sign some kind of a signal so for example you're carrying multiples twins or higher order multiples are going to likely be delivered preterm. Not always, there are moms who are able to carry twins to term absolutely but the risk is higher. So, for example in those situations or you might have a very low risk pregnancy, everything's going wonderfully and then you go to your appointment and you find out your cervix is shortening all of a sudden so suddenly that makes you high risk or everything's going perfectly, beautifully, wonderfully, super low risk and then you go in for your appointment and you they find protein in your urine and your blood pressure's a little bit higher. You're swelling a little bit no signs up until then at that point you become high risk. So I find the label to be less important than what's actually happening in your body and how much is that influencing what could happen for delivery and the timing of the delivery. 

Christa: Okay. so at what point, and again, I’m sure this this differs between each pregnancy but at what point are moms told that their pregnancy is high risk? I know you did mention previously if their first pregnancy was high risk typically their second will be but for someone if it's their first birth, how early could they be told its high risk? 

Parijat: I feel like I’m just like it depends all the time. So there are some factors that we know. So in the united states, if you're over the age of 35 you're automatically categorized as high risk which is why I don't love this title or the label so much because it doesn't actually mean anything other than you're going to have some extra eyes on you and there are slightly more risks to for complications for you or baby during pregnancy, during labor, or delivery but it doesn't mean that it's for sure going to happen or that it's even likely to happen. You could just be you know 36 and pregnant because that's when you got pregnant and that could be it and you could have a very uncomplicated simple pregnancy and smooth easy labor and delivery. So things like that. So age whether you're carrying multiples can will put you in the high risk category. If you have a history of preterm delivery, second or third trimester loss, some perinatologists will calculate a high-risk pregnancy based on even recurrent pregnancy loss in the first trimester. Not all of them will do that but some of them will. So some of those factors if you have a history of any health complications like cancer, oftentimes autoimmune diseases, asthma. I’m starting to see more perinatologists, qualify depression, anxiety, and maternal psychiatric illness as a risk factor. So they consider those pregnancies high risk if you have you know kidney disease, heart disease, diabetes things like that we'll put you in the high-risk category and so you'll know that before you're even pregnant, all those kinds of things. After that let's say none of that applies to you and then you get pregnant, the complications can begin at any point in the pregnancy which again I realize can sound really scary so I don't mean to say it's definitely going to happen to any anybody that's listening but I that is actually also the reality is that you can make it through the first trimester which is often the trimester that women are like okay if I get past this that's the scary time which it can be for many certainly and also there are complications that can pick up in the early to mid-second trimester, end of the second trimester, or even the third trimester. And so it really depends which is why really good quality prenatal care is so important and that you are monitoring yourself really well, that you have a really healthy lifestyle and you are taking good care of yourself beyond just diet and prenatals’ and exercise like just whole health support can really help reduce those risk as can neurobiological support to really help keep your body kind of in as optimal of a place as possible to reduce your risk of complications. 

Christa: Awesome and I mean I love I love the balance too. I mean I think like it's good that you're this doesn't happen to everyone but it is good to be realistic too that this can happen at different times in your pregnancy because we want to share as much knowledge as we can here. So with high-risk pregnancy you're saying it's kind of like this label that oh my gosh it's high risk but if you're 36 years old, it's automatically a high-risk pregnancy. So what in what ways are you monitored differently in a high-risk pregnancy and is it different based on the reason why you're high-risk? 

Parijat: It does depend on the reason why you're high-risk, so if you're high risk just because they age or because you have you're carrying twins, or triplets, or something like that. Typically, most women who have high-risk pregnancies will have at least one check-in with the perinatologist. There are some cases for example if you're like the example we're using you're 36 you're carrying one baby, there's no other health complications, it's very likely your ob is just going to continue working with you may not even see a perinatologist and your OB is going to keep eyes on things and if anything starts to look even orange flags like they will send you over so you may not actually even see a perinatologist. Most of the time many OBs will give at least one check-in and say just go check in with them, do an assessment or do you know a consultation? They'll probably tell you everything's fine, you won't see them ever again. So that's kind of on that side of the spectrum and then depending on what's going on in the pregnancy, if there are multiple complications like in my case for example or a lot of my clients, there are multiple either maternal or fetal or both complications happening and so you could be seeing your maternal fetal medicine specialist weekly for ultrasounds for testing, for blood work, for any number of things and you may also have which happens to my clients as well. Sometimes we need to add other perinatal specialists, perinatal cardiologists, or nephrologists, or pulmonologists because you do need even that additional specialized care. So again, it depends on what's going on in the pregnancy but it could be really vary at any point in that spectrum. 

