Prakash Chandran (Host): Starting a family should be a really exciting experience. But for some couples, it can be anxiety inducing. In this podcast we’ll learn key factors you should consider as you choose the place of your baby’s birth, so you feel more prepared. Let’s talk about it with Dr. Ronald Ramus, an OBGYN with a specialty in maternal fetal medicine at VCU Health. This is Healthy with VCU Health. I'm Prakash Chandran. So first of all, Dr. Ramus, when exactly should people start planning for the birth of their child? 

Ronald Ramus, MD (Guest): Typically preparations should be made a few months before trying to get pregnant. The major issue is to make sure there are no significant medical complications that would effect in early pregnancy the development of your baby. So if a patient has no significant medical complications, the major issue is to just make sure they're on a prenatal vitamin that has folic acid because folic acid reduces the risk of some types of birth defects in the developing fetus.

Host: Okay. Does that just encompass the mother going to their OBGYN and saying, “Hey, listen. I'm thinking of starting a family in a couple of months.” Then they’ll put them on that plan?

Dr. Ramus:   So if you're, again, a young healthy person you can probably just do this on your own. If there are any significant medical concerns or significant questions about medication exposures, medicines that somebody needs to take because of medical conditions then it’s absolutely appropriate to talk to your OBGYN first before trying to conceive.

Host: Okay. I noted here that you specialize in maternal fetal medicine. I've heard, obviously, of an OBGYN, but talk to us a little bit about that specialty.

Dr. Ramus:   So within the OBGYN field there are some folks who get extra training in a subspecialty. Maternal fetal medicine is one of those subspecialties. The focus for MFM doctors is primarily related to ultrasound, prenatal diagnosis, and dealing with medical complications of pregnancy. So for the majority of young women who have babies, they'll never need to see me. Or they might see me or somebody who does what I do for their ultrasounds. Our focus is primarily on complications, both complications related to the unborn baby and medical complications of the mother.

Host: Okay. So it sounds like a general OBGYN can handle most things that come up during pregnancy, but when there are complications or potential risk factors that come up, that’s when they would see a specialist like you. So maybe talk a little bit about those risk factors and conditions and what actually causes a high risk pregnancy to begin with.

Dr. Ramus:   So as you accurately described, most prenatal care can be handled by the OBGYN doctor without any problems. Usually folks like me get involved when moms have medical conditions that can complicate pregnancy management. The most common ones these days are related to blood pressure problems, hypertension, both before pregnancy and during the pregnancy, and diabetes complications. Again, diabetes that exists prior to the pregnancy or diabetes that can develop during a pregnancy. We’re also very involved in patients who have multiple gestations. So twins, triplets, and higher. For a lot of practices, some will do ultrasound evaluations in their office and some will refer patients out for ultrasound evaluations for people like me. So you might see me for your routine ultrasounds, you might never see me. Of course, we’re there primarily to support your doctor. Your OBGYN doctor. So it’s more about our availability to help your doctor do the best job taking care of you in your pregnancy.

Host: Okay. So let’s say a woman goes to her OBGYN and she’s at high risk. Would she then go and seek out a maternal medicine specialist like yourself on her own? Are there many around? Talk a little bit about that.

Dr. Ramus: Sure. So the answer is yes. That commonly happens. So if an individual is considering pregnancy and let’s say she has multiple medical issues. Maybe she has a chronic medical condition like lupus or other medical problems like diabetes or hypertension that we talked about. A lot of times your OBGYN doctor will refer you to somebody like me for what’s called pre-conception consult so that we can try and optimize your care, optimize your medical regimen prior to trying to have your baby. The typical referral patterns in most communities—and it’s certainly true here in Richmond—are primarily related to where your doctor plans to deliver you. So if your doctor practices at a specific hospital, there are typically maternal fetal medicine doctors that support your doctor at that hospital. So in the VCU system if you're coming to see one of my VCU OBGYN colleagues—even a VCU midwife. We support them, of course, also. Then if questions, concerns, complications arise then my job and my colleagues jobs here at VCU is to support those providers to provide you with the best possible care.

