High-Risk Pregnancy: What to Expect

Pregnancy is usually a happy, healthy event. But some moms-to-be may experience complications or chronic conditions that threaten their well-being or that of their baby. What does it mean to have a high-risk pregnancy? What are the common risk factors? And what type of care can you expect to receive if this happens to you and your baby?

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Preggie Pals
High-Risk Pregnancy: What to Expect

Please be advised, this transcription was performed by a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

[Theme Music]

Sean Daneshmand : Pregnancy is usually a happy, healthy event. But some moms-to-be may experience complications or suffer from chronic conditions that threaten their well-being as well as that of their baby. What factors determine the fact that the pregnancy is a high-risk? And what can you do to have the best pregnancy possible? I am Sean Daneshmand, a perinatologist at the San Diego Perinatal Center, and this is Preggie Pals, episode 42.

[Theme Music/Intro]

Sunny Gault : Welcome to Preggie Pals, broadcasting from the Birth Education Center of San Diego. I'm your host, Sunny Gault. Have you downloaded our amazing Preggie Pals app? This is a free way to listen to all of our shows on the go, whether you are waiting at line at the grocery store, or at your next OB appointment. Did you miss an older episode of Preggie Pals? Then join the Preggie Palls Club. You'll get access to all of our archived episodes, transcripts and special bonus content after each new show. Our club members even get a one year free subscription to Pregnancy Magazine. Visit our website for more information, and to sign up. OK, let's introduce our panelists here in the studio, like I said my name is Sunny, I'm not pregnant but I do have two little boys at home. I have a two and a half year-old and I have a little boy who is nine months old. Jennifer, what about you?

Jennifer Frierott : My name is Jennifer, and I have an almost two and an almost four, and I am 20 weeks pregnant right now.

Sunny Gault : Awesome! And Dr. D. is our special guest, he is our special expert today. Dr. D., do you have kids?

Sean Daneshmand : I have one daughter, she is eight years old, she is the sunshine of my life.

Sunny Gault : Of course she is. OK, well thank you guys for joining us on our show today.

Sean Daneshmand : Thanks for having us!

[Theme Music] [Featured Segment: News Headlines]

[00:02:08]

Sunny Gault : Making rounds around the Internet, here's a headline that I found, it's called “Oopsie Babies”, and it says a third of US births are unintended, according to a recent study, and I wanted to get your feedbacks on that. It says, “The findings showed that in total, 37.1 percent of pregnancies in 2006 to 2010 were unintended; the rate in 1982 was 36.5 percent, which means that rate rose to 39.1 in 1988, before falling to 30.6 in 1995.” Now I know that's a lot of numbers, but I think it's just safe to say that despite all of the education that we have out there, there are still so many “oopsie” babies, so I kind of wanted to get your opinions on that. First of all, did you have any “oopsie” babies? Were all your babies planned? And what do you think about the study? Jennifer?

Jennifer Frierott : Yes, I've had two “oopsie” babies.

Sunny Gault : How “oopsie”, 'cause there are different levels of “oopsies”, right?

Jennifer Frierott : Well, with my first, we definitely planned it, it was actually the first time we tried, and we conceived her. And then, I had been nursing her, I had one menstrual cycle, and then boom! We had a surprise.

Sean Daneshmand : Oh my goodness!

Jennifer Frierott : And it was pretty much the same story with this one as well.

Sunny Gault : So you weren't even trying, and it happened right away.

Jennifer Frierott : Yes.

Sunny Gault : How?

Sean Daneshmand : That's wonderful!

Sunny Gault : I'm a little bit jealous, because with my first – so, again, two little boys – and with my first we had to do some fertility stuff, and we tried on our own for about a year, and then I did some minor fertility, I didn't have to do IVF or anything, but I did Clomid, and it took even four-five months on Clomid, in order for it to finally take, and for us to get our little Clomid baby. But then it was funny, we thought we would have to go through the whole thing over again, so we weren't really practicing not to have a baby, to put it lightly, and it was just an amazing thing that I got pregnant, we were like, “Are you serious?” We did not think it was going to be this easy, and you hear about that, you hear about, “Oh, your body recognizes what it's like to be pregnant, and then it's like a switch”. Is there any accuracy to that, Dr. D.?

