- [Announcer] Support for this series comes from Inland Empire Health Plan a health plan with a mission to heal and inspire the human spirit, serving over 1.5 million members in the Inland Empire.

- A lot of times you go to your OB-GYN doctor and you feel like all the doctor did was just say hello to you, and then you listen to the baby's heart rate for maybe a couple seconds, and that was the end of it, right?

What people don't realize is it literally takes a village.

- Behind every diagnosis is a person, a family, a story.

Hi, I'm Leticia Juarez and on this show we are listening to patients and the medical professionals who walk beside them, sharing their struggles, breakthroughs, and the lessons learned along the way.

Together, we're making healthcare clear, compassionate, and closer to home.

So, join me on this journey of Health Caring.

[soft piano music] ♪ - [Leticia] In this episode, we explore one of life's most profound journeys, the moment a woman decides to bring a new life into the world.

It's a time filled with anticipation, challenges, and extraordinary strength.

We speak with two healthcare professionals dedicated to guiding women through this journey, and two mothers whose stories reveal the power of care, courage, and connection.

Our first conversation is with Dr.

Danielle Mason, who helps us understand what prenatal care truly means.

- [Leticia] Well, thank you, Dr.

Mason, for joining me today as we discuss prenatal health.

- My pleasure.

- So, I wanted to ask you if you could kind of tell me a little bit about how you became an OB-GYN.

- I always knew I wanted to care for women since the time I was very young.

For me, it was just very special to see the interaction of my family members with their physicians, especially here in the Inland Empire.

- What is prenatal care?

- So, prenatal care really is the intersection of a pregnant patient with the healthcare system to hopefully ensure the best possible outcome both for the patient and for her child.

- Who provides prenatal care?

- So, prenatal care can be provided by a variety of different members of the healthcare team.

So, traditionally OB-GYNs have provided prenatal care, but also primary care physicians, such as family medicine physicians who undergo training in obstetrics, midwives, nurse practitioners, physician's assistants.

All of these people often work together to provide prenatal care.

- If you could walk me through like, I'm your patient.

I'm newly pregnant; I come to you.

I say, "Dr.

Mason, now what?"

- I think at that very first visit when a patient seeks care with her healthcare provider, the most important thing is really a conversation about what the goals are for the pregnancy, how she's feeling physically, but also mentally.

Is this pregnancy something that was planned?

Is this something that she wants to continue?

And then, we also look at other medical conditions that the patient may have, any related healthcare conditions, any prior surgeries, her prior reproductive history.

We talk a lot about outcomes of previous pregnancies, if the patient has had prior pregnancies.

Because sometimes that can be a clue to us of things that we really want to pay close attention to in this current pregnancy.

At that initial visit, we also do some lab testing.

We're looking for infection, things like hepatitis or HIV or syphilis, so that we can hopefully treat those if needed to ensure a healthy outcome for the baby.

We also perform a pap smear test.

We screen for things like sexually transmitted infections.

We talk about vaccinations, things like flu vaccines or vaccines for whooping cough or RSV later on in the pregnancy.

And then, also we do an ultrasound, which is always-- usually the fun part of the visit where we get to get those first photos of the baby and hopefully see a nice, strong heartbeat.

- It seems like there's a lot in that first visit to make sure that the mother is as healthy as can be.

- Yes.

- What if you see a patient who may not have something entirely healthy about them?

How do you approach that?

- Ideally, we see mom before 10 weeks of pregnancy so we can identify any of those conditions that may put her, her baby at risk.

It gives us the opportunity to refer to a high-risk obstetrics specialist if her pregnancy has complicating factors.

And, that's why that first prenatal visit is so important.

(soft footsteps) - I'm a board certified OB-GYN and maternal fetal medicine specialist.

And, what that means is- well, I like to tell my patients- that I'm honestly the last person they want to see in the pregnancy, because I specialize in taking care of the highly complex and complicated, in other words, "high-risk" pregnancies.

That could be complications related to maternal medical conditions, could be complications related to the pregnancy, or birth defects related to the baby, or other related surgical complications.

- So, when patients come to you, some of them are coming to you for the first time, I'm guessing, terrified.

- Yes.

- How do you put those patients at ease?

Like, what do you do to help them understand their condition and help them get through their pregnancy?

- Yeah.

I truly believe that in order for patients to first of all be partnership in the treatment, they have to understand the condition.

