The woman for women.

By: Ayush Madan

From their extensive years of training, to the lifesaving work they carry out daily, and the massive ripple effect they have on their community and public health, physicians have been held to the highest esteem in society since the Grecian days. Among these revered professionals, those who specialise in maternal- foetal medicine (MFM) hold a particularly vital role, as they ensure the health and safety of both mother and child during one of life’s most critical phases. Earlier this week, I had the pleasure of speaking with Dr. Kavita Narang, an MFM specialist whose story spans continents and defies most conventional paths of medical education.

After graduating from Rangsit University, Dr. Narang became the first Thai doctor in over 20 years to match into a surgical speciality in the US, pursuing her residency in obstetrics and gynaecology at Michigan State University and a fellowship in maternal-foetal medicine at the Mayo Clinic, where she was the sole candidate selected for this highly- competitive programme. During her time here, she contributed to several peer-reviewed publications, earning her the rank of Assistant Professor in just 18 months.

Today, Dr. Narang practices at the Perinatal Associates of the Mid-Atlantic, part of the Pediatrix Medical Group, treating underserved patients in the Delaware-Maryland-Virginia area.She is also a life coach for other doctors, helping them find balance in their demanding profession. Her uplifting personality, nurturing aura, and commitment to mental well-being has made her a sought-after speaker, sharing her insights with medical professionals at conferences across America. Dr. Narang shares with Masala how she manages to do it all.

What is a Maternal-Foetal Medicine specialist, and how does one train to become one?

A Maternal-Foetal Medicine (MFM) specialist, also known as a high-risk pregnancy specialist, is a doctor who specialises in caring for complex and high-risk pregnant patients and their babies. Examples include pregnancies with twins; triplets; recurrent losses; mothers with cancers/heart diseases/liver diseases, etc.; and babies with any abnormalities. The path to training to become an MFM involves completing medical school (usually six years), followed by four years of obstetrics and gynaecology residency training and three years of maternal-foetal medicine fellowship.

Can you tell us a bit about your background and what inspired you to become a maternal-foetal medicine specialist?

I was born and raised here in Bangkok, Thailand, in a very supportive family that highly valued education and big dreams. When I was six years old, my mum was pregnant and had brought home a textbook called You and Your Child. I remember flipping through the pages in awe; the scientific diagrams of a woman with a baby inside her captivated my imagination. As much as I was excited about my brother coming into the world, I was more excited about what I saw in the pictures: a baby inside a woman. The physiology of pregnancy and a woman’s body seemed remarkable. How is this little human surviving in another human? How is a woman’s body able to do that? Those questions filled my mind with deep curiosity, and it was at that moment I knew – I’d spend the rest of my life studying and trying to understand it. It has been my most exciting and never-ending adventure.

How has your childhood, familial, and cultural upbringing influenced your approach to medicine and patient care?

I’m the first doctor in my family, and contrary to expectations, it was my dream and innate desire. This ambition flourished because of a family that believed in me and my dreams. My dad and I used to watch medical shows together when I was a kid, and all the doctors in the US in their blue scrubs looked so heroic in all the ways that they saved lives – I used to tell my dad, “that’s what I want to do one day.” He always reminded me that it will happen for me and that I should go for it. When you are surrounded by people who believe in you from a young age, you grow up to believe everything is possible.

What advancements in the field of Maternal-Foetal Medicine are you most excited about currently?

The advancement of foetal surgery, like for spina bifida – a spinal cord defect – allows in-womb operations that significantly improve survival and quality of life. These surgeries dramatically enhance the chances of survival and the babies’ quality of life. Additionally, advancements in genetic medicine have allowed us to diagnose many conditions in parents and babies before they are born, allowing us to better care for the pregnancy and counsel the patients on their options for a healthy pregnancy.

What are some important things women should be aware of when planning to start a pregnancy?

Start prenatal vitamins and folic acid before pregnancy. Early and consistent prenatal care reduces risks for mother and baby. Your body will go through a lot of changes, and it can be emotionally and physically challenging for some women; be kind to yourself and your body, embrace the changes, and remember that it is temporary, and eventually, worth it.

A lot of women are choosing to have children/ start families later in life; what are some of the risks and benefits they should be aware about?

• Increased risk of preeclampsia, gestational diabetes mellitus, and postpartum haemorrhage

• Increased risk of aneuploidies, especially Down syndrome. I strongly encourage getting non-invasive prenatal testing done.

• Increased risk of infertility; if you are not ready to have children till later into your 40s, consider oocyte or embryo freezing.

Reproductive health can be challenging for women to discuss in Indian culture; how do you address this with your patients and what steps do you take to break these barriers? How can communities work towards destigmatising discussions around reproductive health?

Make the patients feel comfortable and safe; if you talk about a topic without stigma, the patient can mirror the same approach and very slowly open up. I remind my patients that all their conversations with me are confidential; I ask open-ended, empathic questions, and I’m the one to bring certain topics up, as a lot of patients feel shame around discussing them. So I ask questions like, “How is your sex life?” and “How is your bowel and bladder function?” or, “What are your family planning goals?”

During my visits, I also use the opportunity to educate my patients about their reproductive health and what they should look out for, specific to their age group. Knowledge is power – having sex education classes to educate teenagers and young adults is not only necessary but also empowering. It makes them more comfortable having these conversations and seeking help through the right channels when they need to. They will also learn to better care for their reproductive health when they understand it.

Pregnancy is an important journey in a women’s life; what are your thoughts surrounding the existing societal norms around pregnancy in the Indian culture, and what changes would you like to see?

• Do not ask when someone is planning to conceive; some women may be suffering from infertility or may simply not wish to have children.

• Be respectful while commenting on pregnancies; some women may be already very high risk, and your questions can make them very anxious.

• Postpartum depression is very common, and women should be given love and support during this time. Women should be encouraged to voice these concerns if they are having symptoms, and they should not suffer in silence.