Sean Daneshmand : There have not really been any studies on that, but we hear that all the time, patients go through IVF, they have a successful IVF pregnancy and in subsequent pregnancies, they get spontaneously pregnant. We hear this all the time, we see it.

Sunny Gault : So your daughter, was your daughter planned or was she an “oopsie”?

Sean Daneshmand : We were planning, but first try we got lucky, we got pregnant, and we had some complications, she delivered at 34 weeks, but thankfully, she is doing very well. All the concerns we had are no longer there, so we're very lucky.

Sunny Gault : Were you already a perinatologist when that happened?

Sean Daneshmand : I was, and I'm the one who actually made the diagnosis, unfortunately. It was Thanksgiving and Marge, my wife, said “what do contractions feel like?”, and I said, “Well, this is how it feels like, let's go to the office and have a look at your cervix”, and we did. I actually never wanted to look at the baby after the first trimester, I just wanted to be a husband, but Marge said, “Why don't you take a look at her too?” And I looked at her, I looked at the baby and all of the sudden I saw a clot, blood cloth right behind the placenta, and my heart sank. Of course, we took her to the hospital, one of my partners confirmed it, and that was at 29 weeks. But we got very lucky, it's not a very common finding a central placenta abruption and the patient not delivering within a short few hours after that, 24 hours after that. Marge made it for another four and a half weeks.

Sunny Gault : So she was considered high-risk, going back to our topic for today.

Sean Daneshmand : She was considered high-risk at that time.

Sunny Gault : In your practice, do you see a lot of patients – or maybe you don't get this in depth with patients, I'm not sure – that come in with a pregnancy that was unplanned?

Sean Daneshmand : In our line of practice, it's mostly patients that have been trying to get pregnant for a long time, or went through IVF pregnancies, but your right, the rate hasn't changed, it was quoted in the past 40% of pregnancies were unplanned, which again brings us to this topic, how do you prevent complications during your pregnancy especially. January, for example, was birth defect awareness month. So it's important for women to take their prenatal vitamines on a daily basis. You need folic acid, folic acid reduces the risk of neural defects, so it's important to make sure you do see a physician or a health care provider, your midwife or family care practitioner. Just to go over topics, what are the issues. Because you may get pregnant, at least you want to know what things to look out for.

Sunny Gault : OK, well thank you guys for sharing your perspective on this article!

[Theme Music]

[00:06:50]

Sunny Gault : Today we're learning all about high-risk pregnancies. Our expert is Dr. Sean Daneshmand, which you've already heard as part of our news headlines segment, he is a perinatologist at the San Diego Perinatal Center, and he is also the founder of Miracle Babies, an organization providing information and financial support to newborns in the NICU. So Dr. D., as I like to call you, welcome to Preggie Pals!

Sean Daneshmand : Thanks for having me, Sunny!

Sunny Gault : Let's talk about high-risk pregnancies, what is the official definition of it?

Sean Daneshmand : Well, any pregnancy that has a potential complication for mom, baby or both, is considered high-risk. So if a mother has pre-existing conditions for example, or mother has a heart defect that was noticed, or mom has diabetes, or Lupus, auto-immune issues, a clotting issue that predisposes her to have clots, that predisposes her to complications in pregnancy so she is considered high-risk.

Sunny Gault : And can a pregnancy be labeled as high-risk at any point during pregnancy, or is there like a window?

Sean Daneshmand : Sure, there are complications that can happen, a woman can develop something called preeclampsia, which is blood pressure going up during the pregnancy, and that can happen anywhere after 20 weeks, so if a woman ends up having elevated blood pressure, and starts spilling proteins in her urine at 24 weeks, that's considered a high-risk pregnancy. If a woman develops gestational diabetes early on in the pregnancy, with sugars that are abnormal, that require some care, that's a high-risk pregnancy, that becomes more high-risk. And this all depends, Sunny, in high-risk pregnancy, many obstetricians can take care of a high-risk pregnancy, it just depends on their comfort level and the manpower. If you're a solo practitioner, you may not have the time to devote to a patient who has bad blood sugar, so you may send that patient to a high-risk specialist such as myself or my partners, to take care of that patient. Or they may co-manage he patient.

