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GP says high-risk, MW says low-risk?

(17 Posts)
fertilityFTW Thu 04-Oct-12 11:39:24

I'm in the very early stages of a longed for first pregnancy. Have had close to 3 years of TTC, was just about to start infertility treatment when we got our BFP. I am very tiny. Just scraping 5ft and weighing 42kg - BMI comes out to about 17.5 I think. No dietary issues, just very small boned, and the smallest of a very petite family. Because of the BMI and infertility issues GP put me as high risk, and suggested I stick with the consultant with whom we were about to start treatment. MW arrived yesterday and announced that there is absolutely no reason for that and I'm very low-risk - 'isn't that great!" etc. and has written that in my notes all across half a page.
I'm a bit perplexed (in fact woke up this morning in the throes of an anxiety attack which I haven't experienced in many years) so thought I'd reach out for the wisdom of the MN hive-mind smile
My mum, and aunts and cousins have all had to have cs, some elcs, most emcs. Mum's pelvic bones did not cooperate at all (same with aunt and a similarly sized cousin) and after two days of induction and foetal distress she had an emcs. I've always imagined that I would also go that way (esp. since DH's family is known for very destructively large births, MIL has spent most of her life housebound due to related issues and she is a much larger lady) - but now I feel it may all be out of my hands. Do I go along with the wisdom of the MW or should I ferret around more and try to get the consultant led care back? Will the MW be very insistent on VB even if there are issues? Or would a consultant be better placed to advised on the type of childbirth that is most appropriate?
I know it's quite early, but I'd like to be prepared as possible -

SamSmalaidh Thu 04-Oct-12 11:41:45

I think it is possible to have a scan to detect if there are problems with your pelvis - maybe ask the GP/MW about it if you have a family history?

fertilityFTW Thu 04-Oct-12 11:44:17

Wouldn't a scan only find pre-existing structural issues? Mum said all seemed fine with them until it came time to labour and then there was absolutely no movement, bones didn't open at all.

SlightlySuperiorPeasant Thu 04-Oct-12 11:46:08

I'm no expert but even without the family history I would want to see a consultant, even if just for one appointment.

SamSmalaidh Thu 04-Oct-12 11:49:40

I think that is a pre-existing structural issue though isn't it, if the pelvis wasn't able to move normally? I don't know exactly what investigations could be done though.

bluehorizon Thu 04-Oct-12 11:53:05

I'm not sure that potential birth problems are what would classify you high risk during the pregnancy IYSWIM? I had a low risk pregnancy but the midwives were always suggesting that I booked in for a C-section based on my size, the baby's apparent size and the lack of engagement of the head later in the pregnancy. (They were right - I was wrong with my natural birth plans...)
You might have to request a CS if you want one - it would at least hopefully start a dialogue with your health professionals.

BonaDea Thu 04-Oct-12 11:54:25

If your GP is prepared to give you a referral, then I would definitely see that consultant at least once (or perhaps you already have an appointment / referral).

To be honest, I think MWs probably know more than GPs about this sort of thing overall, but it would be nice to hear from a consultant, I should imagine. Also, they will definitely be monitoring you in the normal way, and so presumably even if problems are considered at the moment, they would keep assessing that as time goes on?

bonzo77 Thu 04-Oct-12 12:03:28

Take the consultant referral. It will do no harm and they'll send you back to MW care if appropriate. It might be that they keep you with the MW for ante natal care but back with the consultant to discuss birth plans.

fertilityFTW Thu 04-Oct-12 12:07:18

tbh SamSmalaidh I haven't a clue, but I will ask, so thank you for the suggestion.
bluehorizon if you don't mind my asking, what was your size/baby's size that a cs was felt necessary?
BonaDea I think I am going to ask GP for a referral, just to have the clarity/assurance.
I had a severe anxiety disorder in my 20's and the little shadow of it this morning is what makes me what to do whatever is necessary in terms of being informed and relaxed to keep that sort of thing at bay, not something I'd like to contend with during pg!

hellsbells76 Thu 04-Oct-12 12:08:37

Your BMI would make you 'high risk' in our Trust - anything under (I think) 19 is classified as underweight and we would recommend at least one consultant appt - they may sign you back onto MW-led care after this though. Can you check your Trust's guidelines online and see what they say? Your infertility issues wouldn't make you high risk unless there was an underlying cause that might be relevant of course. Congratulations on your pregnancy smile

fertilityFTW Thu 04-Oct-12 12:08:42

x-post - yes bonzo that would be the most ideal scenario - I hope it's manageable and I don't get 'handled', MW seemed very dismissive of any concerns.

fertilityFTW Thu 04-Oct-12 12:09:47

Thanks hellsbells, that's useful to know - am going to google for guidelines immediately!

fertilityFTW Thu 04-Oct-12 12:13:35

Hmm, guidelines don't seem to be available. Think it'll have to be legwork.

sleeplessinsuburbia Thu 04-Oct-12 12:13:55

I am (was) small and worried about natural delivery as my mother and grandmother couldn't but wasn't high risk. I had an emergency c section because I was right, it was stuck in my pelvis.

I have had many pregnancies and miscarriages since and only received the official high risk label after a still birth. It just means they monitor the pregnancy more (weekly, extra scans etc) SO if your ttc was the result of a health concern or your health and/or baby's health was at risk I can't imagine why they wouldn't class you as high risk.

Bring up your concerns at each appointment and try to relax!

fertilityFTW Thu 04-Oct-12 12:21:15

Thanks sleepless that's good advice (esp. the relaxing bit which I'm finding hard to do!). It's interesting that you found the family history was telling, the MW was very emphatic that that is not the case hmm though I was leaning towards the family history as a reliable forecast.

bluehorizon Thu 04-Oct-12 12:28:29

Hi again. I am not sure that actual size of mother and baby that useful in judging. I am 5ft1 and my first baby was 8lb. I know several people my size who have delivered larger babies though. I do have very narrow hips but again that is not supposed to be a definite sign.
The community midwives all seemed to be laughing up their sleeves when I was talking about my planned homebirth, and afterwards when I spoke to one she said she just 'knew' that I was unlikely to have a natural birth.
Something that I wish I had known before was that if the baby's head is not engaged at 40 weeks (I went to 42+ and the head was still not engaged) the chances of a natural birth are quite low. I think someone said 20% chance of natural delivery if induced in these circumstances. Maybe nearer the time you can talk about CS if you don't get any luck now? Congrats on the pregnancy and try to relax and enjoy it!

sleeplessinsuburbia Thu 04-Oct-12 12:51:11

Yep I basically had every midwife laugh at me and say its old fashioned to compare to your mother. My body is identical to my mother's and my grandmother's so I felt it would be relevant.

A specialist told me after the c section that he was always interested in the family history but it still wouldn't count as high risk. I know it's frustrating when they ignore your concerns, as I've become more assertive I don't hesitate to say things like " could you please record my concerns".

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