Candace Wason was just 23 weeks pregnant when she began to feel steady, insistent contractions. “Most people would have ignored it,” Wason says, because benign intermittent uterine tightening, called Braxton-Hicks contractions, are fairly common in expecting moms.
Wason, though, had two reasons to pay careful attention. First, she was finally pregnant after eight wrenching years of infertility and wanted to ensure the successful arrival of her first child. Second, she is an obstetrics nurse with extensive knowledge of pregnancy complications.
Concerned about the strength and frequency of her contractions, Wason contacted UAB’s Maternal Fetal Medical (MFM) Division. She was admitted for treatment of severe preterm labor. Her doctor was John Hauth, M.D., a UAB maternal fetal medicine specialist.
“I was terrified,” she recalls. “I had worked at Northwestern University’s hospital as the manager of the high-risk obstetrics floor. I was well aware of the complications of prematurity, and I knew when I went into labor that my child was not viable.”
Wason spent nine weeks at UAB on bedrest. Medicine to halt her contractions was pumped intravenously into her body while she read and watched Chevy Chase movies on a VCR. Though she hadn’t planned on marking more than two months of her pregnancy in a hospital bed, Wason adapted by visualizing the outcome she desired. “I told myself, what’s a few weeks of being uncomfortable for a lifetime of joy?”
‘A Lifetime of Joy’
That joy began on June 10, 1989, when son Bobby was born to Wason and her husband, Robert. The newborn was six weeks early and weighed 4 lbs., 11 oz. but had no complications. Bobby, now 18 and about 6 feet tall, heads to college this fall to study journalism.
When Wason found herself pregnant again about eight years later—this time with twins conceived through in vitro fertilization—she knew her pregnancy was a high-risk one. UAB and Dr. Hauth once again provided her prenatal care.
“I was very scared,” says Wason, who was 42 at the time, “but I just did what I needed to do.” That meant bedrest starting at her 15th week of pregnancy, this time at her Mountain Brook home. Dr. Hauth or UAB nurses called regularly—sometimes daily—to monitor
her condition.
“It was great,” she says. “It just made me feel more confident because I didn’t have to make every decision, including, do I have to run to the hospital?”
At 34 weeks pregnant, her contractions became so strong that she was admitted to UAB. Dr. Hauth delivered her twin girls by emergency C-section in November 1997. Kathryn and Laura each weighed 4 lbs., 10 oz., and were healthy enough to go home with their ecstatic mother.
Super Specialists
Wason credits UAB’s MFM subspecialists with ensuring successful conclusions to her pregnancies. That’s all in a day’s work for the 11 UAB MFM specialists, who each year treat about 700 women transferred to UAB with medical conditions that put their pregnancies in danger. An additional 300 women from the greater Birmingham area choose these
subspecialists for their pregnancy care due to a previous high-risk pregnancy or concern of possible complications. They are a very select group within the 65,000 women whose babies are born in Alabama each year.
During more than two decades at UAB, Dr. Hauth has delivered sextuplets born at 28 weeks and scores of twins, triplets and some quadruplets. “This is a happy field,” he says of his specialty. “It’s fun. I shouldn’t say I’d do it for free, but I might.”
Delivering babies is his favorite part of a profession where patients can experience dangerous symptoms and intense emotions.
The high-risk patients UAB cares for fall into two broad categories: Some mothers-to-be have medical conditions such as heart problems, diabetes, asthma, epilepsy or kidney disease
that can complicate their pregnancies. Other women who have no health problems have pregnancy-related conditions that demand specialized treatment and close monitoring.
These patients are cared for by UAB’s MFM specialists, some of the nation’s most rigorously trained doctors. There are more than 42,000 obstetricians and gynecologists in the U.S., but only about 2,000 are board-certified MFM specialists like the 11 at UAB.
Premature Labor
About half of the women with high-risk pregnancies who are transferred to UAB involve spontaneous preterm labor, the condition that sent Wason to UAB. The percentage of pregnancies with premature labor has increased in the past decade, from just below 10 percent to about 12 percent, Dr. Hauth says. That increase might be due to a rise in in vitro
fertilization, which is more likely to result in twins. Twins are more likely to be born early, usually just after 35 weeks.
Preterm ruptured membranes and preeclampsia, a mysterious, unpreventable condition that occurs in about 7 percent of otherwise routine pregnancies, are each responsible for about 25 percent of UAB’s high-risk admissions. “We have no idea what causes preeclampsia,” Dr. Hauth says, noting that it’s one of the leading causes of maternal death in undeveloped
countries. “If we knew, we could be considered for the Nobel prize.”
Highly Specialized
These specialists must complete 11 years of medical training: four years of medical
school, a four-year residency capped by oral and written board examinations, then a three-year fellowship, a thesis and more testing.
The specialty has existed only since the mid-1970s. It followed on the heels of the invention of the infant respirator, which dramatically boosted survival rates in babies younger than 28 weeks. “Before that, you wouldn’t even anticipate that a baby would survive if he or she was under 28 weeks,” Dr. Hauth says.
The growing number of premature babies needed specialized care to help them thrive. That need triggered an explosion of hospital neonatal intensive care units, dubbed NICUs, staffed by specialists called neonatologists. But before a preemie ever sees a neonatologist at UAB, his mom has likely already received state-of-the-art medical attention from the MFM specialists.
Wason was so impressed by UAB’s quality of care that she decided to work Tuesday afternoons at UAB’s Maternal Fetal Medicine Clinic. She counsels and cares for pregnant women with diabetes. “I had such a positive experience,” she says. “I decided that if there was any way I could help other people, I’d do it.”