Sunny Gault : So the patient may have two different doctors, is that what you're saying?

Sean Daneshmand : Absolutely.

Sunny Gault : So if you have had a high-risk pregnancy in the past, are you guaranteed to have another one, or what are your odds? I know nothing is a guarantee in this, but what are your odds?

Sean Daneshmand : It depends on what it is, if you've had a history of pre-term delivery for example, then you have an increased risk of having another pre-term child. But again, many times those patients are managed by the obstetrician and the perinatologist, so the patient comes in for serial cervical assessments, we look at the patient's cervical needs starting after 16 to 18 weeks. Many of those can be managed together. But let's say the patient had, for example, a baby with a major congenital heart defect. When this pregnancy is diagnosed again, there is a 3 to 6% risk that the baby may have it again, and that's called a risk pregnancy. A woman has a pre-existing condition, a woman has heart diseases, a history of myocardial infarction or heart attack, diabetes, type 1 diabetes – that's definitely a high-risk pregnancy. But if a woman ends up having, for example, cesarean section for placenta previa, it doesn't necessarily mean that she is going to have it again, so she can go to a general OB and then be seen again.

Sunny Gault : So there's hope, that's what you're saying.

Sean Daneshmand : Absolutely.

Sunny Gault : Because I think that some of our listeners may have already had a high-risk pregnancy, maybe it was a difficult pregnancy, and maybe they may not want to have another one, because of that. So I just wanted to clarify – just because you had one in your first pregnancy, it doesn't mean you're going to have another one.

Sean Daneshmand : Absolutely, yeah.

Sunny Gault : OK.

Jennifer Frierott : So, how is a pregnancy diagnosed as high-risk?

Sean Daneshmand : For example, if a mom comes in, one of these unattended pregnancies, she comes in and we realize that she has twins, for example, than, depending on the placentation, let's say there is one placenta for both babies, so the babies are in one sack, that is considered a high-risk pregnancy. Let's say a mom comes in and she has a condition called placenta previa, and she's had a prior cesarean section, and we suspect that the placenta is embedding into the muscle of the uterus, called the placenta accreta, that's considered high-risk pregnancy. Mom develops – again, like we talked about, comes in and says, “I'm not feeling so well”, we look at the baby and the baby is very growth restricted, and turns out moms have preeclampsia, that's considered a high-risk pregnancy. So, again, it all depends on the fact that it's very important for women to seek preconception counseling. Anyone who want to get pregnant, if you are planning on getting pregnant, it's always a good idea to see your health care provider, whether it's your midwife, family practitioner or your obstetrician, and talk to them about your medical history. Is there anything remarkable in your history, a family history that requires further investigation, at least be knowledgeable about it.

Sunny Gault : Are there specific risk pregnancies?

Sean Daneshmand : Age is a risk factor for pregnancies...

Sunny Gault : What age?

Sean Daneshmand : 17 and younger, and usually 40 and above, we talk about 35 and above but women that are 40 and older have an increased risk for having gestational diabetes, hypertensive related crises or preeclampsia.

Sunny Gault : Is that considered advanced maternal age?

Sean Daneshmand : That's considered advanced maternal age, anyone 35 and older. We don't use the term “advanced maternal age” that much anymore, but yes. All the screening tests that we are offering patients that were 35, we now offer to anyone. So if a 20-year-old comes in who's pregnant, we offer them same screening tests and diagnostic tests, so anyone who is interested in having those screening tests. But generally women who are 35 and older have an increased risk of having babies with chromosome abnormalities, and Down syndrome is the most common.

Sunny Gault : What role does genetics play in all of this?

