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Possibility of Homebirth (Mum with Thyroid issues?)

(31 Posts)
ReikiMummy Tue 05-Feb-13 18:13:33

So..... hmm

I've browsed a fair few of the home birth threads in Pregnancy and in Childbirth - so not 100% where to post this! It could land in either...

I had my second midwife appointment today, with (as it turns out) a midwife who is retiring in 2 weeks time.

Anyway, at the first midwife appointment, when asked what my birth plan was I didn't really know what to say. (I admit.. I did answer "Have a baby...??" being a bit naive about it all...)

Having thought about it, I figured I'd ask the MW if there was any reason I couldn't have a home birth. Really not sure I'm going to be having any more (not for want of trying, just seeing how long it took to get PG this time around!)

MW advised against a homebrith due to being treated for an underactive thyroid (for the past god knows how many years...), and the fact that it's my first baby.

She did suggest I ask the Obstetrician consultant type person who is involved in my "case" due to thryoid thing. (Just for info - started out as over-active thryoid (hyper...) and was then sent 'under' (hypo) by radioactive iodine when about 19 years old)

So - has anyone else out there with thyroid issues been told this?

Is this just the MW being careful as she's retiring in a couple of weeks?
Should I stick out for what I want? (So far the pregnancy has been fine, no morning sickness, no problems at all). All was fine at the last consultant's appointment.

I know people won't be able to comment specifically on my case, however if anyone can advise regarding their own experiences I'd be most grateful!

Thanks smile

rosiedays Sat 16-Feb-13 09:51:56

I got my blods back yesterday and THS is down to 18 (T3 /T4 in normal limits) so we're getting there. will speak to const' on monday re increse by 25mg? 3 weeks till scan seems endless! x

rosiedays Tue 12-Feb-13 08:20:57

thank you bartlet thanks
i agree christelle2207 it's very reasuring to have someone to ask.
every day is one day closer smile

Christelle2207 Mon 11-Feb-13 19:10:50

I'm so pleased there is someone here that knows what she's talking about, so difficult to find the energy to argue with gps but in the met important of circumstances. Fingers crossed Rosie you get sorted out.

BartletForTeamGB Mon 11-Feb-13 17:47:24

Oh, Rosie, that sounds hard.

I'm not going to be able to say much that will reassure you properly because we just won't know until the baby is born. There also won't be much that they'll be able to tell you about your scan other than all the usual sort of stuff. I imagine they will probably go growth scans to check the baby's growth in the later stages of pregnancy.

What is known is the maternal hypothyroidism does increase the risk of miscarriage, pre-eclampsia, placental abnormalities, low birth weight infants, and postpartum haemorrhage. It may also have an effect on the baby's IQ.

What is clear is that the vast majority of pregnancies will be completely uncomplicated. The important thing is that you are on correct treatment now and are under close review by a consultant. I can't tell you not to worry because I am a mother and I would (and am about my own pregnancy complications!) but there is very little we can do other than wait and see.

www.thyroid.org/faq-thyroid-disease-and-pregnancy/

rosiedays Mon 11-Feb-13 17:02:10

bartlet All
i read this and get more and more worried. at 10 weeks my TSH was >100 at 14 weeks on 150mg it was 52. I'm now on 200mg and will get bloods done again on thursday. when i asked what harm this could do to baby my consultant (who was shocked to see me back for second appointment) said she was suprised i had got / stayed pg at all and all we can do is wait and see. I know she's probably right but would like to know worst case so can prepair mentally. should i be asking any perticular Q's at 20week scan?
really hope you don't mind me asking.thanks

busfull Mon 11-Feb-13 16:37:33

Ahh - thanks Bartlett, that makes sense. And thankyou in general for providing an expert view as I have been worrying myself sick trawling medical journals and struggling with the home/hospital decisions as the process at the clinic seems to be wait four hours, get five minutes chat and not really any explanation. I am not medically trained at all but have access to all the research databases at work (so I do worry that maybe I should stop looking as a little knowledge is always a dangerous thing!).

I've just lost a bit of trust I think.

BartletForTeamGB Mon 11-Feb-13 16:32:46

"Also did you have symptoms of hypothyroidism (just ask as some of the papers actually class this an sub-clinical hypthyroidism - less risk)."

