what is high risk and when does it mean cs?

[mrsnec]

Morning all!

I'm around 20 weeks.

I had a scan with a new doctor last week. I'm not in the UK.

Doctor looked at my records. This is my 3rd pg. 1 termination years ago and an mc in October at 12 weeks. I've also had abdominal surgery an exploratory laparotomy after an accident to check organ damage and repair stomach muscles.

I'm 36 and doctor also thinks I'm overweight (77kg at 5ft 3) and blood sugar too high (90).

Taking all that into account the doctor says to me 'my god you've got some history' and I can't seem to shake those words. Does that mean I'm high risk? Can I ask your experiences of this? What makes you high risk and when would they decide if you need a section she didn't really explain herself. If that's required it's not a problem I think I'd just like to know if that's what they're planning and why and what factors make someone high risk. Thanks in advance.

It depends on so much. For example I have several things that make me high risk for one hospital but I am considered low risk at another hospital. It also depends on what the high risk bit is about. For me it increases the chance of an early birth but if I get to full term the birth bit will not be a concern. High risk doesn't have to mean a c section but it will depend on what the risks are.

Are you able to make an appointment with the Doctor or even a GP? Do you have friends that have given birth in the country you are in? Having someone help you chart the health system can be really useful. IIf you don't maybe see if there is a Positive Birth group near you or consider a doula.
Sorry I'm not more helpful.

Age, BMI, diabetes, previous preeclampsia etc are the main risk factors.
I am 37, with a previous very slightly prem delivery (36?4) which was by EMCS due to breech presentation and spontaneous labour. Therefore in the uk I am high risk and under a consultant. It doesn't automatically mean CS, although it does mean that this is an option.
Some of the risk assessment will vary from country to country, but they ought to involve you in the decision making process. You may be offered a choice between VB and CS, depending on circumstances.
CS isn't so bad... No tearing or bruising, and I was able to walk a couple of miles with the pram within a week. You probably need to ask what they mean if it is going to prey on your mind like this. There is also no need to decide what kind of delivery you want until much nearer the time (I next see my consultant at 36 weeks).

It doesn't sound terrible, it just sounds complicated. Try to think positive.

Hi mrsnec I think you are probably reading too much into a thoughtless, unprofessional remark. Neither the termination nor the MC make this pregnancy any higher risk once you have got past first trimester, or are likely to have any effect on your birth experience (except emotionally) I have had 4MC, have a diagnosed immune condition and was on loads of meds in first trimester, as soon as I got past 12 weeks I was back on a standard care pathway.
I would guess the same about your previous surgery unless any of your reproductive organs sustained any damage, but that's something you might want to ask specifically.
Your weight might increase risk factors but is unlikely to mean you need a Csection, it would be sensible to eat well and try to limit your gain in the next 20 weeks.
I'd get them to address each concern at your next appointment, and point out that choosing your words carefully around anxious pregnant women might be a good idea!

Sorry, didn't address the blood sugar bit - your BMI would make you at higher risk of gestational diabetes anyway. In the UK this is checked with a glucose tolerance test at about 28 weeks ( fasting blood glucose, drink some vile sugary stuff, repeat bloods in 2 hours) Mild GD can be controlled with diet, more severe requires insulin injections, normally will result in additional growth scans as one of the risks is baby getting very big which can affect birth. I would look into this and modify your diet now but expect to be monitored for this potential complication.

I went down as high risk for being fat.
Same as when I had Dd and my blood pressure was never higher than 118/90 and I recovered from my emcs very quickly

Try not to worry - with the "history" comment, they were probably referring to your surgery following your accident and possibly the mc. I'm not asking for details but if there were complications with your previous pregnancies/deliveries, they may have meant that as well. Increasing age always means your pregnancy is technically more risky from a medical point of view. Your weight means you are more likely to develop gestational diabetes (possibly pre-eclampsia too?) and your blood sugar is also high already so they will just monitor that.

Risk factors generally are age, weight, previous complications (including mc), other medical conditions and social factors e.g smoking, excessive drinking. As a health professional, it drives me nuts when those employed in healthcare (not always, but often doctors!) make these throwaway comments that aren't necessary and just cause patients to stress needlessly about things .

Hello, congratulations on your pregnancy! The comment from the doctor was uncalled for in my opinion and I'm sorry that it's been bothering you. (a) you really don't have that much history and (b) what's happened before aren't things that make you high risk this time at least not in the way they analyse it in the uk. (As an aside my history before my first baby was very similar to yours except I've had one more bit of abdominal surgery but that didn't worry anyone - in fact it showed that I'd got through surgery in the uterine area and that I was ok under general anaesthetist).