Sean Daneshmand : Well, every few months, another new screening is available. We can't really do much about genetics. But one thing we can do is if we know there's a specific, for example, anomaly, and it's linked to a genetic abnormality, then we can screen for that. So let's say a woman has a small chromosomal deletion with her last previous pregnancy, with that baby, she could have chorionic villus sampling, which is done in the first trimester, amniocenteses, that specifically looks for that deletion. But one thing we always talk about is the genes are there, some parents want to know, and many parents don't want to know. It's the environment also that's very important. You mentioned again what constitutes a high-risk pregnancy, health, obesity is a risk factor, and that leads to other complications during pregnancy and after pregnancy.

Sunny Gault : So you said that you could develop a high-risk pregnancy at any point in your pregnancy. Are there certain symptoms that we as pregnant women should be looking out for? I mean, we are seeing our doctor and there should be tests done, and even tests done even before you're pregnant. But I'm just thinking, especially for women who have already had a high-risk pregnancy, they may be looking for signs.

Sean Daneshmand : In general, let's say a woman comes in and, if she has had a history of high-risk pregnancy, then we're going to be looking for those signs, so for a woman who's had a history of pre-term delivery, then we're going to be looking for again signs of pre-term labor, cervical shortening, screening tests, so definitely we're going to be looking for those signs and symptoms. If a low-risk patient comes in, what are the things we look at? Well, during the pregnancy, let's say the patient comes in and says, “I'm very nauseous, I'm vomiting a lot, I'm not doing well” , you want to look for other abnormalities that can cause those symptoms, which is a disease with a diagnosis of exclusion, molar pregnancies sometimes can cause those symptoms, hyperthyroidism, abnormalities in your thyroid gland can cause those symptoms. Then, in the first trimester, we also do the prenatal lab, there can be abnormalities in the labs, for example antibodies to their blood type, then in the first trimester we also do a screening test called a nuchal translucency, and that we're looking at the baby, that screening test is to screen for Down syndrome and other chromosomal abnormalities such as Trisomy 18. There is also a screening test for cardiac defects. In that screening test, for example, the baby comes back having an increased nuchal fold measurements or having abnormalities, because we can tell a lot now with babies in the first trimester. Recently, I saw a patient who had multiple abnormalities diagnosed at 11 and a half weeks. So that designates a high-risk pregnancy. And then, in the second trimester, then you have your quad screen, which again screens for Down syndrome, Trisomy 18, neural defects, something called Smith-Lemli-Opitz syndrome, which is a cholesterol synthesis abnormality. Then you have your anatomy scan, and if on that anatomy scan we see a baby that we suspect has a heart defect, then that's when you meet with the genetic counselor to talk about disassociation with chromosome abnormalities, and patients may decide to do an amniocenteses or do a blood test that looks for fetal ARN and the maternal blood, and then from there, again, if it is confirmed in the patient, then he has to go see a cardiologist and get the whole team. A woman ends up – has a high risk for example for diabetes, because her mom has diabetes or her sister has diabetes, or with her last baby she had diabetes, and she screens positive for diabetes, she may have had pre-existing diabetes, before the pregnancy, so that constitutes high-risk. So throughout the whole pregnancy, you're looking for any signs of symptoms, and that's why it's important to seek prenatal care early in your pregnancy, and also to keep your appointments, and really have a good report with your obstetrician and talk to them. I just had a patient who came in recently and said, “Oh, Dr. D., I've been having this itchiness by the way, for the past several months, two months”, well there's a condition in pregnancy called cholestasis, which carries a risk to the pregnancy. And I asked her, “I'm glad you told me this today, but I wish you would have told me this a month ago, or two months ago when you found out”. So keep an open report with your patient and your physician.

Sunny Gault : No symptom is too small.

Sean Daneshmand : No symptom is too small, that's what they're there for. Talk about your symptoms, have an open discussion, you got to feel comfortable with your healthcare provider.

Jennifer Frierott : I have a question for you, my first trimester lab test came back with a low-grade bladder infection and strep B in my urine, and I did not have that with my first two, so they mentioned that when I'm actually in labor in delivery, I'll need to have some antibiotics.