We also have what I would call a small practice of our own. So one of the challenges in modern medicine is that when patients have medical complications, lots of different doctors get involved. So, for example, if you have diabetes, you might see your OBGYN doctor during the pregnancy. You might then see your endocrinologist doctor to manage your diabetes, and then you might see somebody like me to do ultrasounds and antenatal testing on your baby to make sure everything’s going well. Well, one of the unique things about VCU is that the maternal fetal medicine doctors here have small practices so that we can kind of consolidate that care in patients that truly are of the highest risk and have the most complications. I think it tends to streamline the number of appointments and the number of individuals involved so that you don’t get mixed messages about what’s going on and how to proceed.  

Host: Yeah. That makes a lot of sense. It really seems like in VCU there's a comprehensive level of support, especially with that small practice model. One of the things that I wanted to ask was for a woman that is trying to or thinking about saying to start a family—We talked about at the top of the episode how while it’s supposed to be an exciting time, it’s often anxiety inducing. So what piece of advice might you have for those women that are thinking about trying to start a family?

Dr. Ramus:   I think that in this day and age it’s very common for young families and young women to consider delaying childbirth because of other issues—primarily career related issues, but it could be many different reasons. That’s fine. It’s not a problem. But ultimately as young women get into their mid-30s and later, it truly does complicate pregnancies. Not drastically, but it does have an effect. So don’t go into this thinking I have forever. You don’t have forever. You need to be thinking about these issues as soon as it’s appropriate to be thinking about the issues based on your situation, your family status, etcetera. So there—Again, I don’t want to paint a grim picture, but ultimately earlier, 20s, is better than later. So I think that’s something to keep in mind.

Secondarily I think one of the big issues that we deal with in the United States, throughout the world is obesity. Obesity complicates everything, including pregnancies. So ultimately it’s a reminder to individuals who are dealing with obesity that it might be treatment or a dietary plan, even bariatric surgery. Those kinds of things might be best done before considering a pregnancy. Should radical treatments be required such as surgery, there are clearly recommendations to wait at least 18 months after a procedure before considering a pregnancy. So it can have a dramatic impact on a timeline of when you want to have children. So just think about those chronic medical issues. We don’t think about obesity as a medical issue, but it clearly is. It clearly has implications regarding especially hypertension and diabetes in a pregnancy.

Host: Okay Dr. Ramus. Really appreciate all of that insight. Is there anything else that we didn’t cover today that you think is important for our audience to know?

Dr. Ramus:   I think the two things that I try to remind women of on a regular basis who are pregnant is number one, enjoy your pregnancy. I mean there are so many things to be worried about and fearful about. We can choose to focus on those, or we can choose to focus on the developing life within us and nurturing that developing life. I really try and encourage my patients to really just enjoy the pregnancy rather than get caught up in a lot of the concerns that frequently the individual patient or their doctor have absolutely no control over. Then the other thing I try and encourage pregnant women to do is to listen to their body. When we have things to do, places to go, people to see, we tend to ignore the clues that our body gives us. Pregnancy is not the time to do that. You have to listen to your body. When it’s time to rest, you get off your feet. When it’s time to get something to drink because you're thirsty, you need to do that. So being in tune with your body and listening to the clues that your body gives you is something that becomes really important in having a happy and successful pregnancy.

Host: Yeah. That’s really sound advice Dr. Ramus. You're absolutely right. It is a beautiful time. The best part about it is that people can feel supported over there at VCU Health. So hopefully Dr. Ramus has taken some of the anxiety in the pregnancy planning and what factors to consider as you chose the right hospital for yourself. Thanks for checking out this episode of Healthy with VCU Health. Visit vcumom.com for more information and to sign up for a tour of the labor and delivery unit. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.