Joey Wahler (Host): They pose a higher risk. So, we're discussing pregnancies later in life. Our guests are Dr. Trace Deighan, an obstetrics and gynecology physician, and his patient, Mallory Manners. This is Health Matters from Southeast Georgia Health System. Thanks so much for joining us. I am Joey Wahler. Hi there, Doc, Mallory. Welcome.

Trace C. Deighan, MD: Hi. Thank you for having us.

Host: Yeah. Great to have you both aboard. So, this is an interesting subject. It affects so many out there. And yet, I think maybe sometimes it gets a little overlooked. What do you think, Doc?

Trace C. Deighan, MD: Yeah. So, it's something that's really important, especially as our population is starting to have kids a little bit of a later age. You know, back in the '70s, the average age of people having babies usually started at 21. Now, it's up to 27. But still, a good amount of people are starting their families in their mid to late 30s now. So, it's something really important to discuss.

Host: Absolutely. But first, let's backtrack for a quick moment. Dr. Deighan, what first inspired you in a nutshell to work in both healthcare and specifically treating women and expectant mothers?

Trace C. Deighan, MD: Yeah. So, that was certainly a long journey. So, I always thought I might want to go into medical field back in grade school and high school, I was always interested in science, and liked to learn about things like that and the human body and life itself. I went through undergrad and that kind of continued to progress through my biology and chemistry classes and things like that.

And then, once I got to medical school, initially I thought I might want to do orthopedics, go into sports medicine, something like that. i realized I don't really like to see bones break, I don't like to see them, you know, in graphic sports injuries. So, I thought I'd choose something else.

But then, when I did my rotations, including one at Southeast Georgia Health System, I got to experience what it's like to be an OB-GYN in this field and get to take care of women through all walks of life. You get to do a lot of primary care. You get to take care of women as they go through the kind of the huge life events of pregnancy and having their children and postpartum. And then, you get to keep on seeing these women either for the next pregnancy or just kind of for their routine care going forward. And it's very unique opportunity to get to take care of people for 20, 30, 40 years if we're lucky.

Host: That's great. Mallory, tell us first please what you do.

Mallory Manners: So, I work for a military service organization supporting our service members and their when they're deployed and also stationed here at home.

Host: It must be interesting work to say the least. Huh?

Mallory Manners: It is. It's interesting and always changing.

Host: And although similar, yet different, certainly a tie in with the doctor and that you deal with families, right?

Mallory Manners: I do, yes. Families are often, you know, separated over deployments and they have their own unique struggles to go through.

Host: I am sure they do. And so, Mallory, what first brought you to the area?

Mallory Manners: So, my job actually went fully remote at the beginning of the pandemic. I was up in Washington DC. And so, I decided to come to family. My parents had recently retired to Southeast Georgia. So, i just wanted to be closer to them after being up north for a while. And then, I met my husband here, and the rest is history.

Host: It sounds like a good history. So as for your particular case, may I ask first how old you were when you first learned you were pregnant?

Mallory Manners: I was 37 and I turned 38 while pregnant.

Host: And do you recall what thoughts or concerns were going through your mind when you first found out you were pregnant, especially knowing that this was a later in life pregnancy?

Mallory Manners: Yeah, I think my biggest concern was, you know, you hear a lot as you get older that the longer you wait, it's higher risk. I guess really not knowing what exactly that meant. So, it was important to me to find out and ask the questions of what it means to be a higher risk pregnancy. And so, Dr. Deaghan was really great about answering those questions and I would come in with a lot of questions and he never made me feel rushed through any appointment.

Trace C. Deighan, MD: It wasn't that many questions.

Host: Setting the record straight, Doc. Love it. But I was about to say, I'm sure anyone going into a pregnancy at any age would have a ton of questions, right, Doctor?

Trace C. Deighan, MD: Right. And I think part of the reason we see people at least once a month in pregnancy, and part of the reason is I don't want people to feel like they have to have all the questions all at one time, because things will pop up throughout the 40 weeks that you didn't even think to ask the last time, and things can change. So, questions that you didn't think you would have will inevitably pop up.

Host: So, Doctor, kind of a two-part question here next for you. First, what's considered a later in life pregnancy age-wise? What's the cutoff there, if you will? And what are the important things that you need to immediately point out to someone that's about to go through that?

Trace C. Deighan, MD: Absolutely. So, American College of OB-GYN defines later in life pregnancy as advanced maternal age. Now, fortunately, they got rid of the term that I think is horrible called geriatric bariatric pregnancy, so we don't do that anymore. But advanced maternal age is after the age of 35 and up. But we actually break that down into risk stratification. So, 35 to 39 is in its own tier. And then, 40 to 44. And then, 45 and older is a different tier as well.