Sean Daneshmand : Group B streptococcus is a bacteria that resides in our intestinal tract. In 2002, the CDC did a multicenter study looking at it. In the past, we used to treat patients based on risk factors, so a woman would come in in pre-term labor for example, at 25 weeks, she would get antibiotics. Why? Because we noticed that in the 1980s, when we were giving antibiotics to patients, there were fewer NICU admissions, there were fewer patients that were going to be admitted to the newborn nursery, getting antibiotics. So we're sort of looking at group B strep, which is a bacteria that's classified as strep throat, strep A, group B is in the intestinal tract. So if a woman has it, if the bacteria is colonizing her vagina, which comes from the intestinal tract, from the anus, and it's a very normal thing, 30% of women have it. If there's high colonization of it, it can be in the vagina, and it could be in your urine. So in the 2002 CDC multicenter study, we realized that 18% of the women that had the bacteria in the vagina did not have the risk factors. So in the US, we adopted the culture technique. So women at 36 weeks or 37 weeks get a cultural swab outside the vagina and anal sphincter because if the bacteria is inside, it's got to be right at the outside. And if they screen positive for it, they get antibiotics in labor. If you have bacteria in your urine, that signifies a high colonization. And that means you should get antibiotics when you go to labor.

Sunny Gault : Alright, well when we come back, we're going to talk about what type of care you should expect to receive if you have a high-risk pregnancy. We'll be right back.

[Theme Music]

[00:19:18]

Sunny Gault : Welcome back everyone, today we are talking about high-risk pregnancies and what you can expect, and our special guest is Dr. Sean Daneshmand, he is a perinatologist at the San Diego Perinatal Center. So Dr. D., let's talk about what women should expect if they are diagnosed with having a high-risk pregnancy. I know you're a perinatologist, do they automatically go and see a perinatologist? What does that look like?

Sean Daneshmand : It depends, Sunny, on what the condition is, for example, if a woman has quadruplets, usually they directly go to a perinatologist and see that perinatologist. If a woman is diagnosed for example with gestational diabetes and requires some care with insulin, for example, then she may be comanaged with a perinatologist. So a perinatologist is basically an obstetrician who has done two to three years more of treating just high-risk pregnancies. And really, again, it depends on the comfort level and the manpower of the obstetrician. If an OB has several partners, and she doesn't have to be called frequently and can manage a patient who's got some abnormal blood sugar, then a lot of times they just comanage it with the perinatologist. The patient comes into the perinatologist office, gets an ultrasound, goes over their blood sugars, and it's basically a team effort. A lot of times what we do is we really manage the team. For example, if a baby is diagnosed with a heart defect, we're the ones who are coordinating the care of this patient and unborn baby with the obstetrician, with the pediatric cardiologist, with the cardiothoracic surgeon, with the neonatologist at the hospital, for example in my hospital, at Mary Birch and also at the children hospital, because that's where the baby is going to be going for a surgery, so we're kind of the middle person, making sure that this patient gets the best care they need.

Sunny Gault : And how are high-risk pregnancies treated, what can you expect if you are diagnosed with having a high-risk of pregnancy?

Sean Daneshmand : It depends again on the condition, for example if a patient has a condition called vasa praevia, which is - anything in front of the cervix is called a praevia – so if there are fetal vessels in front of the cervix, that's called the vasa praevia, something we look at on ultrasound on every patient that we see. So if a patient has this condition, this patient is going to be admitted to the hospital anywhere from 28 to 32 weeks, and delivered at about 35 weeks. If the patient has for example what we talked about earlier, momo twins, which is monochorionic, one placenta and one sack which both twins reside in, than that mom gets admitted to the hospital at 24-26-27-28 weeks, depending on what the mom decides after she speaks for example with the neonatologist, and until the duration, because it's a high risk of one of the babies passing away, since they're sharing the same placenta and many times exchanging blood, the other baby can have some neurologic damage or pass away. So we monitor these babies a lot more carefully. So it really depends on the condition is.

Sunny Gault : In general, are we talking about at least more appointments, more ultrasounds.

Sean Daneshmand : Certainly a lot more appointments, if a woman comes in at the age of 40 for example, in my practice, this patient is, as we talked about, genetic screenings, also then, since they're at risk for hypertension, diabetes, an early screening for diabetes, they get a second one when they're at the third trimester, every month they get an ultrasound, and I actually ask all my patients over 40 to get a blood pressure monitor starting at 20 weeks to check their blood pressure. They have to go through something called a non-stress test...

