So upset - week 41 and all of a sudden I am told I am "high risk"

[ladyfoucault]

Sorry, this is a long story ... I am now week 41 and so far I was told I had a low risk pregnancy. In week 38, I made the mistake to ring one of the community midwives (my own midwife was away) to say that I had been very thirsty. That midwife told me to get a blood glucose test done at the hospital which I did. The second score (after the fasting) was slightly raised so I was seen by the diabetes team afterwards. I had another blood glucose test plus did home testing plus had a growth scan which showed the baby was a normal size, possibly on the small side. The diabetes consultant said to me he was confident that I did not have gestational diabetes, he said at that stage they would not usually carry out the blood glucose test (I forgot the reason unfortunately) plus the other tests and the scan were reassuring. So far, so good, I was pleased with this of course and took it that I was therefore still low risk.
Now being past the 40 weeks I was on edge this week. A few days ago, after a night of no sleep and following a quite unsettling telephone conversation with my parents who live far away I was particularly anxious and because I couldn't remember whether I had felt the baby move I rang the hospital. They told me to come in where I got a CTG done. It was fine. The midwife who saw me there showed my notes to the consultant who said they would like me to come in for an induction the next day. I had been to the hospital twice before, earlier in my pregnancy, because I couldn't remember whether I had felt the baby move (I guess I am of a nervous disposition) - it was always fine - but this was cited as a reason. I said I didn't want an induction but would see my midwife the next day and discuss what to do. The consultant and the midwife at the hospital were fine with this (I didn't see the consultant but the midwife spoke to him). They booked me in for another CTG at the weekend.
On Friday, I saw my midwife who supported me when I said I didn't want to have an induction. She said as long as I felt the baby move well this was okay. The plan was for me to monitor the baby and to think about having a sweep at the beginning of next week.
Yesterday, when I had the CTG the consultant said that due to a history of lack of fetal movements and a raised blood glucose level I was high risk, and being overdue I should have an induction and the plan I had made with my community midwife was putting my baby at risk. I had an argument with him when I said that I was told by the diabetes consultant that I did not have gestational diabetes, and that me having come to hospital three times was possibly more to do with my anxiety than a proper lack of fetal movements.
This consultant, who most of the time did not even address me or look at me but conversed with my partner instead, said I should come into hospital for daily monitoring if I don't have an induction, so I am now booked in again today for a CTG. I can feel all the work I have done of weeks of hypnotherapy being ruined, I am starting to associate hospital with stress and fear and I wonder what to do. I don't know why this consultant yesterday reacted so strongly, and I feel this is not evidence based. Ideally, I would like to monitor the baby at home (baby is moving about wildly as I write this) and stay away from the hospital as long as possible as it does nothing for my peace of mind. I know I could do this but this consultant has scared me so much. What do I do?

Why do you not want to be induced? Hasn't anybody made you aware of the risks of going overdue?

I understand not wanting to be induced, I'm not sure the above post is very useful.

I would think of the monitoring as a good thing - any opportunity to know baby is ok is good. Try not to worry about the birth being ruined by all this, the baby will make an appearance one way or another, and it will be what it will be, ultimately the journey does not matter it is the destination which is important.

Try and relax, get monitored (daily if necessary) and make the decision to be induced based on what you find from that. Your birth won't be perfect - none are, but it will be amazing.

The risk of stillbirth rises sharply after 40 weeks. Maybe the OP is not aware of this. If not, take a look at the table in this article: www.ncbi.nlm.nih.gov/pmc/articles/PMC1117555/

You have to remember OP they've seen it all, know the risks and if they weren't concerned they wouldn't have said anything.

I know it's very hard to have prepared for a certain kind of birth and have it ripped away from you but you can be induced and still have a fantastic borth :)
Sounds patronising and obvious but remember the most important only thing at the end of the day is a healthy baby and a healthy mummy.

