TORONTO - The devastation of losing her premature son followed by another high-risk pregnancy led Kelly Whitehead on a search for answers.
After years of research, the mother of two has written a guide aimed at women who have had or may have a premature birth or suffered through a second-trimester loss.
With her book, "High-Risk Pregnancy: Why Me? Understanding and Managing a Potential Preterm Pregnancy" (Evolve Publishing), Whitehead sought to share medical information as well as candid advice with fellow moms.
"No woman feels comfortable talking about dealing with not being able to have sex for so long, or 'What is their discharge supposed to look like?' and being afraid to use the bathroom," she said in an interview from Vernon, N.J. "I really wanted to be really honest and raw, and I think that's what I achieved."
"To some, it might not be their style and they might not agree with that type of approach. But most of the women I've talked to are really appreciative of that because it kind of talks about the stuff they're too embarrassed to talk about."
The book offers comprehensive details on risk factors associated with high-risk pregnancies, potential treatments and strategies, as well as covering myriad issues related to preterm labour.
It also outlines conditions that may affect some moms such as preeclampsia and preterm premature rupture of membranes, where the water breaks early.
"I didn't realize how complex the issues were," Whitehead said. "When my doctors told me 'We don't really know,' we were really angry and we blamed our doctors after our loss.
"I didn't realize just how difficult and sometimes how it is so much a shot in the dark, and how (with) management of these conditions there is so much to know," she added. "That's why it is important for the woman to pay attention to her body and to speak up and not be afraid to speak up.
"I learned a lot. For me, it helped to close that circle and come to grips and understand things."
Data released by the Canadian Institute for Health Information in 2009 revealed that preterm births in Canada had increased 25 per cent over the past 10 or 12 years.
From 2006-07, 8.1. per cent of babies in this country were born preterm, meaning they were delivered before 37 weeks of gestation. In the early 1990s, preterm babies comprised around 6.6 per cent of births in Canada.
For Whitehead, 34, a microbiologist and doula, she said there was considerable doubt about trying again and uncertainty she could carry a baby after losing her son 22 weeks into pregnancy in 2004.
Whitehead was diagnosed with an incompetent cervix (IC), a rare condition in which the cervix dilates prior to term, and is linked to premature labour.
"I'd pick up a book (and) on IC there'd be one paragraph on it, and there would not be to (an) extent the level of detail that I really wanted to understand," she recalled.
For her two subsequent pregnancies, she underwent a cervical cerclage where the cervix is stitched closed, and successfully carried both her daughter and son to term. But the pregnancies weren't without their challenges.
Prior to giving birth to daughter Madison, who is now six, Whitehead was on bed rest for 4 1/2 months. While carrying son Drew, now three, Whitehead was able to work part-time in the lab but was unable to lift Madison or vacuum around the house.
Anecdotes from fellow moms are threaded throughout the book.
High-risk expectant moms who fear another loss or having a premature baby can also experience isolation and concerns over changes in their relationships with spouses or partners that can further amplify feelings of vulnerability, Whitehead noted.
"On top of all the panic and stress (felt) by most pregnant women ... they have all these additional worries and medical burdens to consider, and the health and safety of not only themselves for some women in certain conditions but also of their baby or babies — and their family changes."
Whitehead encourages women not to enter pregnancy in fear. For those who may have risk factors, such as being obese or underweight, having high blood pressure, diabetes, carrying multiples, pregnant by in vitro fertilization or with a prior history of early labour, Whitehead said they should work with their doctors to have a plan in place to monitor their progress.
The book is backed by Dr. Vincenzo Berghella, a maternal-fetal medicine specialist who assisted Whitehead with drafts and ideas she sent to him for review.
Berghella said he believes there continues to be a major gap with respect to the public's knowledge surrounding preterm births in terms of incidence and what can be done to avoid and even prevent early labour.
"There's some things that are obvious but continue to happen too often in terms of do not smoke in pregnancy, avoid sexually transmitted diseases, avoid infection," said Berghella, a professor in the department of obstetrics and gynecology at Thomas Jefferson University in Philadelphia.
He believes Whitehead makes a good point about the value of women seeking out a doctor or specialist in maternal fetal medicine to have their histories assessed early on.
"The best message is to encourage women to get a pre-pregnancy or preconception visit and go over their own issues regarding weight, exercise, avoiding the risk factors even before they get pregnant," said Berghella.
Despite potential problems, a consistent message emphasized by Whitehead is for moms at high risk to try to make the most of their experiences.
She writes in the book about encouraging women to seek joy in picking out baby outfits and strollers and trying to spend some time behaving like a "'normal' pregnant gal" even if they are faced with other limitations during their pregnancies.
"I want them to really just realize that this is an amazing time," Whitehead said. "Yeah, it does stink — the nausea, the waking, if you're on bed rest — but it really is such a unique time in life."