Sunny Gault : I did that for gestational diabetes.

Sean Daneshmand : Yeah, so around 24 weeks they do that, twice a week, that's again another objective way of reassuring ourselves that our babies are healthy. So absolutely, definitely a lot more appointments.

Sunny Gault : What about testing, and this may depend on the condition, but are there a lot more tests that are done and are any of those tests invasive?

Sean Daneshmand : If you find any kind of abnormality with the baby, then again we always talk about the fact that we always suspect a chromosome abnormality associated with that. So if there's a heart defect, could the baby have a chromosomal defect? So more ultrasounds, amniocenteses possibly, and again, it depends on what the patient is going to deal with it. Some persons just want it for information, but knowing the chromosome in the care of an anomalous baby, a baby that has a heart defect, will help definitely for a better management of the baby. But again it depends, you leave it up to the patient, you provide him with information and the patients will decide.

Sunny Gault : We actually did an episode for Preggie Pals on genetic testing, it was only a few episodes ago, so if you guys are listening to this, I know we've been talking a lot about genetic testing, we actually had someone come in and talk about that, so you guys can refer to that episode for more information. Are there ways that we can try to prevent some of this stuff? What can we do, in going into a new pregnancy, obviously there is tests and stuff, but what can be done prior to know what our risk factors are and what are odds are? But if we're just starting on on a pregnancy, or maybe we're at the end, what can we do to just have a healthier pregnancy in general?

Sean Daneshmand : Well, take your folic acid, take your prenatal vitamin every day. Regardless on whether you are planning on getting pregnant or not, because, like we talked about, we said a third of the patients get pregnant without planning. Make sure you're eating very well, one thing I tell all my patients is that the genes are there from you and your partner, but the environment is something you can control, so make sure you're eating very healthy. Cut out sugar, cut out the preservatives and start exercising and minding your body, and increase your fiber. That's something that's extremely important like we talked about again, obesity has many complications during pregnancy. Not only for the mother but for the child as well. So there's a direct correlation between maternal body weight and baby. Babies will tend to be larger when they're born they tend to be heavier, and that, as you know, it's a huge problem right here in the US for us, with children being diagnosed with type 2 diabetes and hypertension. Other things are, when you're planning on getting pregnant, you should obviously try to avoid alcohol, smoking is a no-no, because of our hemoglobin levels carbon monoxide, and that's again not a good thing for our babies. And again, if you have any pre-existing conditions, such as hypertension, diabetes, any genetic issues that you've had. Mom has had a clotting disorder, grandma had a clotting disorder – definitely get preconception counseling. Get informed before you get pregnant, that's probably the best advice, that's one thing that could change the course of the pregnancy.

Sunny Gault : What advice do you have for women out there who may have just been diagnosed with a high-risk pregnancy?

Sean Daneshmand : Make sure you're informed as much as possible, speak to your obstetrician, speak to your perinatologist, have a good report with them, again, that's really crucial, a lot of times patients don't go to the Internet so much.

Sunny Gault : It can really scare you, we've all had that, right?

Jennifer Frierott : Yes.

Sean Daneshmand : I mean, I think it's very difficult, I mean a lot of the information that we get is from the Internet, and patients come in and all of the sudden they are told that there is an abnormality with their baby, and they go on the Internet, and a lot of times they do get scared with some of the information they find there. And that's why it's important to find a team of people that you can speak to, you can talk to, you can address questions with. One thing to remember is you are not alone, there are a lot of women unfortunately out there, and families that are going through these difficult times. This is just – every time a patient comes in, I tell him, “Unfortunately, I've talked with three other patients for example in the last three weeks about this condition”. So remember that you are not alone, and there is help out there, and there are people that are willing to help.

Sunny Gault : Are there certain resources that you would recommend?

Sean Daneshmand : Absolutely. For example, for Down syndrome there is a great resource here in San Diego, even for cystic fibrosis there's a great resource. The best people to know about those are your genetic counselors, so ask to be referred to those, and just even googling them. But San Diego has a great program for babies with Down syndrome, where moms can meet other parents, a lot of excellent resources for those parents, so they don't feel like they're alone. And again, early intervention is key.

