Preconception And Pregnancy: Special Issues

Most women have a very good chance of experiencing a healthy journey through conception and pregnancy. But sometimes, special issues arise that call for extra care and informed decisions. Don’t be afraid to discuss these issues with your health care provider. Your midwife can be an invaluable source of information and support as you work through your unique challenges.


Sometimes it just takes time and patience to get pregnant, but about 1 in every 10 women has infertility. You have infertility if you can’t get pregnant after 1 year of trying, or 6 months of trying if you are 35 years or older. Millions of couples struggle with infertility – either partner can be affected, so it’s important that you both see a health care provider – but most are helped with medications and other treatments. It’s time to see your midwife:

  • if you have been having sex regularly with no birth control and have not achieved pregnancy within the timeframe mentioned above,
  • if you have irregular periods (spaced 35 days or more apart) or no periods, or
  • if you or your partner has a known fertility problem.

Learn more by reading the Share With Women handout on Infertility.


Miscarriage, or early loss of a pregnancy, occurs in 10% – 15% of women with known pregnancies. Sometimes a miscarriage will happen before a woman even knows she is pregnant. Others happen as late as 20 weeks into pregnancy. Most occur during the first trimester, or the first 13 weeks of pregnancy. Usually women who had regular periods before miscarriage will return to their normal cycles within 6 weeks after miscarriage and can try to get pregnant again as soon as they feel ready. Learn more by reading the Share With Women handout on Miscarriage.

Sometimes there are obvious reasons for a miscarriage, like genetic issues in the baby, but sometimes there aren’t. There is no right or wrong way to feel if you have a miscarriage. Grief is very normal. Ask your health care provider about pregnancy loss support groups, and don’t be afraid to talk openly with them about your feelings.

Vaginal Birth After Cesarean (VBAC)

About 1 in every 3 births in the United States happens via cesarean surgery—a procedure that comes with risks to both moms and babies, including heavy bleeding and infection after the birth of the baby. If you’ve had a cesarean birth before and are preparing to give birth again, you have a choice to make between scheduling another cesarean or trying a vaginal birth after cesarean (VBAC).

The decision is very personal and takes careful consideration of the risks and benefits for mom and baby. There is no shortage of scientific evidence that VBAC is a safe option for the majority of women who have had a prior cesarean birth. There are still some circumstances where it is necessary to have a repeat cesarean – for example, if you had a transverse incision during your previous cesarean surgery. Your midwife can help you evaluate your unique risk profile and help you make an informed decision. It is important to address this with your health care provider early in pregnancy.

For a detailed guide, view Lamaze International’s A Woman’s Guide to VBAC.

Depression, Anxiety, and Other Mental Health Issues

In the United States, 1 in 5 adults will deal with a mental health issue every year. If you are one of them and you struggle with depression, anxiety, or other mental health issues, you’ll need to pay special attention to your mental and emotional state during preconception, pregnancy, and the postpartum period. Some women encounter mental health issues for the first time or experience a worsening of symptoms during pregnancy or in the first year after birth. It’s also possible that your symptoms may be relieved somewhat during pregnancy, depending on your body’s response to the hormones involved in the various stages of your baby’s growth.

Finding a health care provider who will help you weigh the risks and benefits of various treatments and preventive measures is essential. Do not assume that treating a mental health issue with medication will prevent you from having the option to breastfeed. In fact, many medications are likely to be okay to use during breastfeeding. Learn more by reading the Share With Women handout on Depression and Medications during Pregnancy. You can also research the effects of pharmaceutical treatments for other mental health issues at

If you are in crisis or think you may hurt yourself or your baby, call 911 or 1-800-273-TALK (8255) or go to

Intimate Partner Violence

Also referred to as domestic violence, intimate partner violence is a common experience. It can happen to anyone—adult, child, male, or female. Women are the most common victims. One of every 3 women will be abused at some point in her life. The abuser may be a man or a woman, but men are usually the abusers. Find out more about the signs of intimate partner violence and how to protect yourself by reading the Share With Women handout on Intimate Partner Violence. If you need to talk to someone about your situation now, call the National Domestic Violence Hotline at 1-800-799-7233. Additional resources are the National Teen Dating Abuse Hotline and the National Sexual Assault Hotline.

If you need to talk to someone about your situation now, call the National Domestic Violence Hotline at 1-800-799-7233.

High-Risk Pregnancy

Midwives are experts in caring for women who expect to have a healthy pregnancy and who have a low risk of developing problems. Midwives are also educated to recognize deviations from the norm before they become serious problems and work together with physicians and other health care professionals to get women the individualized care they need.

If you’re worried about a special health condition or risk, talk to your health care provider about your options for care. Sometimes even if a pregnancy is high risk, your midwife will work in collaboration with a physician. The best way to find out if a midwife could be right for you is to call the practice you’re interested in to discuss your unique situation.

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