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Consultant-led care with hypothyroidism

(20 Posts)
iamkestrel Sat 11-Mar-17 17:53:22

Hi, I'm 7 weeks pregnant and have hypothyroidism.

I went to see my GP this week to ask for a referral to a birth centre for my antenatal care as I really don't like the idea of delivering in hospital, but was told that I probably require consultant-led care and wouldn't be allowed to use a birth centre.

I'm still waiting for confirmation as she needed to consult with a midwife on this, but it's really stressing me out as I don't want a hospital birth if I can avoid it!

Does anyone else have experiences of this? Has anyone been able to deliver in a birth centre with hypothyroidism?

Winniethepooer Sat 11-Mar-17 18:06:48

When i was pregnant i was under consultant care as i have an underactive thyroid.

There was a birth centre attached to the hospital. I actually wanted a home birth so they were more then happy for me to use the birth centre.

Ultimately its your choice.

More importantly has your medication been adjusted?
Are you going to have regular blood tests especially in the next few weeks?

I had a MMC due to hypothyroidism.

iamkestrel Sat 11-Mar-17 18:17:14

Hi, thank you! Yes I have had a blood test last week and I don't currently need any adjustment but I am scheduled for another in a couple of weeks' time.

Did being at home have any effect on your baby's care immediately after birth? The GP suggested to me that because the baby would need tests straight after birth I would need to be in a hospital environment.

Winniethepooer Sat 11-Mar-17 18:24:17

The consultant wasn't happy about a home birth as it was dc6 & I'm in my 40s.

So i gave birth in the birth centre. A water birth.

We were discharged a few hours after the birth. Blood tests were taken from the baby on the 10th day to check her thyroid.

If your hypothyroidism is stable the baby should be fine.

My GP doubled my thyroxine straight away in line with NICE guidelines.

I would question your G.Ps depth of knowledge of hypothyroidism in pregnancy.

Hedgeh0g Sat 11-Mar-17 18:27:13

I was consultant led with hypothyroidism. I was told it wouldn't affect whether I could use the midwife led unit (assuming I got to term with no other complications), as the thyroid issue wouldn't affect the birth itself, it just needed to be managed properly so as not to affect the pregnancy.

Hedgeh0g Sat 11-Mar-17 18:28:29

Meant to say, never tested the theory though, as I chose an elective c section for other reasons.

Pitchforktotheface Sat 11-Mar-17 18:38:38

Take your meds, get your levels checked every 6 weeks and see your consultant and they'll likely sign you off at 36weeks. That's what my consultant said. I went to the birth centre. Its attached to the delivery suite at my hospital so no distance to travel but even so, once I was signed off I could have had a home birth if I'd wanted.

GuessHowMuchILoveGin Sat 11-Mar-17 18:58:44

Same experience as many others. At 36 weeks after dose adjustments and bloods tests every trimester, I was asked if I wanted to be discharged back to MW care so I could deliver in the MLU.

verybookish Sat 11-Mar-17 19:19:21

Congratulations on your pregnancy! I have hashimoto with a burned out thyroid so am hypo too for all intents and purposes. In my case the place of my birth was my own choice as I was not under consultant care.

I would however really recommend that you ask to be under special endocrinological care with someone who has experience with looking after pregnant ladies. I have nothing but love and respect for midwives but those looking after me at least were not on top of pregnancy specific ranges for tsh etc. The same goes for many gps unfortunately. Ask whether there is a specialist clinic close by ( many are phone clinics). The gold standard of care for hypo in pregnancy now is to up your thyroxin even if your tsh is still ok because it can change very quickly and dramatically. If you want I can go and lock for a link where it is all explained.

jinglebellmel Sat 11-Mar-17 21:21:40

I'm 25 weeks with hypothyroid and consultant led - as long as there are no other issues I'm fine to give birth in the birth centre. If it's properly managed it should make very little, if any difference to your pregnancy and birth. Make sure you get a blood test and medication adjusted if neccesary though ASAP, it's during the first 12 weeks that it's most important. I had 2 miscarriages when I was undiagnosed - sure you'll be absolutely fine but do push for them to review your dosage early on .

jinglebellmel Sat 11-Mar-17 21:24:02

Also just to add, I think your baby only needs testing if you have the autoimmune type of hypothyroid.

DirtyDancing Sat 11-Mar-17 21:57:01

Sorry I just don't understand this.

