An unexpected Mother's Day arrives after a very difficult pregnancy [The San Diego Union-Tribune]
San Diego Union-Tribune (CA)
Maria Gelastopoulos didn't expect to be a mother this Mother's Day. But a difficult pregnancy — one that included seven blood transfusions and a three-week hospital stay — brought her daughter Athena into her arms 10 weeks earlier than her May 28 due date.
Now weighing just a bit more than six pounds with a shock of dark hair, she is ready to deliver a bouquet of disarming smiles Sunday, a few leg kicks and arm waves thrown in for variety, as families gather to honor all those who have brought life into the world.
Athena's arrival is its own timely tribute. Her middle name is Eleni in remembrance of her great grandmother, Eleni Karis, who died six years ago, just after Mother's day. Through the adversity of a complicated pregnancy, she said, she could feel her grandmother's presence.
"We had trouble getting pregnant, so from the beginning she was our miracle and, with what we went through, we're both here so somebody was definitely watching over us," Maria said, gently stroking her daughter's chest beside her husband, Gaudencio Mendoza Suarez, inside the couple's North Park apartment this week.
As they settle into life as new parents, the couple can't help but recognize just how close they came to tragedy.
Previously diagnosed with Type 1 diabetes, Maria was enrolled in the high-risk pregnancy program at Scripps Health when her blood pressure spiked in her second trimester. Her condition gradually deteriorated, leading to precautionary hospitalization before her medical team induced labor at 30 weeks with Athena born on March 20 weighing two pounds, nine ounces.
The complications she experienced during pregnancy, which has still not been fully explained, included massive swelling that caused more than 40 pounds of rapid weight gain, starting with her lower body and progressing to her lungs and heart, impairing her circulatory and respiratory function.
"It was difficult breathing, and they had me on oxygen; they said I was very close to going into heart failure," Maria said.
Intensive therapy that continued for a full two weeks after delivery eventually turned the situation around, but not without a cross-discipline effort that included specialists in cardiology, nephrology, endocrinology and neonatology.
While hers is an extreme example, Maria's situation is becoming increasingly common. Insurers Blue Cross and Blue Shield analyzed the claims of 1.8 million women who gave birth from 2014 through 2018, finding that complications during pregnancy increased more than 16 percent during the two-year span. Postpartum depression, a condition that can leave women feeling hopeless after giving birth, also increased with nearly one in 10 mothers diagnosed in 2018, according to the Blue Cross-Blue Shield analysis.
As with other medical problems, the risk for postpartum depression increases if early symptoms of distress such as anxiety go untreated.
A career spent working with women in high-risk pregnancies left Dr. Shahram Daneshmand, medical director of the maternal-fetal medicine program at Scripps Clinic, feeling like more could and should be done to try and prevent poor results in complicated pregnancies. The group, which oversees deliveries at all four of Scripps' hospitals, took concrete action recently, hiring its first case manager specializing in complex pregnancies. Though the position was not yet in play for most of Maria's pregnancy, it is expected to help in similar situations.
When multiple specialties get involved, Daneshmand said, patients can quickly become overwhelmed. The sheer number of medical appointments alone can lead to miscommunications between patients and providers and also between one specialist and another. Transplant medicine, which routinely spans many medical specialties, has long turned to nurses acting as care coordinators to make sure that patients' stress levels aren't increased simply by the massive amount of scheduling and follow-up that their treatment plans require.
"The idea is to have one person who's really managing these complex patients round-the-clock," Daneshmand said. "Yes, you can always send an email to your doctor if you have a question, but it's just not the same as having someone that you can talk to on a regular basis to bounce any questions you have, to make sure this person is navigating all of the different paths you have to take to ensure a healthy pregnancy."
Coordinators also have the time it takes to screen expectant mothers for the early signs of depression, referring those who are struggling to counselors for therapy early. A collaboration with a local nonprofit to get these appointments done quickly without the need for time-consuming health insurance approvals is in the works and is to be announced mid-month.
Mental health maintenance, he said, needs to become more proactive during pregnancy if rates of postpartum depression are to be reduced.
"I honestly think that is one of the biggest areas that we're unfortunately failing in," Daneshmand said, addressing conditions nationwide. "They're talking about it, but they're not always willing to do something about it."
But the need to do better, he added, goes beyond mental health and beyond delivery. Women who experience significant complications during pregnancy face significantly worse odds of complications later in life. Women who develop gestational diabetes before they give birth have been shown to have a 50 percent greater chance of developing Type 2 diabetes later in life. And those who deliver prematurely and also have a high blood pressure complication called preeclampsia have significantly greater risk of heart disease in the future.
The industry, Daneshmand said, is moving toward a "fourth trimester" model for women to make sure they get the follow-up care they need after delivering.
"We have to make sure we are following them more closely to make sure that we are more preventive rather than reactionary," he said.
Of course, on Mother's Day, those concerns can be set aside temporarily to make plenty of room to celebrate.
She doesn't know it yet, but Athena's family is particularly accomplished at helping families raise mimosas every second Sunday in May. Her grandfather, John Gelastopoulos, is the owner of the Broken Yolk Cafe, an enterprise that started serving breakfasts and lunches in Pacific Beach and that now has 34 locations nationwide.
This story originally appeared in San Diego Union-Tribune.