So, my first visit is generally pretty long, and we spend a lot of time just talk about everything that the condition is and the potential complications associated with that condition.

And then, we outline the general management of it.

And then, the final thing, of course, is about reassurance, right?

So, I like to tell all my patients, in fact, that if I take care of the pregnancy along with them, let me do the worrying, right?

Let them just enjoy the pregnancy as much as they can, and when I get to a point in my worry about the condition that I feel like I need to share that worry with them, I will let them know.

- And, you have to have that really honest relationship with them- - Absolutely.

- so that they understand that you will tell them when something is going not quite as planned.

- Absolutely.

I think trust is the key here.

- [Leticia] What should an expectant parent look for in a prenatal care provider?

- [Dr.

Mason] I think one of the most important things is feeling that you have a connection with your prenatal care provider and that your provider has your best interest at heart as well as the interest of the baby.

Ensuring that your provider is up-to-date with the latest evidence and the latest guidelines.

And also, that your provider has the appropriate certifications to be able to either intervene in case of an emergency or refer to the appropriate specialist.

- [Dr.

Yao] A lot of times you go to your OB-GYN doctor and you feel like all the doctor did was just say hello to you, and then you listened to the baby's heart rate for maybe a couple seconds and that was the end of it, right?

What people don't realize is it literally takes a village to take care of one pregnancy.

And, when you have these kind of routine visits and you establish a rapport with your physician, then things come up.

Things come up that you may not recognize as important, that may have huge implications on the health of the pregnancy and also for the future of the baby.

- What is the most common health challenge mothers face during that perinatal period?

- I think there are a lot of different issues that patients can face.

Pregnancy itself is unique; every single pregnancy.

Even if you had 5 or 10, every single one is a little bit different.

If you want to think about, you know, in terms of the medical conditions that impact pregnancy outcome, a lot of these things are preexisting conditions.

You know, they've happened way before the pregnancy.

Things like diabetes and chronic hypertension, for example.

And, for many of these conditions, the healthier your physical condition is before you start the pregnancy, the better you are able to tolerate the physical stress of the pregnancy, and therefore the better the baby will develop also during the pregnancy.

So, oftentimes, even though, you know, we generally loosely use the term "perinatology," we really want to actually see our patients prior to them getting pregnant, as soon as they start thinking about getting pregnant.

- Yeah, 'cause it's a very physical demanding.

- Absolutely.

- Done it twice!

- Yes!

(laughs) I can't say I have!

But, yes!

I-- Yes!

- I have done it twice, and I will say this, I was a high-risk pregnancy because of my age.

But, I also made sure that I was healthy enough to carry, as well.

- Yeah.

- And, that was me having a conversation with my doctor prior to getting pregnant because I knew that I was an older mom.

- Mm hm.

- So, that's also another thing you have to do with your patient as you're preparing.

Now, I understand Alyssa Castillo is your patient.

- Yes.

- When you saw her, what was it like?

(knock at door) - Hi, Alyssa!

- Hi.

- How's it going?

- It's going!

(laughs) - Long time, no see!

- [Dr.

Yao] You know, Alyssa's case is unique in the fact that she was asymptomatic, right?

Meaning that she did not develop any complications related to her heart condition.

The routine prenatal care?

You know, you get your blood pressures taken, you check your heart rate, and as long as the baby is growing fine, you don't have any other way to suspect that there may be a complication.

So, sometimes you can incidentally find really serious issues with the pregnancy, or even outside of pregnancy for that matter, because of some other unforeseen event.

- [Leticia] I understand that not all your pregnancies went the way you expected.

- Right.

- Can you tell me about your first pregnancy and how that went?

- Everything was normal.

At 30 weeks pregnant, I got in a car accident, and that led to the process of my diagnosis.

My nurse triaged me, and just with a simple stethoscope, listened to my heart, caught the missed beat, and I was then diagnosed with the cardiomyopathy.

She looked at me and she said, "Have you ever, like, had an EKG or an echo?"

Then, I just immediately knew because of my mom's history, what that meant.

- Can you talk about that?

- So, when I was four, my mom died of cardiomyopathy.

But, it went undetected her whole pregnancy.

So, she ended up coding in the emergency room, and her autopsy revealed that it was cardiomyopathy.

- And, your mom was pregnant at the time.

- And, my mom was full-term pregnant with my sister.

And, due to the condition, my sister, the baby, she also passed due to inadequate blood flow and oxygen.

She was born with 2% brain activity.