If you are, like me, hypothyroid, yes you should be under a consultant, but it doesn't mean you can't have a midwife led or home birth.

The consultant should check your Levels every 4-6 weeks and administer/ change your medication accordingly. You need your TSH under 3. Easily monitored. You should be offered 2-3 extra growth scans. But if all is fine, then it should not impact on having a normal, low risk birth

booox Sun 12-Mar-17 07:12:45

As all have said, but, if levels are very good, don't immediately raise. I did at 4 weeks and became hyper. Test first, then raise if creeping up. Mine was 0.2! I had a bad time raising with my first son which is what made me anxious. I'm going to march back in demanding a test and raise at 6 weeks mind you as I think that's when you need it.

Lapin387 Sun 12-Mar-17 08:38:19

I'm hypothyroid and my consultant appointment isn't until 26 weeks. I am getting quite worried about it. I upped my dose when I got my bfp and had bloods at about 8 weeks which were fine. I'm now 16 weeks so persuaded the nurse to do another test on Friday. GP hasn't taken charge of it, just referred me to be consultant led. Looking at various guidelines, some say bloods once per trimester is fine, but it's worrying hearing people on here say bloods every 4-6 weeks. It feels like I'm managing this myself!

booox Sun 12-Mar-17 09:12:16

If the levels are ok you don't need repeat bloods. They sometimes check 2 weeks later to check a rise has taken ok if the first set were off.

With my ds I had them every 2 weeks in the first trimester as with hind sight a 25 raise wasn't enough - each time the tsh was higher. (I later found there was an issue with the brand of thyroxine - this is rare and better regulated now, it was the Teva 100 in 2011-12. They had their license withdrawn and only just got it back).

I need to reassure you that despite by 12 weeks a tsh of 13 after raising 3 times, he's absolutely fine! I wasn't very well though. Also I then went hyper as was transferred into the hospital drugs which were right but stronger.

The guidelines have changed rightly so that it's endo led care - in practice in not sure everywhere is doing this.

I always ask for results and I will be marching in and requesting a test if the system doesn't follow as it's supposed to.

I actually found gp led care better in the end last time (after the initial battle) as they were working with me ordering regular tests to make sure I got levels right. In a way I've got no idea what's going to happen via the hospital. Last time it was a obstetrician not an endo, I doubt it will be an endo this time.

booox Sun 12-Mar-17 09:15:07

It can be 4 weeks during the first trimester, then once per trimester.

Sadly, we do need to self manage.

A friend with a now healthy 18 mo old had thyroxine raised with her first, nothing happened with her second. She was quite ignorant about it so didn't question it till she felt horrendous. Gps never used to know about it, and by 12 weeks it's too late. Sadly many still don't know.

Crumbs1 Sun 12-Mar-17 09:18:44

I had consultant care but not because of hypothyroidism, which was never mentioned.

PurpleOwl86 Sun 12-Mar-17 09:41:56

I also have an underactive thyroid. Saw the GP while trying to get pregnant, had blood tests, and was told it shouldn't be a problem, but I'd have to up the dose if I got pregnant, which I did.

Once I got pregnant, my GP sent me to the midwife, who told me I'd have to see the consultant because of the thyroid. I saw the consultant only for my 16 week appointment, and she signed me off back to the midwife. I am going for a home birth and all I got so far was "yes, of course you can" from all of them.

countingdown2gin Sun 12-Mar-17 21:26:36

Hi. I'm currently pregnant with my second and have a history of overactive thyroid and I'm consultant led. I'm likely to have a c section for various other reasons but wanted to say that my consultant seems really on it so thought I'd pass on what I've been told:

1. Need to have bloods checked every 4 weeks due to baby taking more as it gets bigger
2. You need your thyroid checked after birth as it can through your levels about
3. If you have an autoimmune thyroid condition I had to have my antibodies blood test at 22 weeks. If that came back positive neonatal team would need to be on standby to check as sometimes your antibodies attack baby's thyroid.

I'm not sure if that is useful but I didn't have any tests or explanation when pregnant with DS which resulted in a panic when he was born and him needing tests at 10 days old confusedso like to pass on as much as I know now.

iamkestrel Sun 12-Mar-17 22:21:58

Thanks so much everyone, that is really reassuring. I'm hoping then that I'll be able to have a consultant oversee my care but that all will go smoothly and I'll be allowed to use the birth centre... that would be amazing if they allow it!

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