And so, as Mallory was alluding to, there are increased risks with pregnancy. And they go up as we go into each subsequent tier. And some of these risks include increased risk of hypertensive disorders, preterm deliveries, increased risk of babies that are a little smaller at time of delivery. Also, increased risk of cesarean birth.

Host: It's interesting discussing this. I was thinking back to a while back when I asked an OB-GYN about higher risk pregnancies for women later in life, the very subject we're discussing and he said, "In my book, all pregnancies are high-risk" as if to say they all come with their own set of risks, right?

Trace C. Deighan, MD: A hundred percent. What's unique about our field and something that always keeps us on our toes is you can have completely normal prenatal care and someone come in at 48 weeks, and then things can turn on a dime. And I don't want to get into specifics of bad things that can happen. But every time you deliver a baby and they have a good outcome, it is a blessing and truly a miracle sometimes. So, no, I agree, there's no low risk pregnancy.

Host: You took the word right out of my mouth. It really is—I guess sometimes the word is overused. It really is still considered a miracle, isn't it?

Trace C. Deighan, MD: Absolutely.

Host: So Mallory, balancing your demanding career at a high-risk pregnancy is no small feat naturally. How did you approach self-care, therefore, and how did your care team support that?

Mallory Manners: So during this pregnancy, it was really important for me to stay active. I had a Peloton bike and I enjoyed taking walks. So, that was important to me to continue that, as long as possible, as long as I was comfortable on the bike and as long as I was medically allowed, I would say, for it to be safe.

And I managed to do that up until about 30, the 36-week mark, which I was really proud of myself for, because it was one of my goals. Each appointment, we started getting a little closer to the preeclampsia fears. My blood pressure was just not staying where we would like it to, despite, you know, working out and very strict diet. It is just, I'm sure, a combination of genetics and age.

So, it was important to me to have the team that was supportive and communicating all of these things to me. I wasn't kept in the dark about anything, which was great. I'm the type of person, I don't like surprises. So, I wanted to know as much as possible. So, that was great with them. And then, my work as well, I've been with this organization for almost nine years. So, the team was very supportive about my work as far as like keeping my stress low, working with me on projects to make sure everything was covered in case I had to, you know, leave early or if, you know, something were to happen, I need to be on bedrest. So, I have a lot of support, and that's really important too, is having a great support system.

Host: Yeah, no question about that. So, Doctor, you touched on a list of some of the more common risks or concerns with a later in life pregnancy. Is there one in particular that's most common, one thing that pops up the most? And along with that, why is ongoing prenatal care therefore so important for higher risk pregnancies to head off some of these things at the past, so to speak.

Trace C. Deighan, MD: Yeah, absolutely. So, I think one thing that we kind of all think about in advanced maternal age pregnancies is the risk of chromosomal issues and aneuploidy. So, risks of down syndrome, things like that. But once you kind of rule that out, which happens usually pretty early, hypertensive disorders are usually the highest or the most common things that can happen. And once again, there's always spectrums in OB of mild hypertension versus severe hypertension or preeclampsia. And so once again, as we kind of get closer towards the end of pregnancy, we do increase our prenatal visits, partially just, you know, to make sure mom's feeling okay and make sure good fetal movement, make sure the baby's heart rate looks good.

But I'm always looking at blood pressure at the end of pregnancy. And also, making sure that there's not a lot of protein in the urine because those can come up very suddenly and situations can change very quickly and you don't want to be three weeks out from having seen the patient. And then you, see them, and you're in some trouble. So, we do once again increase our frequency of at least once a week towards the end of pregnancy and sometimes even more often than that.

Host: And Doctor, Mallory talked a little bit about it a moment or two ago, but to pick up on her point about feeling more comfortable because of the team that she worked with, supporting her and so forth, why is building a strong connection for you and yours with a patient like Mallory so important in providing effective care here?

Trace C. Deighan, MD: So for Mallory and any mom that's kind of going through this, this is the most important thing they're ever going to do. And so, one of the things for me, I have to kind of respond to things that happen fairly quickly with either her care or the baby's care. And I have to relay that information in a way that she can trust.

So, for her, she was starting to show signs of preeclampsia towards the end of pregnancy. And things were kind of changing from our initial plan of delivery care. So, we had to kind of adjust, say, "Okay, your blood pressure is rising. You're starting to have increased swelling. We probably need to have this baby earlier than we initially thought. And if that development of that rapport did not happen, I wouldn't expect her really to trust me with that. And so, it is really important for me to earn that trust when I do suggest we do something different than what the original plan of care was.

