When is High Risk not High Risk? Professional opinions please...

[MrsBadger]

Opinions from Ob/Gyns, MWs etc much appreciated:

I'm 12wks, primagravida.
I'm heterozygous for an inherited thrombophilia (Factor V Leiden), have never had a clot, am young, healthy, active, don't smoke etc.
At my first visit to my GP she referred me to the High Risk Preganancy Unit 'just in case'.
Had normal blood+urine at 10wk MW booking in, normal dating scan at 11+4.

Today I had the appointment at the HRPU - saw MW for weight, height, bp, heartbeat, lots of bloods (FBC, liver function, APS - about 7).
Saw a registrar (the Prof was busy).
She said the thrombophilia means I'll need LMW heparin for 6wks after delivery.
I asked how this would affect my care for the rest of pg - would I need to stay under the HRPU as my risky bit wasn't till after the birth?
She said yes.
I asked how this would affect labour and birth - I'd liked the idea of a waterbirth but the hospital only has one pool, so knew I'd have a better chance of that if I stayed at home.
She said Prof likes to have high-risk women in hospital, and besides, I wouldn't be able to use the pool as I'd need continuous foetal monitoring.
I asked why I'd need continuous foetal monitoring - as far as I knew the thrombophilia wasn't a big risk during labour and birth.
She said all high-risk women had it, and muttered something about 'increased risk of abruption'.
I said fair enough, but in that case I'd like an active labour as the thought of being stuck flat on my back on a table freaks me out.
She was non-committal on this point.

She's booked me a uterine arterial doppler for 24wks 'because all high-risk women get one', and said we'd have to see about birth options after that.

I left faintly frustrated and with the feeling that I was seen as Awkward and Unreasonable because I hadn't smiled sweetly and said 'Yes doctor, whatever you think is best'.

So.

I seem to be getting lumped together with women with much bigger medical problems than me but can't do anything to get back to 'normal' MW / GP care.

Or is the thrombophilia a much bigger risk during labour and birth than anything I've read so far has suggested and I should put up, shut up and prepare for a fully medicalised birth?

Mrs B
I'm not in any way an expert but I do write about pregnancy stuff from time to time and could ask a consultant for you - Willow2 and I have the number of a very lovely Irish one who'd tell it to you straight but is not one for making unduly gloomy predictions...CAT me if you'd like.

hello - my pg was similar as i had 2 unexplained blood clots and was told i was a high risk pg. I had a full thrombophilia screen but they never found a cause. I was put on heparin from about week 19 or pg as i had another suspected clot ... i injected every day and then had 6 weeks of warfarin after the baby was born which for me was useless as i never got therapeutic. I was treated as high risk which seemed to mean more scans and more appointments with heamatologists and consultants. I kept myself well and had reasonable pregnancy and excellent natural birth (stitches after were awful as the heparin made me bleed a lot!!). I breastfed and was fine and so was baby. I want a homebirth next time so i know how you feel - i felt "medicalised" ...

with thrombophilia etc there is an increased risk of clots and this can affect the blood flow to the placenta POTENTIALLY ...
Try to eat well, exercise gently, i wore attractive (!) support stockings which helped and plenty of fluids - CAT me if you want to know more!

Nothing to do with your condition - but I was high risk (rare to have

induction after c-section) and though the registrar said I would need continuous foetal monitoring I went and had a strop at my consultant who said no, it wasn't necessary in my case

depends on the consultant though; mine was a lovely fluffy bunny of a consultant

if you do get someone to agree to it you have to make sure it is actually written in your notes, otherwise the midwives will ignore you in the event as you try to drunkenly protest through your drug-fogged haze

(ps is it likely that this parcel that the Royal Mail tried to deliver this afternoon is any way Pony-related? cos if it is I can take dd down to the post office after school - if it is unlikely I will not be popular for dragging her out in the freezing cold to pick up something super-tedious and I can get dh to do it tomorrow)

(I'm Cappuccino btw)

could you give birth in a midwife-led unit which is co-sited with an obstetric ward?

(if you're Cupcakes, Capp, teecee, misdee, Enid or Bozza then the parcels's probably ponies - I don't recognise you in that Valentines hat you have on)

Thanks for all the input - I think part of the problem is I haven't even met the consultant yet - he may indeed be a fluffy bunny with a tight-arsed Miss Moneypenny of a registrar.

The 24wk doppler will hopefully show up any problems re placental clots / insufficient placenta etc which I guess is why she was so cagey re talking about birth options till after it's been done.

bundle, unfortunately not - my options are home, midwife-only unit 20 miles in the wrong direction, or the teaching hospital.

Oh well, it seems they may have a point after all.

I've forced myself to read a proper scientific review paper about thrombophilia and pg outcome (Santis e al 2006 ), and discovered just what I am at increased risk of, including pregnancy loss, pre-eclampsia, intra-uterine growth retardation and placental abruption, meaning that the bloods, the doppler and (possibly) the continuous foetal monitoring are a good idea.

Of course if the registrar had bothered to tell me any of this I might have been less stroppy.

I'm happier about the idea of a medicalised birth now I know more about the evidence base, but am still feeling cross about how little information I was given today, and especially cross on behalf of women in my situation who don't have access to the literature I do.

I will stop fuming eventually, I promise...

You have my sympathy. Some medics are good with informed patients, and are happy to work with you to figure out what's best. And some are intimidated by patients who don't sit meekly and say 'yes doctor, whatever you say doctor'.

MrsBadger, you may well find that the consultant is a lot more relaxed than the registrar - I would insist that you see the consultant next time you go (you are entitled to) - I'd put it in writing that you want to be seen by the boss, not one of their underlings.

I definitely found this to be the case last time I was pg ...

ejt

i had a blood clotting issue when pregnant

taylormama who posted earlier is my sister, she has had two DVT;s , our mum has had one...i presented in the 3rd trimester with a susected clot and a protein s deficiency. i was tested for factor V leiden, but it was clear..i was put on low dose aspirin for the reamainder of my pregnancy.

i was also high risk having had a previous c.s. but ended up having a normal vaginal delivery..with no complications ..

i am pretty sure my suspected clot was a clot , as i had all the symptoms including swollen, hot calf, unable to bend leg properly, problem putting foot on the ground, but it wasn;t a clot never found out what it was.

Dont know anything about the condition but just wanted to say I am also classed as high risk and have manged to put my foot down while in labour and had several very active births.
They can still monitor you throughout without having you tied to the bed.

You dont need to be worrying about this kind of thing now lovvie,when you get into that delivery suite, not many people are brave enough to shout louder than a woman in labour