Will I be classed as high risk? What does this mean?

[sel2223]

Hi ladies,

I'm around 8/9 weeks pregnant (first pregnancy) and have my booking in appointment next week. This is all brand new to me but I've been reading about high risk pregnancies and consultant led care and I have a feeling I'm going to tick a few boxes with that one. I can't seem to find a definitive list of reasons why women are classed as high risk online or anything that tells me what that actually means in practical terms:

• I'm 37
• My BMI is 31
• 4/5 months ago, I was assaulted and suffered a small subarachnoid haemorrhage (bleed on the brain). I'm recovering well but still have headaches, fatigue, dizzy spells and am currently being assessed for PTSD and post concussion syndrome.
• For the past 18 months or so, I've been under consultant care for potential myositis as the CPK levels in my bloods are consistently very high. I've had no symptoms of this aside from the blood results but was asked last year if i had any plans to get pregnant (i didn't at that time) as pregnancy can apparently be a trigger if the condition is lying dormant.

I know I'll be able to discuss all this with the midwife at my appointment next week anyway but I'm already a nervous wreck so just want to be prepared in advance if you know what I mean.

If I am classed as high risk, what does that actually mean?

Thanks in advance for any info/advice /experience anyone might have x

As you have read, it will mean that you will have consultant lead care, you will see a midwife primarily but will have some appointments with a consultant and possibly with a specialist midwife. You might have a few extra tests. You would be encouraged to have your baby in a hospital with doctors available rather than at home or in a midwife led unit.

But your MW will explain all this

Hi, for context, I have diabetes, have suffered from deep vein thrombosis, am a little overweight and last year was in a coma for 7 week suffered total lung failure and cardiac arrest. I am classed as 'intermediate risk'. I am consultant led, which just means I get additional consultant appointments once a month, extra scans every 4 weeks from 20 weeks.

I think from what you say you will be the same risk level as me and the only definite difference I can see is that I will not be offered homebirth or birth in a water tub etc. But I may be wrong and in your case you will get offered that! I still see the community mid wife as normal.

You mention the doctor asked you about getting pregnant. Is it risky to get pregnant with the blood disorder?

I’m consultant led due to a neuromuscular condition. Up until 28 weeks I had mostly normal community midwife care and scans. I did meet a consultant at 16 weeks. At 28 weeks I had a growth scan and saw the consultant (and anaesthetist but that’s specific to me I think). I will now see the consultant every time I have a growth scan (which is every 4 weeks) in addition to seeing my community midwife.

My consultant has written to both of my specialists for advice on pregnancy and birth (outcome of my 16 week appointment) so they may want to write to your consultant for your condition.

Birth choices are something consultant will discuss, and will probably prefer you to birth on a labour ward. I didn’t get any choice but I need to have an assisted delivery so not unexpected!

The process does vary slightly depending on where you are, but your midwife will have a better idea on that.

Congratulations on your pregnancy

Thank you all so much for taking the time to reply and congratulations to those of you expecting at the moment.

@LH1987 I wasn't even aware there was an 'intermediate risk' category but i could well fit into that judging by your situation. Thank you for sharing and good luck with your pregnancy x

I'm "high risk" due to age and history of MH problems (nothing exotic). I've had a few consultant appointments in which very little happened, tbh, although it was convenient when I wanted to talk about ELCS.

@bloated1977 I'm not sure to be honest. I said I wasn't planning to get pregnant and nothing more was said. I've tried searching online but very limited info x

@keyboard91 Thank you for sharing your experience. I'm under a neuromuscular specialist for the blood thing and the neuro sciences outpatient ward for the head injury. It makes sense that the consultant would speak to the specialists to get info about the conditions and pregnancy. I hope everything goes well with the rest of your pregnancy x

@Tableclothing thanks for replying. It sounds like it's mostly just extra monitoring providing everything stays looking ok? Did you have to fight for an ELCS?

Hi @sel2223, if you have any health condition, the NHS says you should consult a doctor before getting pregnant. I wouldn't worry about the fact you were asked before. I have an annual check for my diabetes and got asked that question almost everytime. I did not consult a doctor before but it wasn't an issue, just got quickly referred to a consultant.

High risk definitely and your history of hemorraghic stroke will probably make you the highest risk but that’s good. It means more consultant appointments, scans, and proactive treatment. You will probably also need to stay longer and have longer postpartum care with the hospital which are all positives.

@LH1987 it wasn't planned but now very much wanted. I feel like I'm doing everything backwards lol. Hopefully all will be ok x

@GrumpyHoonMain thank you so much, you sound very knowledgeable on the subject. I suppose non of that is a bad thing if it ensures we're both healthy! X

Congratulations on your pregnancy and sorry to hear about the symptoms you’re still experiencing after your SAH - what treatment did you have?

I’ve been referred to a consultant due to a SAH 5 years ago, because I had the coiling surgery they are concerned about the effect of increased pressure in the brain during labour - this will probably be the same for you.

