May 6, 2019
Many areas in rural Alabama are prenatal deserts and that impacts how Dr. Connie Leeper cares for some of her pregnant patients.
Leeper, a family medicine obstetrician, might ask rural patients about their plans for getting to the hospital when they go into labor. Some of her patients live an hour or more from the nearest hospital. Others might not have reliable transportation.
“It plays into how you offer prenatal care,” said Leeper, who practices at University Medical Center, including at its Demopolis location, and is assistant professor of family, internal and rural medicine at the College of Community Health Sciences. She presented in April to the Women’s Leadership Alliance, an initiative of the Chamber of Commerce of West Alabama.
Inducing labor is considered in these cases, she said, though typically not for first-time moms. While inductions carry some risk, “if the cervix is dilated and the patient has had babies before, there’s less risk. So, I do offer inductions to some of my rural patients. It’s all about what’s best for the baby and what’s best for mom.”
Leeper said prenatal and pregnancy care “is really important to decrease risks for mom and baby.”
Ideally, Leeper likes for patients to see her and talk about becoming pregnant – before they are pregnant. At these visits, they discuss if it’s a good time in the patient’s life and health to be pregnant. They identify risk factors for mom, baby and pregnancy, and can optimize health with supplemental folic acid, which can help mitigate spinal cord and other potential health defects.
Once a woman is pregnant, a due date is determined, and pregnancy symptoms are managed. From 15 to 28 weeks, the baby’s growth is monitored, its anatomy can be checked via ultrasound and mom is screened for gestational diabetes and anemia. From 28 to 40 weeks, patients are seen more frequently. Leeper monitors the baby’s growth and for possible complications.
During labor, the patient is evaluated for complications and the baby for wellbeing. If labor progresses, women usually delivery vaginally. If labor does not progress, if the baby is too big or shows signs of distress, a C-section might be the safer route, Leeper said.
She said it’s important to monitor a patient’s recovery even after she is released from the hospital and goes home. “There’s lots of hormone changes and lack of sleep. Postpartum depression is common. We don’t want moms to suffer alone at home.”