- So, you're 30 weeks pregnant with your first child.

That's gotta be terrifying.

And, you're here at Loma Linda.

- Yes.

- And, they do all the tests and determine that you have this cardiomyopathy, which you knew of because of your mom's history.

- Right.

- What is it for you?

- It was a life-changing diagnosis.

It kind of flipped my world upside down.

I had this, like, sudden feeling of, like, impending doom.

But, symptom-wise, I'm fine.

It was more of a mental diagnosis, I feel, than it was a physical diagnosis.

- 'Cause you didn't have any symptoms that said "I was short of breath".

Or, are these things you were looking out for because of your own history?

- Hm mm.

I just-- I had been an athlete my whole childhood and I never had any issues.

And so, being pregnant and the shortness of breath, I just-- "I'm pregnant."

So, I didn't even think anything of it!

(chuckles) - Did having Dr.

Yao and your OB-G team together, did they help you feel like you're safe?

Like, being in that contact?

- Yeah.

Like, Dr.

Yao especially made me confident in the care I was receiving, but also within my own body to trust my body, my symptoms.

And, just made it easier.

Obviously, I went to have two more under his care.

- You're pregnant right now.

- Yes.

- How are you feeling?

- Confident, healthy, happy.

(chuckles) - [Dr.

Yao] Take deep breaths for me.

Last one.

And, as always, if you need anything in between that time, just message me on-- Okay?

- Sounds good.

- Alright.

See ya next time!

- See you!

- [Dr.

Mason] So, labor is such a special time for mom and the family.

And so, as healthcare providers, our job is really to make sure that we deliver a healthy baby and hopefully provide mom with the birth experience that she desires, but ultimately to make sure that she is safe and minimize complications during the delivery process.

After the patient leaves the hospital, we are not finished with care!

(laughs) That postpartum period is actually very, very important.

And, sometimes people think that the postpartum visit is not all that important.

They've had their baby and if they're doing well, sometimes they might not come in for that postpartum visit.

But, really we're checking on their general health and also planning for the future for future pregnancies.

So, it really, really is very important.

- [Leticia] Are there any preventative screenings or services that you wish more people would use before thinking about becoming pregnant?

- [Dr.

Yao] Of course.

I mean, I wish everybody would go see their doctor regularly, at least once a year.

You know, at least get their blood pressures taken.

Based on their age, get their other health screening, like diabetes screening.

Nowadays, women are getting pregnant later and later.

So before they get pregnant, they really should just make sure they are healthy.

I think that would be the best advice I can give anybody who's thinking about pregnancy.

- If you could give any advice to any expectant parent, what would it be?

- To keep a positive outlook.

[light piano music] Doesn't matter how complicated or risky the pregnancy is.

Once a decision is made to continue the pregnancy, always think positive, because if you don't, that additional social and psychological stress is going to impact the entire pregnancy and the baby's development significantly.

Mental and social stress can impact the pregnancy.

That really just can be improved upon if they felt more positive.

- [Leticia] After experiencing a pregnancy loss, Jacqueline Dollard faced her next pregnancy with fear and uncertainty.

But, with her trusted healthcare team by her side, she found strength and support through every moment, the good and the difficult.

- [Leticia] So, Jackie?

Welcome to the program.

I appreciate you being here to talk about this very important topic of prenatal care.

I know you had some of your own experiences.

If you could kind of tell us a little bit about your prenatal experience, your first touchpoint here at Loma Linda.

- Yeah.

The first time I had an experience with Loma Linda, I came into the ER 'cause I had previously found out we had lost our pregnancy at 13 weeks, and I came in for a D & C.

- How did that experience kind of shape you at that moment?

- It was the hardest thing I've ever been through in my life, but the care team here, they separated, 'cause they did have to go to labor and delivery.

And, they kept me separate from the live pregnancies.

And, just doing that really, really helped, you know, my mental state.

And then, because you go back to the operating room by yourself, you don't have any of, like, your normal support.

You know, the nurse held my hand the entire way back.

And then, I had started crying in the, sorry, the delivery room.

And, (shaky voice) there was a whole team of women there that just hugged me until I was able to go on again and go through that procedure.

I felt so supported and just so loved by people I didn't even know.

- Obviously, losing your daughter?

- Mm hm.

Yeah.

- Did that trauma going forward into your next pregnancy, like, how long after did you get pregnant?

- It took us quite a bit of time to conceive again.