Sunny Gault : And in other cities they probably have this type of resources.

Sean Daneshmand : Oh, absolutely.

Sunny Gault : OK, great. Alright, Dr. D., thank you so much for joining us today!

Sean Daneshmand : Thank you Sunny!

Sunny Gault : Do you have a question about a high-risk pregnancy? You can ask Dr. D., simply call our voice-mail at 619-866-4775 and leave us a message, or email us through our website, and we'll include the answer on a future episode. For members of our Preggie Pals Club, the conversation continues as we explore your chances of having a C-section with a high-risk pregnancy.

[Theme Music] [Featured Segments: Becoming Dad]

[00:27:50]

Sunny Gault : Before we wrap up today's show, here's Dr. Danny Singley, with tips on becoming a new dad.

Daniel Singley : Hi Preggie Pals! My name is Dr. Daniel Singley, I'm a licensed clinical psychologist, specializing in men's issues, and founder of Basic Training for New Dads. These days, new fathers are expected to be much more involved with their newborn babies' care. However, we tend not to have much in the way of models, or clear rode maps about how to do so. This segment addresses how our own fathers' modeling and stereotypes about dads in the media can play a role in how new dads think about themselves as fathers. Often, dads in US culture are overtly or suddenly excluded from parenting roles. There is often a support of network of experienced mothers, like family, friends and neighbors, that support a new mother, but who will often criticize a new father's lack of knowledge about bathing, diapering, feeding, etc. Fathers are then less likely to engage in these tasks and tend to leave them to the mother. Which makes it less likely that the dad will have the same kind of transformation and goals and values and relationship expectations that women do. Some examples of negative stereotypes in the media include children's books. 50% of children's books that include a reference to a parent have only mom as a parent. And in television commercials, females are 50% more often to be seen as parents, 50% more likely to be nurturing or comforting a child, and 600% percent more likely to be involved in teaching a child. Think about the implications of leaving Homer Simpson to take care of Maggie with Marge nowhere to be found and the light bulb is likely to go off for you. A related issue is what I call the “Dads generation gap”. In general, men who are now having their first child, are likely to have come from a family with fairly traditional inherited roles. Commonly, fathers of men in the current generation are fairly uninvolved with the care of their infants or children, and our often coming from the place of “I'll step in when the kid throws a ball or needs straightening out!” Society expects that men having children these days to be daddy 2.0, and to be involved. So the issue is that without much in the way of concrete models and instructions about how to do so, the lack of involved male, dads or father figures and the face of the stereotype of the bumbling dad, can result in him disengaging when the stress of adjusting to the role of new dad hits. So what to do? Moms, be proactive about giving dad very clear instructions about how he can be directly involved in the baby's care as soon as possible. With the basics, bathing, changing, soothing, giving the bottle – dad will develop the confidence to stay involved. Also, as soon as feasible, give dad alone time with baby. Nothing says “I'm totally a solid dad” like taking care of the child by going out for a walk or drive to the store, along with a well-stacked baby bag. Have your eyes and ears open to people, media and long-standing ideas that give the message that dads just aren't cut out to handle infants. Dads, you're well equiped to be very engaging as a partner and dad, so role up your sleeves, crank up the diaper genie, and get in there when it's game time. Thanks very much for listening, and I hope this information has been helpful. I'm Dr. Daniel Singley, at NewDadsClass.com, and be sure to keep listening to Preggie Pals for more tips on how new dads can make the most of their journey into new fatherhood.

Sunny Gault : That wraps up today's show, we appreciate you listening to Preggie Pals. Don't forget to check out our sister shows, Parent Savers, for parents with newborns, infants and toddlers, and our show The Boob Group, for moms who breastfeed their babies. Coming up next week, we're continuing our series on pregnancy exercises. Did you know you can get a great workout simply by wearing your baby or pushing a stroller? Find out how. This is Preggie Pals, your pregnancy, your way.

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[Disclaimer]

This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though the information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified healthcare provider.

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