What makes a pregnancy high risk are certain factors that can increase the likelihood of complications - for me it's age (I'm 38( raised BMI (I'm way, way heavier than you) plus high blood pressure and now very late onset gestational diabetes. All it's meant for me is that extra monitoring / appointments are required to make sure the baby and I keep well, and my monitoring has been consultant-led not midwife led. It's working well for me so far because the main team I have looking after me (at King's College Hospital, the blood pressure antenatal clinic) are absolutely wonderful. For me it may well mean an induction before 40 weeks (so from around 38 onwards) because GD and high bp can lead to the placenta failing early and also an increased risk of pre eclampsia so they'll want the baby out to avoid that happening, and which may in turn lead to a c section if the baby really really needs to be whipped out quickly, but for me it won't automatically involve a c section. It all depends on your particular specific circumstances and why (if at all) it is that they decide to class you as high risk. Here it does mean that I don't really have the option of birthing at home or in a midwife led unit but I personally feel more comfortable with the whole panoply of the medical profession within very easy access so I'm absolutely fine with that although some women have different views (eg a friend really wants a home birth but is advised against it after a post partum haemorrhage last time).

There are some risk factors that mean that a c section will usually be scheduled (eg if you have a low lying placenta which could put you and the baby at risk were you to go into labour "naturally") but as I say it depends on the circumstances. Good luck with the rest of the pregnancy - I hope it all goes well.

I think he has a big mouth! Guidance on c sections varies country to country and even Dr to Dr - but I (who also have a bit of a 'story') have been told nothing's certain until after 28 weeks. Size of baby, how you're able to carry, blood sugar etc' all matter and they can't predict at 20 weeks.

I'm high risk due to a blood condition and recurrent MC. I'm mid 30s but due to my general OK health they don't deem that a factor anymore till a few years time. In real terms it has meant I've had check ups with normal staff (MW, Sonographer) in a clinic with Ob/gyn Drs. If they see anything that worries them, they pass me on to the Dr. This has happened once and it was more me being anxious and asking!
My birth seems to be heading the same way ... I'll be 'normal' but they'll have a Dr aware that I have additional needs.
I have not been told at all that I will have to have a C section or anything, just that they'd advise against a home birth but can have a water birth on their premisis if all goes well.

I was high risk due to previous abdominal surgery - massive open surgery as a baby leaving me with a huge scar and lasting problems that got a lot worse during pregnancy. Also family history of pre-eclampsia and gestational diabetes, plus family history (my brother) of fatal genetic disorders and it wasn't known if I was a carrier.

I had more appointments throughout pregnancy, great care, and had a normal delivery (induced for high BP but that was a very sudden onset thing and the induction was done as a precaution), no C section, great birth. :)

Thanks everyone, no comments were made about the placenta and my bp was ok both times too.

I do know a couple of ladies that have had babies in that hospital. They had no complications. Commented on the doctors being rude and the cultural differences but just put up with it. I also have a friend who's a trained doula but never qualified.

I'm just frustrated I end up more anxious after every appointment.

I didn't have any complications from my surgery just a very severe reaction to pain meds (Tramadol) I mentioned this too. The only pain relief they give in labour here is pethidine, no epidurals, no gas and air.I am worried I might react to pethidine too but they'd never even heard of Tramadol and had no idea what I was talking about.

Gps here are only small village surgeries that refer to the general hospital I'm at anyway. I've booked an extra scan at a private clinic but I might check it out at the same time.

I am watching what I eat. I'm no stranger to diets I did lose loads before I got pg. I just didn't want to carry on dieting while I was pg and I was happy at the actual size I was despite being overweight according to my bmi.

Orange, you are not considered high risk for smoking, I know several people who smoked throughout, were honest about it and were put at low risk. It would only mean so if you had other factors to go with it, a young slim healthy smoker is never considered high risk so no idea why people always peddle this.

This isnt me saying its a good idea by the way.

It's funny they didn't even mention drinking and smoking! I don't do either but I don't think it would be a concern here especially as my doctor told me to drink more coffee as I was looking tired!

I think I'd be happier if they'd said we think you might be high risk because....

Sounds like some of you have had great treatment.

Squiz, in an ideal world the set up you have sounds just right. I think I'd go for a water birth if I could or even just for labour but it's not an option here. I don't think I'd feel safe enough at home either but I do think I need to feel a bit more relaxed about the doctors and the hospital. At my last appointment they kept us waiting 3 hours. That doesn't help!

Sorry, my mistake!

im high risk because of my kidneys and now ones blocked ive got have a nephrostomy tube fitted but dont when yet as its a risk of starting early labour off. plus im high risk for preeclampsia aswel, im also under cpnsultant led care. it doesnt alqays mean a csection either, thats normal drastic caaes but uve said ur blood sugars r high so ul be closely monitored for gestational diabetes x

Have a chat with your doula friend about what types of non medical pain relief you could use if you don't want pethadine. I'm not sure if tramadol and pethadine are in the same family but worth asking.

Some pain relief options. Do they have a shower in the delivery room? Tens machine? breathing? yoga? active positions? also hot water bottles/hot wheat bags held in place can be really useful.