Just wanted to clarify this. Subclinical hypothyroidism doesn't actually have anything to do with symptoms but is when TSH is high but T4 is normal. It probably precedes the development of overt hypothyroidism. But, yes, the risks are probably lower.

busfull Mon 11-Feb-13 16:25:20

Hi all,

I was diagnosed hypothyroid in my last pregnancy. At my booking in appt I declared that during my finals at Uni I'd had a goiter but received no treatment because it came and went in a week - and I never got tested as I moved away and back home and had no symtoms. Anyway this was enough to mean I had to go to the hospital endo clinic but they didn't actually test my levels until I was about 16 weeks. I ended up being really worried as the levels were never really controlled until the third trimester but actually no related probs with labour and birth apart from an induction and being strapped to a monitor and forced to lie on my back for hours which I am sure caused the need for a vacuum assisted delivery in the end.

Needless to say I am going for a home (preferably upright) birth this time (now 31 weeks) and my consultant is amenable but even this time around when I KNEW what the guidelines were for TSH in pregancy I couldn't get my GP to increase my dose until I was officially booked in and referred to the hospital clinic which took 11 weeks.

Re labour / delivery outcomes, the only research I have found that links problems in full-term delivery to hypothyroidism (I will find the reference - it's at home) was not that scary and seems to relate to inadequate control early in pregancy - they don't know why but it could be because lack of thyroxine can in some cases cause probs with development of the placenta that may increase likelihood of neonatal distress in labour leading to a slightly higher chance of emergency c-section in these cases.

Anyway - as a result of no-one being prepared to tacke action at the beginning (I wish I'd just taken more myself) I ended up very under (TSH of 13) at about 13 weeks this time but was back to under 3.0 within the six weeks before I was tested again with just a 25g adjustment and my consultant sees no reason why this should interfere with home birth plans even though it happened presumably within a key period for placental development.

Also did you have symptoms of hypothyroidism (just ask as some of the papers actually class this an sub-clinical hypthyroidism - less risk).

Good luck whatever you decide - if you want a buddy - I'm still going for home!

ReikiMummy Fri 08-Feb-13 18:42:48

Christelle I know what you mean about having to battle to get dose reviewed.

Luckily tho my docs will refer me - its the endocrinologist who I have battles with. :S

BartletForTeamGB Fri 08-Feb-13 13:44:42

christelle, there should be no reason to be seen privately. This is bread and butter stuff for endocrinologists. The guidelines are very, very clear that you should be referred. Can you see someone else in the practice?

www.gpnotebook.co.uk/simplepage.cfm?ID=288686150

Christelle2207 Fri 08-Feb-13 09:09:52

I am really annoyed that the gp is so unsympathetic and basically won't let me increase my dose without a fight. Presumably others do as they should, it's so unfair. He just won't refer me to an endo. Anyway I see the obs next week, if they aren't helpful I shall refer myself privately. Luckily I have health insurance through which should cover (most of) the cost. It doesn't cover pregnancy per se, but this isn't really a pregnancy issue is it, just happens to be something to be more worried about in pregnancy.

ReikiMummy Thu 07-Feb-13 23:52:13

Thank you Bartlet will check next time i'm in the doctors smile thanks

BartletForTeamGB Thu 07-Feb-13 16:44:09

I'm not that fussed about T4 in most cases of hypothyroidism, but we do like to see T4 in pregnancy normally. If the blood form says you are pregnant, the lab will normally do both.

ReikiMummy Thu 07-Feb-13 15:47:35

Well when my GP send my bloods off for tft checks - if the TSH comes back in normal range they won't even do the tests for T3 and T4.

"Costs...." apparently....???? Should I start insisting?

BartletForTeamGB Thu 07-Feb-13 14:52:24

christelle, I'm with you on this. We do aim to keep TSH less than 2.5 throughout pregnancy and the dose does tend to up in first trimester most markedly but then a little bit throughout. You did the right thing and should be referred to an endocrinologist. It is not right that you are managing this on your own (with the help of someone who claims to be one wink (I really am, honest!) on the internet). It really frustrates me that some GPs still don't manage this appropriately despite clear guidelines.

HazleNutt Thu 07-Feb-13 12:51:58

Oh and I would guess that he has not tested your T4? It's recommended that both are tested during pregnancy. Also, in my case as said, TSH is 0,5 or pretty much at the lower limit, but my T4 is just mid-range, nowhere near hyper.

Christelle2207 Thu 07-Feb-13 12:28:56

well im pleased I fought my corner then. if it's gone up by 1 in a month if I left it another month it could go up by another 1 then that could take 2 months to get it back down again. He admitted that thyroxin would do no harm to baby (I might get palpitations apparently?!!) so why would I want to take the risk.