And, the whole pregnancy I had pretty severe PTSD.

Just afraid to lose again, and just trying to hit those milestones of being okay, and so this pregnancy is okay.

Until the doctors say otherwise, I'm fine.

The baby's fine.

And, just trying to talk myself through that.

- So, while you're going through your second pregnancy with this PTSD of losing your daughter, you're also dealing with your own medical complication that was pretty serious.

Can you talk to us about that?

- Yeah.

I was just puking constantly, and I ended up going into the ER two times to have IV fluids before we found a regimen of medications that could help control it so I was able to keep down water and food.

- That must've been, like, just a big weight on you, because you're dealing with, like, is this gonna contribute to the pregnancy- - Mm hm.

- complications that could come from this of not getting enough fluids or food into you.

- Oh, definitely.

I lost 13 pounds in one week.

And, that's definitely scary.

- How is it that-- How did your prenatal care team help you through that?

- Luckily with MyChart, (chuckles) I have access to my doctor, you know, through messaging.

And, I was able to message her constantly if I had any issues and she was constantly reassuring me.

Like, "It's okay.

"We're gonna find the right kind of medication for you.

"Just go to the ER for anything you need.

And, just come in.

Don't hesitate."

- And you came from, like, Menifee.

- Mm hm.

- So, there's another Loma Linda Hospital, but you bypassed that one and came straight to this one!

- Yes.

Yes!

(chuckles) - How important was it to be seen here by a doctor who you felt comfortable with?

- Incredibly important.

I had already an established care team with Dr.

Caruso, and I've probably seen just about every doctor here!

(chuckles) And, all the nurses are just phenomenal.

- So, it was important to have that comfort as you're going through the second- - Oh, yes.

- part.

During those-?

I'm guessing you never missed a prenatal visit.

- No, never!

(laughs) - How important was it for you to get to each one of those?

- For me, going to those appointments just really calmed a lot of my fears.

Because of my age and the complications, I was getting a lot of ultrasounds.

So, just to be able to hear my baby and see my baby on the ultrasound before I could use, like, an at-home fetal doppler and everything, it was so important just to, like, relax.

"Okay, she's okay.

I'm fine.

Let me get to the next appointment."

- During one of those prenatal visits, during the 20-week one, I'm guessing that's when they picked up on something they saw in your daughter's anatomy.

- Yes.

She had pyelectasis of her kidneys.

So, swelling of the kidneys; they were retaining extra fluid.

And, the Maternal Fetal Medicine had me coming in once a month to do extra ultrasounds just so that they could look at that to see if it was getting better or worse.

- So, you're dealing with a lot!

- Yeah.

So, the ultrasounds added the sense of security.

But "Oh, no.

Baby's got something wrong."

But, even the pediatric urology department was so good, and they're like, "This is really common.

Things should clear up."

Even my regular doctor was just, like, "It's nothing to be worried about.

Baby's fine.

"Even if they have this issue after they're born, they're still fine."

- Now, is it this time that you had the car accident?

Was it with this-?

- [Jackie] I had the car accident at 18 weeks.

- At 18 weeks with Olivia?

- Yeah.

I was rear-ended at 40 miles an hour at a stop sign with a hit-and-run driver, which immediately I was freaking out because of the loss before.

Was seen for the car accident; everything appeared to be okay.

The next day, I had decreased fetal movement.

So I immediately, like, "Let's go down to Loma Linda and just make sure everything's okay."

And, they get you in right away and made sure I got another ultrasound.

They said, "Baby's good.

You're good to go!

(laughs) "No reason to be scared.

Just come in again if there's any issues."

- And, were there any issues going forward?

Like what-?

I hate to say this, but what else?

(both laugh) - Yeah, what else?

Well, because of the car accident, I ended up experiencing a lot of pain in my stomach right around where the seatbelt was.

This is probably a month later.

And so, I just-?

That kind of pain in your stomach, I'm like, "I better go get checked out."

And, after a CT scan and everything, they had found that I had two hernias right along my seatbelt line from where my previous C-section was.

- Was that gonna cause any complications for your delivery?

- Not for the delivery.

But, just with tissue moving in and out of the hernia that it would just cause pain.

And, luckily about a week later, the tissue moved out of the hernia, and I didn't experience any pain the rest of the pregnancy for that!

(chuckles) - So, when your daughter was born, knowing that she had this kidney issue, how was that delivery with your daughter here?

