Your Pregnancy Matters
‘Can’t get pregnant’ vs. ‘shouldn’t get pregnant’: Know the difference
October 29, 2019
Semantics matter, especially when the words a provider chooses can lead to unintended confusion about health care.
One example we often encounter in the maternal-fetal medicine office is patients who've been told they "can't get pregnant" – when their provider really meant they "shouldn't get pregnant."
A recent study on fertility during dialysis for advanced kidney disease highlighted this issue. Researchers discovered that patients become pregnant at a higher rate than previously thought.
Data from almost 48,000 women on dialysis between 2005 and 2013 were analyzed and showed that 18 of every 1,000 women became pregnant while on dialysis—including 40 women per 1,000 between the ages of 20-24. However, fewer than 30% of women who became pregnant during the study had a live born infant.
In an interview about the study, one of the researchers concluded that women on dialysis might want to get pregnant. That may be true, but I have another idea: Too often, providers and patients fail to properly communicate, which can lead to negative outcomes for patients.
Four little words, lots of implications
Many women in our high-risk pregnancy practice have ongoing medical problems that can reduce fertility and cause pregnancy complications.
As medical care improves their baseline health and quality of life, three things can happen:
- Menstrual irregularities might improve, increasing ovulation;
- They feel better and have more sex; and
- They misinterpret a single statement: “You can’t get pregnant.”
These four little words can be taken in two very different ways. Providers often intend to say the patient shouldn’t get pregnant until her medical condition improves. But many patients come into our office pregnant after hearing those words. They interpreted the statement to mean it was physically impossible for them to become pregnant.
"The bottom line is that words matter in health care. Doctors must be cognizant of the words they choose when speaking with patients – and patients must feel empowered to ask clarifying questions."
In the study mentioned above, researchers noted that the pregnancy rate of patients on dialysis over time was fairly stable. That suggests providers haven’t gotten better at communicating this message to our patients, and this failure in communication can happen in any setting.
The Clements University Hospital Ob/Gyn team is trained not to use this type of vague language with patients, especially those with complex medical issues. We only tell a patient "you can't get pregnant" if she physically cannot – for example, if she had a hysterectomy. However, we will discuss fertility challenges related to her condition, as well as potential health risks if she becomes pregnant.
For example – and related to the study mentioned earlier – kidney disease can decrease the ability to produce healthy eggs that can be fertilized. A woman on dialysis may not have regular periods due to abnormal hormone levels. But that doesn't mean she can't get pregnant. And once she does, the additional strain on the kidneys can affect the baby’s development and the patient’s health.
Related reading: Erica’s pregnancy story of a heart attack at 31, baby at 36.
If you have a chronic medical condition and want to become pregnant (or if you're surprised by an unexpected pregnancy), it's important to visit a maternal-fetal medicine doctor right away for the best chance at a healthy outcome.
Supporting women before, during, and after pregnancy
Ideally, we’d like to visit with you before you become pregnant. We will discuss your unique concerns and gather a team of specialists to guide your care. Our high-risk pregnancy team sees patients on the same campus as other specialized providers, so we take a team approach to navigating complex pregnancies.
For example, depending on your condition, your specialist might recommend changing your medication dosage during pregnancy or using a different type of treatment. A dietitian might recommend adding supplements or including more of a certain type of food in your diet. A physical therapist could suggest exercises to strengthen certain muscle groups affected by your condition.
If it’s necessary to make improvements to your health before you become pregnant, we will work with you to find effective and safe contraception based on your condition.
The bottom line is that words matter in health care. Doctors must be cognizant of the words they choose when speaking with patients – and patients must feel empowered to ask clarifying questions. If a provider has told you that you can't get pregnant, make sure you understand what they really mean and don't hesitate to get a second opinion if having a baby is important to you.