Fingers crossed 100mcg sorts me out.

HazleNutt Thu 07-Feb-13 08:53:50

Christelle I would certainly say he's unhelpful. TSH should be lower in pregnancy than otherwise and mine is actually kept at 0,5.

Christelle2207 Thu 07-Feb-13 08:45:35

(sorry to hijack) Bartlet hello again you've been very helpful previously. So my TSH has now gone from 2.1 end of December (good) to 3.0 end of January (not so good, but worrying me a bit because it's heading in the wrong direction).

I had to push gp to increase my dose from 75mcg (since mid december) to 100mcg - he was quite annoying about it and adamant that it could do me more harm than good. He's being unhelpful right?
Won't refer me to endocrinologist but I do have appointment with obstetrician next week who will hopefully help. I will ask him about home birth possibility too though I suspect I will be happy with the hospital at the end of the day.

pansyflimflam Wed 06-Feb-13 18:42:03

I am the same as you and am technically high risk because if thyroid and being elderly (!!!!!) but have had 4 home births, so yes it is worth sticking it out. Hyper is a problem but hypo isn't really as long as it is well managed throughout the pregnancy. You need to have a friendly chat with a endocrinologist and see what they have to say but all thyroid probs are lumped in together for the risk thing and in actual fact they are very different. All my labours and births were easy peasy and no probs at all. Best of luck bu stand your ground.

ReikiMummy Wed 06-Feb-13 18:34:44

Hi - thanks HazelNutt and Bartlet thanks

Answers!

- Didn't have Graves disease, no antibodies showing from blood test done last week. (Still don't know what the cause of the overactive thyroid was (which started when I was about 16), but there is no mention anywhere in my notes of being diagnosed with Graves disease).

- Have been having regular TFT checks, only I keep forgetting to ask doctor/midwife what the levels are... (will do at next appt because I've written it down as a reminder)

- Thyroxine was upped immediately after discovering I was PG by 25mcg. Next TFT test is due at end of Feb to monitor again. (Did have another one in January but that showed as ok and no change required at that time).

- All other measurements of babykins have been classed as "OK" by the Obstetrician... and in the letter to the doc the only thing she requested was that my bloods were done before they see me the next time in clinic beginning of March. The next "development check" will be 20wk scan at end Feb.

Thank you for the link Bartlet have bookmarked and will go and devour it in a bit! Also thank you for your detailed reply, its helped me a lot and things don't feel quite so murky and unclear!

Reiki x

BartletForTeamGB Wed 06-Feb-13 10:51:23

www.endo-society.org/guidelines/final/upload/Clinical-Guideline-Management-of-Thyroid-Dysfunction-during-Pregnancy-Postpartum.pdf

These are the guidelines we use. Really the focus is maintaining your TSH at less than 2.5. This normally requires an increase in dose of 30-50% during pregnancy. You do need repeat TFTs done around every 6-8 weeks so I'd make sure you've had some done since becoming pregnant to ensure that you are on the right dose for the moment.

As for a homebirth, there shouldn't be major issues generally although seeing an obstetrician and endocrinologist is always sensible. The issue with you specifically is that you presumably had Graves' disease and probably had positive TSH receptor antibodies. There is (even after treatment that corrects the overactive thyroid) the risk that these antibodies transfer to the baby and make the baby hyperthyroid.

(This is why we actually worry less about people who have just had an underactive thyroid or, as in HazleNutt's case, don't even have a thyroid. With them, it is pretty much just a matter of replacing thyroxine.)

To watch for this, your doctors will check your antibodies and your bloods and do extra monitoring of the baby. In that link, search for "2.3.2. Diagnosis of fetal hyperthyroidism" to read a bit more about it.

I hope that link helps for when you see your doctors to discuss things. Whether a home birth is sensible in your case is only a decision that can be made with the benefit of your blood tests and how the baby is doing etc.

HazleNutt Wed 06-Feb-13 10:17:30

Reiki but you are having your levels tested during pregnancy? Most women need a dosage adjustment.

ReikiMummy Wed 06-Feb-13 10:04:54

HazleNutt - I don't think mine works at all although technically it's still 'there'!

ReikiMummy Wed 06-Feb-13 10:04:18

Thanks everyone,
Rosie hope all goes well for you too. My thyroid is what you could call stable, the dose hasn't changed a great deal since I started on thyroixine replacement.

Flisspapa thanks for the links, will check them out later on.

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