- The delivery, I had a scheduled C-section just because we had, had so many complications.

I had been approved for a vaginal birth after cesarean.

And, just with all the issues, me and my doctor just made the decision.

Like, you know, after everything I'd been through, it's just less complicated just to have that C-section.

You know, "Baby's gonna be here.

She's gonna be okay."

And so, we both decided together that's what we wanted to do.

Although ultimately it was my decision, which I really appreciated.

But, once she was delivered, everything was smoothie.

Like, went smooth, and just hearing her cry for the first time was just amazing after everything we had been through.

- [Leticia] Yeah, that must've been such a sense of relief.

- Yeah!

- She was in good hands.

Then, she went off to maternal and infant care.

Did she go to the NICU?

Or, how did that work?

- No, no.

She was fine.

I was able to take her right away after I was done getting stitched up and wheeled into recovery.

I was able to hold her right away.

And, the next day they took her down to ultrasound to have her kidneys looked at.

And everything was, not normal, but within safe ranges.

- And, did that put you at ease, knowing that she's getting this care?

- Mm hm!

- Even though she may have this issue, she's getting that continued care.

- Oh, definitely.

The pediatric urology team was always in contact with me.

They're like, "Okay.

We'll do another ultrasound "at three months and see how it is, and then we'll go from there."

- So, after Olivia and everything that you went through with getting Olivia here, she's now two years old.

- Mm hm!

- She seems to be thriving!

- Yes!

- And, you were able to get pregnant again.

- I was!

We actually got pregnant right away because my doctors made sure my hormones were in control.

And, luckily there were no ER visits for IVs or anything this time around.

- So, you have Olivia and you have Claire.

- Mm hm.

- Claire is now one month old.

- Yes.

- And, I'm guessing there are still more prenatal visits?

Or-?

- I have one for my six-week appointment.

Mm hm.

- And, it's important to continue those appointments even after the-- Like you said, the baby's already here.

- Oh, absolutely.

And even once you go home from delivering, there's still things that can pop up such as postpartum eclampsia.

You wanna be, you know, watching out for that.

So, like, I had major swelling after, and I said, "Is this normal?"

They're like, "It's normal.

Should go down within a week or two."

And, even the lactation specialists.

So, anytime you need help with that, like, they're always there.

- Yeah.

It seems like every step of the way the prenatal care was getting you the care you needed, but also your daughter.

- Oh, of course.

Yeah.

- And, it's like from the beginning to the end, it seems all connected together.

- [Jackie] No, and everybody communicated with each other and know exactly what was going on.

- [Leticia] So, you mentioned feeling supported during labor and delivery.

Kind of tell us about the environment and the staff in those moments, because obviously they knew your history.

- Yeah.

Dr.

Caruso is just fantastic.

She's been amazing.

I've known her for over four years now, from our first pregnancy to the third that we just had.

And, just her entire team?

They're just so patient.

- And, you said she stayed past the time she should've gone home to help deliver.

- Yeah.

I had a scheduled C-section with my daughter Claire, who's a month old.

And, we were supposed to be here at 1:30, and it was just emergency after emergency after emergency.

And, my doctor's like, "I'm gonna stay no matter how long it takes."

I was like, "Just get those other people taken care of 'cause they're emergencies.

I know you're gonna be here for me."

So, it was real nice.

And just-?

You don't hear about doctors staying nine hours past their shifts.

They have their own families.

They have their own lives.

But, because we had established this relationship that was, you know, it's been four years in the making, she's like, "I'm gonna stay and I'm gonna deliver your baby.

So, don't worry!"

(laughs) - Well, it's important to have those relationships.

And, I think that's why this series is so important to convey that to people.

Women who maybe are going through this for the first time, or maybe even the third, fourth time, is to know that there is good care out there.

- Yeah.

- You just need to find it.

Well, thank you, Jackie- - Thank you so much.

- for joining us on this program and telling us about your experience.

♪ - [Leticia] Perinatal health is about more than delivering a baby.

It's about protecting the life of the mother and child.

Doctors say it takes a village, from obstetricians and specialists to doulas and community health workers to guide mothers through pregnancy and beyond.

The message is clear: make the visits, ask the questions, and seek support, because perinatal care saves lives.

[light uplifting music] ♪ ♪ ♪ - [Announcer] Support for this series comes from Inland Empire Health Plan, a health plan with a mission to heal and inspire the human spirit, serving over 1.5 million members in the Inland Empire.