Drink more coffee because you're looking tired?!! What odd advice! It doesn't sound like you're having things explained to you very well. I'd recommend taking in a list of questions to your next appointment and don't be afraid to rattle through all of them. And if at any point get a doctor or midwife who is good at explaining, latch on to them and ask everything you need to know. Has the doctor actually said you're high risk, or just raised a couple of things eg sugars that need to be kept an eye on in case they develop into something that requires treatment?

I did discuss that kind of thing with my doula friend. She didn't mention non medical pain relief.there are showers but nothing else they do encourage moving around but in terms of relaxation techniques local ladies just pray! I'm not religious though.

I had dismissed tens machines and wheat bags etc thinking they wouldn't work but I'm going to look into those.

I'm undecided about the pethidine. It is a similar drug to Tramadol and whilst not in the same family online research has told me it can cause the same reaction. I have been very sick throughout my pregnancy anyway and I know I'm likely to be sick in labour anyway but I have a strange fear or being sick in hospital, but realise I might be silly refusing pain meds just because they might make me sick! I definitely need to make them understand this though.

I thought the coffee comment was ridiculous. I have aversions to tea and coffee anyway and anything else I've had to cut out because of the blood sugar and weight issues. and the locals here consume silly amounts of coffee.

When I googled it 90 isn't that high for blood sugar anyway. But I'm asking my diabetic friends for advice. One is the same age as me and the same stage in pg too.

Doctor didn't actually use the words 'high risk' it was just the comment about my history and everything else I've just been getting myself into a state. I've yet to meet an hcp at this hospital that can answer my questions but I'm going to make a list and hope I get one next time.

I didn't want pethadine as I'd had it before during an emergency and whilst it was good pain relief it did leave me feeling very spaced out, which whilst great when you want to disassociate, wasn't something I wanted in labour as I wanted to be in as full control of my faculties as possible. So I think this is worth bearing in mind. I did end up having a shot of it in my labour but that was because nobody thought I was actually in labour but I was in a lot of pain so desperate, so I accepted it thinking it would have worn off by the time I actually was in active labour. (It didn't as I had the baby about 15 minutes later).

Also getting your partner or who ever is going with you to learn some pressure points to push rub is really helpful. I found hard rubs on my back really good.

You could also look into hynobirthing which is breathing and relaxation designed to help have a calmer birth

Thanks everyone I'm going to discuss my concerns about pethidine next time and look into tens and hypnobirthing. Will chat to dh about pressure points but he's not been great at things like that so far!

Put it out of your head for now- they will decide what's best for you at around 36 weeks or so. Who knows what the future holds- your baby could be breech which will mean a section in any event, or you could end up with a low lying placenta, any number of things.

Dont worry about it for now and enjoy the next 10 weeks. I really enjoyed weeks 20-30, i'm 35 now and things are tricky. As it happens i'm due in tomorrow for my 36 week appt at which time they will check on babies position (he's been breech all along) and possibly give me a date for a section in 3 weeks. I dont mind in the slightest- any of my friends who've had planned sections swear blind it's the way to go!! Give me a stomach scar over a fanny scar any day- i've had friends with 4th degree tears who've needed 40 stitches down below and have never recovered. Anyway, i digress!!!

That's what I want chicamomma, I'm having a private scan a week on Monday when I hope I'll get some reassurance and enjoy the pregnancy. I haven't made a big announcement yet, I've not celebrated it and I still haven't told all my family so I was hoping I could do that for a bit.

If I get 10 weeks enjoyment out of it that would be marvellous! I have moments when I think I want a planned section scar doesn't bother me in the slightest but the thought of a longer recovery does but you're right I best not worry about it now. Good luck tomorrow.

In your situation i'd be worried about an emergency section- which is a far bigger recovery than a planned one. No comparison by all accounts. that's not to say that you would end up with an emergency- but if your previous scars from the ab surgery were under pressure it might be a road they'd go down mid labour. So given your history (sorry for using that again!!) i'd go for the section if they offered me one. Personally.

Thanks- looking fwd to getting some answers tomorrow- i'm bad with uncertainty, as i suspect you are. I'm a project manager so even the idea of going 10 days over gives me chills. End of the day the only thing that matters is the health of the baby- i dont give a shit if i have a longer recovery. In any event, it's not necessarily a longer recovery anyway- people have nasty shit happen to them in vaginal deliveries too.
Trust that the medics will do the right thing by you- i know i am..

PS- the actual termination would make no difference - i had one too and she said that unless my cervix was damanged by the procedure (which it doesnt seem to have been, at least as far as they can tell on the ultrasounds) that it makes no diff. Same for the MC. it's the ab surgery i'd worry about, and possibly the blood sugars- are they going to give you a gestational diabetes test?

i hope you enjoy the announcement- you should, it's very exciting- you're having a baby!!!!