Wishing you lots of luck :)

You can still use your hypnotherapy too

It wasn't a mistake to tell your midwife you were feeling very thirsty. You seem to be viewing the hospital and the consultant as the enemy determined to ruin your lovely hypno birth. They aren't.

A 40 week gestation period is uncommon in other western countries. It is normally 41 or 42 weeks, sometimes 44 weeks. In the UK we seem to be 'too' keen to get baby out by 40 weeks.

IMO that link is neither helpful or reassuring for the OP given her mentioning her anxieties throughout her post.

Op - put your natalhypnotherapy cd on and relax. Your baby will be here in the not so distant future and until then, get yourself 'checked' by the hospital daily to keep them happy

As a fellow natalhypnotherapy lady, just REMEMBER your body will do what it is suppose to do - birth your baby. Trust your body. I went 41+3 and had a successful and natural birth that I wanted. But I did go to the hospital twice before I went in to labour to check dd was ok.

www.countthekicks.org.uk

That link may not be reassuring but the op may not be aware of the significant increase of risk of still birth after 40 weeks. I wasn't until recently and I've had two children. It certainly isn't something your acreage community midwife tells you.

X post

Also agree with foofighter

Please listen to the medical professionals. If you have diabetes (which you may, I am astounded that they didn't test you) then the placenta can deteriorate very suddenly and quickly, leading to a still birth.

Please don't put your fear of hospitals and desire for a hypnobirth above the safety and recommendations of the experts. They aren't doing this to spite you, they are trying to ensure that your baby arrives safely.

Can you just clarify: you had a CTG on Saturday ('yesterday') and booked again for Sunday? You do have raised blood glucose, and a recent history which might indicate reduced movements.

The current consultant sounds as if he is going by the evidence, and the diabetes one seems to be the one who went by gut rather than complete the battery of tests that would give firm diagnosis.

Don't get hung up on the terminology of "low/high" risk. The risk of the pregnancy is unrelated to delivery and what might happen then.

I dont think the above post is v helpful to the anxious OP. If the specialist said OP does not have diabetes it is very unlikely OP does. Gestational diabetes presents with very specific clinical signs - in fact the sugar test is used in most other countries only to support the specialist's view. The UK has lost its way in making so many women do the GTT.
OP - get your CD on, relax, your baby & body will do what they need to do if you relax enough to allow it BUT do allow the medics to monitor you to keep them on side. Sounds like your MW is good so Fingers crossed all goes well.
& remember, as someone else said, what will be will be & the important thing is to have a healthy baby & healthy mummy at the end of this so however LO gets out is less important. The hypno birthing should help with accepting that too - keep your affirmations to hand as a reminder!!
Good luck.

I don't understand why they didn't test you, and the contradictory advice from both consultants (and the scary info on this thread) isn't helpful. Personally I have always been inclined to trust my MWs more than the doctors as they are the frontline of birthing but I'm a lentil weavery home birther and doctors tend not to support them IME..

I understand you not wanting an induction, and unfortunately consultants and midwives do seem to have opposing views on many things. Not wanting to be induced myself as 40 weeks I was made to feel like an inconvenience by the hospital, lots of rolling eyes and tutting. Following hospital protocol was higher on the list than what i wanted. I got to 42 weeks with DC4, thankfully she came the night before my induction which was booked in for 42 +3. I knew at some point it was likely I would need to accept intervention.

As someone said, don't get hung up on the birth in your head, relax and accept you need to go with the flow to some extent. However, do remember you are always in charge.

Go for the monitoring, ask for the diabetes test, do whatever you can to relax. Do you have a friend who has had children and can support you? I found this support invaluable.

Good luck

Okay, the consultant is reacting to what he can see on the notes which is:

Borderline raised blood sugar
A history of reduced fetal movements
You are now over 40 weeks

It's likely that he is thinking "what is the point in waiting, let's get this baby out"?

It would be nice if he had treated you like a human being rather than as just a vessal for a baby.