Host: Mallory, how about feeling connected to the right doctor in this case, joining us today as well, obviously? What do you want to say about this man in terms of how much he and those on his team made you feel more comfortable going through this experience?

Mallory Manners: Well, I have to say, I came into his office probably around the 12-week marker. I did have another doctor and it just wasn't the best relationship. So, we reached out, a family friend recommended Dr. Deaghan. And it was just, I mean, the best experience. My husband is also a huge fan. He would come to every appointment and he loved Dr. Deaghan.

So, it was awesome. I never felt uncomfortable. I never left there with more questions than answers, which was really important to me. And then I also knew that if I thought of something later, I could always call the office. And his nurses and staff were always more than willing to help me out.

And then, I have to say the delivery team, that whole experience was just wonderful. They were the nicest people, the nicest nurses. I went back a couple times and ran into them because I had another family friend who was having a baby there. So, I tried to get the same nurses for them, but it didn't work out. But I did get to run into them, and that was great to see them after the fact because the entire delivery process is a little bit of a blur. So, to see them, especially because mine ended up being a little high-risk and kind of emergency c-section at the end there, that all became kind of a blur, but it was nice seeing them again and catching up.

Host: That's nice to hear. And so, a couple other things for you two. In summary here, doctor, what encouragement or advice would you give to mothers unsure about becoming pregnant later in life in the first place, or who may be feeling anxious or overwhelmed right now?

Trace C. Deighan, MD: So, I love to have these conversations. I'm happy to have them after people know they're pregnant, but I'd love to have them before you become pregnant. So, we call these preconception counseling visits. Very important to have, if you have any questions and you write them down and come with your husband, your boyfriend, your partner. And we can have these discussions early. And yeah, I do encourage people to try and find a provider that they do trust and doesn't feel rushed to be with you.

Host: Mallory, we kind of buried the lead here, as they say in journalism because we've got to know before we let you go, of course, what did you have and what's their name?

Mallory Manners: I have a boy. And we were also joking around, we had really no idea how big he was going to be. I had a lot of different sizes thrown out at me during my ultrasounds. So, it was anywhere from like eight pounds to over 10. We were not quite sure. So, we went in there, and I had a baby boy named Philip, who was seven pounds, seven ounces. So, we were very, very happy about that.

Host: How would you describe the feeling when you see and hold that baby for the first time?

Mallory Manners: Overwhelming. I mean, just nothing in the world can describe how you feel when you hold your child for the first time. Just the joy. I mean, just overwhelming joy, like tears of joy. And then, just the weight of it is a lot, but it's also like one of the best and probably the best thing I'll ever do.

Host: And in this case, a little bit of an exhale and a feeling of relief as well at that point.

Mallory Manners: Yes, yes. I guess I was just out of it a little bit during the—I was on a lot of medicine for the preeclampsia. And so, when he finally got here and they were explaining to me, you know, everything that I'd gone through and what needed to happen after the C-section and things they were still monitoring, that was a little eyeopening. But also, I knew I was in really great hands. I never worried for a moment, you know, that my team wasn't fully aware of what was going on, or they didn't know what to do. So, they made me very calm and relaxed, and that was important to me.

And they also filled in my family really well that was visiting. They took the time in the hallway to answer questions. And so, that was wonderful too.

Host: Doc, Mallory says even her husband was a big fan of yours. When you get the husband on your side, you're home free, right?

Trace C. Deighan, MD: Yeah, mom's number one. Husband's always a good bonus, for sure.

Host: And then, finally here, Mallory, for those joining us who may be facing similar fears or uncertainty in their own pregnancy journey, what's your best message or advice for them?

Mallory Manners: I would say don't be scared to ask question. I mean, there are no dumb questions. My friends and I always say that the women's health is kind of a team sport. I mean, I was also asking a lot of questions from friends that had had children recently and, you know, like, what should I know about this or expect from this?

And then, I would go in and confirm with the doctor of how it related to my journey. I'm not a fan of surprises. So, the more research, the better. That's how I feel. That's how I approach situations. I like having everything laid out in front of me.

Host: I think many of us do. Well, folks, we trust you are now more familiar with pregnancies a bit later in life. Doctor, Mallory, thanks for sharing this story. And we hope to have you both experience nothing more than continued success in both the Professional And in your case, Mallory, the motherhood world.

Mallory Manners: Thank you.

Host: Absolutely. For more information, please visit sghs.org/maternity. If you found this podcast helpful, please do share it on your social media. And thanks so much again for being part of Health Matters from Southeast Georgia Health System.