Christa: Kind of like the amazing advice you offered for moms of preemies or I kind of want to hear your advice for moms that are currently in high risk pregnancy because I’m sure you know depending on each situation it's different but it can be extremely stressful and you know like to just focus on everything going on. So what advice or tips would you have for those moms? 

Parijat: It would be similar to the preemie tip of take it day by day. So I get, I say this and my head's also going but you did this too so I get it I understand our need to plan and prepare and really want to know kind of what the future holds and also the best thing that we can do for ourselves and our body is to be focused on what our body needs right now because that's the thing we can control. I think you started this whole conversation about this idea of high-risk pregnancy can feel like we're out of control and I find that finding those points of control is so important, so you can control for example what you put in your body, when you're eating, when you're drinking. You can control how you're able to move even if you're told to be on bed rest or have modified activity restrictions, you do have choices still within that very rarely will a woman be asked to like not move at all. That's it's like a teeny tiny percentage of people. So where can I find opportunities to make choices, where can I find opportunities to impact my body and my pregnancy in within the parameters that I’ve been given like find those opportunities to make those choices and take back some of that control. You can't control the outcome, nobody can, your medical team can't even but you can influence the journey to get there and I think that's really powerful and kind of taking back some of that that power that feels like it's often taken from you when you've developed complications or are faced with some really scary situations. Definitely and so I know you post like a ton of helpful information for healthy high-risk pregnancy on your socials so I- just for everyone listening, what other kind of courses or advice do you offer on your pages for all the moms listening? So the best place to start is well first come to Instagram and say hi because I’d love to meet you. Let me know you we met through this podcast. I think the best place to start is my book pregnancy brain which describes kind of the neurobiological approach that I keep referring to what how do we support our bodies in in a way that we're not being told from through our medical care in order to reduce the risk of complications and pre-term delivery. So that's called Pregnancy Brain which you can grab on Amazon and Barnes noble or you can request it from your local bookstore or library and then I specifically work with a very small number of people one-on-one through their pregnancy after second or third trimester loss or pre-term delivery to actually support them to optimize their health and health care and their next pregnancy to improve their outcomes in their next pregnancy. That's a very tiny group of women that I work with every year but if that sounds like something you'd love, I would be honored to work with you through that. 

Christa: Awesome, that's great and any of the links you have that you want to share I can put below too so people can easily find them as well and so I always like to end our podcast with a couple of fun thinking questions I call them, so if you can have a billboard made today where you could share one tip with moms everywhere what would you have it say? 

Parijat: You are so much stronger than you feel right now. 

Christa: I love it. I think it's perfect. That's great and what is a quote or a phrase you think of often when it comes to parenting or just life in general?

Parijat: I think lately actually what's especially in the last year or so what's been coming up a lot and just kind of tumbling out of my mouth is everything's going to be okay, we're going to be okay and just kind of without even thinking I realize I’m saying it and my little one just said it to me the other day and I was like, where'd you hear that? 

Christa: Oh that's awesome and it's sometimes like the simplest phrase can make all the difference and just like a reminder of like you know what this too shall pass if it's you know if you're going through a rough time or you know what have you so. that's awesome and one more time again, where can everyone follow you your Instagram and all that yes? 

Parijat: Yes! So I typically hang out on Instagram, you can find me on healthy high-risk pregnancy on Instagram. We'd love for you to come by and say hi or if you want to take a screenshot of this episode and tag both of us and let us know what your biggest takeaway was, I love hearing that from listeners too. 

Christa: Yay awesome, well thank you so much for coming on party shot, it's been awesome talking to you and great getting to know you and what you do. 

Parijat: Thank you thank you so much for having me, this was awesome.

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