Obstetrics has a very high litigation rate which is why consultants tend to err on the side of caution. The liklihood is that if you refuse induction then you will go spontaneously into labour within the next week and have a nice delivery of your baby.

The consultant is thinking of the "worst case scenario" and in his mind you are putting your baby at risk.

I think going in and having daily CTG monitoring is a good compromise - that way you will know if there are any signs of problems but....it is YOUR choice, it's YOUR body and YOUR baby.

Have a look at Angela Horn's Homebirth site - even if you are not having a homebirth her research is good and will give you some pointers about raised blood sugars, reduced fetal movements etc.

And maybe ask for a second opinion. You are perfectly entitled to.

OP I think you should really take on board some of the clinical facts mentioned above re: going overdue and placenta deterioration. Daily monitoring is all good and well but 24 hours inbetween is a long time.

I was overdue and my birth didn't go according to plan AND I was all 'hypnotherapied' up. I must say even though I was expecting an epidural and didn't get one and was terrified beyond belief (third baby!) I handled it very well. Much better than I would have expected and I put that fully down to the hypnotherapy, so don't worry that it will be wasted, it won't.

Placenta health after week 40 is VERY important.

Please understand that the health professionals (I'm one) want that baby out sooner rather than later so there is a happy outcome for everyone.

Best of luck OP

P.S As soon as my induction was booked baby came naturally!

If you are already overdue, any reason why the midwife hasn't given you a sweep already? It might kick off labour naturally and then everyone would be happy.

The 'scary; information on this thread is mostly FACT.

It may be your body, your decision, but for your future happiness it would be wise to make an INFORMED decision.

The OP did state that she was 'scared' and 'what should I do?'.

I have found that arming oneself with relavent information goes a long was toward disarming fear.

ladyfoucault said in OP that the sweep was planned for tomorrow.

Will that still be going ahead, or has the plan been overtaken by events?

It's not an informed decision though if the consultant cannot even address the OP face to face.

Yes placental health DOES start to deteriorate after 40 weeks but despite this most labours start spontaneously and end happily.

If the cervix is not ripe for induction then all that will happen is failed induction and caesarean section. Nothing wrong with a caesarean, I had one myself but what a shame if it's not really needed.

If we induce on the basis of the placenta deteriorating after 40 weeks the we might just as well induce on the due date. If we do that though we will see an even greater rise in intervention and many babies and mothers damaged as a result.

There are ways of checking placental health, far better to do that than just induce without knowing if the body is ready.

Induction drugs are powerful and have been implicated in the death of babies when used incorrectly. Nothing is without risk, it's about weighing up whether it is riskier to wait or to have an induction.

I have seen women have rapid and precipitate labours after induction. The baby is born rapidly, usually requires intensive support due to shock and the mother is left shaken.

I have equally cared for women experiencing the sadness of stillbirth with diabetes or other (sometimes unexplained) causes.

It's about achieving a balance, not rushing in too quickly and about using the technology we have to achieve the optimum outcome for both Mum AND baby. That's the goal, healthy mother and healthy baby - achieving that is not always as simple as induction sadly.

I don't understand what the problem is with the ctgs? From what I gather, the standard practice with overdue PGs is either induction or watchful waiting I.e. Regular nonitorig. It is not an invasive test and offers no risk to you or the baby. And it us evidence based in that the rusk of stillbirth is greater. I'd find the regular ctgs reassuring tbh.

OP raised sugar levels cause the placenta to deteriorate very fast after 40 weeks, even if you don't have full blown gestational diabetes.

How your baby comes into the world doesn't matter. What matters is that they, and you, are healthy.

The consultant should have spoken to you and not just your partner, but perhaps they felt your hostility and were hoping your partner could persuade you?

Marie- its after 42 weeks the still birth risk increases from 1 in 1000 to 1 in 500. Induction is risky in itself, to the mother and the child so these risks need to be weighed up against each other.