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‘Can’t Get Pregnant’ Vs. ‘shouldn’t Get Pregnant’: Know The Difference

Semantics matter, especially when the words aprovider chooses can lead to unintended confusion about health care.

One example we often encounter in thematernal-fetal medicine office is patients who've been told they "can'tget pregnant" – when their provider really meant they "shouldn'tget pregnant."

A recent study onfertility during dialysis for advanced kidney disease highlighted this issue. Researchersdiscovered that patients become pregnant at a higher rate than previouslythought.

Data from almost 48,000 women on dialysisbetween 2005 and 2013 were analyzed and showed that 18 of every 1,000 womenbecame pregnant while on dialysis—including 40 women per 1,000 between the agesof 20-24. However, fewer than 30% of women who became pregnant during the studyhad a live born infant.

In an interview about the study, one of the researchersconcluded that women on dialysis might want to get pregnant.That may be true, but I have another idea: Too often, providers andpatients fail to properly communicate, which can lead to negative outcomes forpatients.

Four little words, lots ofimplications

Many women in our high-riskpregnancy practice have ongoing medical problems that can reduce fertilityand cause pregnancy complications.

As medical care improves their baseline healthand quality of life, three things can happen:

  • Menstrual irregularities might improve,increasing ovulation;
  • They feel better and have more sex;and
  • They misinterpret a singlestatement: “You can’t get pregnant.” 

These four little words can be taken in twovery different ways. Providers often intend to say thepatient shouldn’t get pregnant untilher medical condition improves. But many patients come into our office pregnantafter hearing those words. They interpreted the statement to mean it was physically impossible for them to becomepregnant.

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.

Some chronic health conditions, such as heart disease, diabetes, or high blood pressure, can affect a woman’s chances of becoming pregnant and increase the risk of pregnancy complications.

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.

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.

Do you want to visit an Ob/Gyn? Call 214-645-8300 or request an appointment online.

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