As PPs have said, this means more appointments and scans, so can only be a good thing!

On a separate note, I was diagnosed with PTSD too, and had all the symptoms you’ve listed - I promise it all gets better with time

Take care x

@sel2223, it will absolutely be okay. I was just saying to my partner, I can't breath but another specialist consultant, specialist midwife or sonographer pops up. Despite the risk I feel very secure because if anything were to go wrong, they would pick up on it pretty quickly. In some ways, I imagine this level of care means I am less anxious than those who are low risk. Good luck and congratulation x

Did you have to fight for an ELCS?

Mmmm yes and no.

(Due to antenatal anxiety/depression I had a lot of extra appointments with GP and consultant especially (not very useful when you see different staff every time, and as I work in MH I usually came away feeling I knew more than they did...). Eventually I got a referral to the perinatal psychology service which was much better. )

My GP and midwife both did a slightly weird thing where, when I said "I'm thinking aloud ELCS" -hoping to be given information - they said "oh right" and looked away and then changed the subject. Midwife did a bit of a cat's bum mouth as well. Not feeling very well at the time, I found it extremely difficult to say "I want a ELCS and I want you to explain the process for making that happen".

I ended up talking about it to the perinatal psychologist (well, it came up in the first session). She explained that in my Trust (they do things differently in different places), women requesting ELCS have to be seen by a psychologist before talking to a consultant about it. I was fairly to hear that, and the psychologist seemed pretty embarrassed about it too. Ostensibly, the reason for this is to identify women who want to have a vaginal delivery but are just a bit nervous and could be supported to overcome their anxiety. Anyway, after 5 mins conversation the psych said she would fully support me in asking for ELCS. (Apparently I have a phobia of labour and a strong understanding of the relative risks of vaginal vs Caesarean delivery.)

(You'll see people on here saying "vaginal delivery is safer" - frankly, this is so vague as to be meaningless. It very much depends on how you define "safer" and the physiology of the mother and the baby, which varies enormously from case to case. Quite often, CS is safer, which is why it is performed)

Anyway. The psych then set up an appointment with the lead consultant and also spoke to her on the phone. When I went to see the LC, she asked why I was there and when I said I wanted a ELCS said "OK" and started talking me through procedures. I'd been led to expect a difficult conversation (MW had warned me that it was hard to get ELCS in my Trust) and eventually asked the LC why she wasn't trying to put me off (yeah I know). She looked at me like and said "Your body, your choice." I think I love her a little bit. She seemed so relaxed about it all that I ended up quizzing her about specific risks and even then she said "Well, it can be an issue for some people but in your circumstances it's very unlikely. I wouldn't worry."

I guess it makes sense that the person who performs multiple CS every week would be more relaxed about it than people who don't.

@Dav87 thank you for taking the time to reply. I was in hospital 5 days but was fortunate that the bleed started to reduce in size on it's own so no surgery or particular treatment required! Now it's just follow up appointments, monitoring and nerve meds (which I've stopped taken since finding out I was pregnant).
That's interesting what you said about the increased pressure during labour as that was something my GP mentioned when I told them! Are you still going to try for a natural birth or are they suggesting a c-section would be better?
Happy to hear it gets better! Thank you. I appreciate it x

@LH1987 that's a great way of looking at it actually. Thank you and good luck to you too x

@Tableclothing wow, thank you. I'm pleased you had some knowledgeable and understanding people on your side! When are you due?
I am only at the very beginning stages but interested to hear people's experiences of ELCS. I need to find out more regarding my physical and mental health issues and the impact labour might have....it might not even be a choice I get to make.
It's helpful to bear your experience though so thank you x

I haven’t got my first consultant appointment until 20 weeks, so I’ve got some time to think about it (currently 11+2!).
I spoke to someone at my SAH support group who told me they only give you 30 minutes to deliver naturally before taking you for an emergency c-section - so I’ll be finding out if that is the case and if so, I will probably ask for an ELCS, as I think that’s a tall order!
Maybe everyone is different so I’m keeping an open mind and will see what they say at the first appointment x

My consultant did warn me that if I had a bleed on the brain (side effect of my blood thinner) that I would not be able to give birth vaginally. So I think you will have support

Are you taking a higher dose of folic acid? 5mg rather than 400mcg. Wasn’t sure if you’d had any contact with your midwife yet. You can get your GP to prescribe it if not.

@Dav87 I'm about 3 weeks behind you so would be really interested to hear what they say at your first consultant appointment...30 minutes is nothing!! X

@GrumpyHoonMain thank you. My GP did say that it's probably better that it was traumatic rather than spontaneous so less chance of another bleed but not sure if that's right. I'm still within 6 months of the injury at the moment so being monitored and can't drive due to risk of epilepsy.

@NotYourHun I've got my first appointment with the midwife on the 15th so not spoken to them yet. Should I be taking extra?

I've got my first appointment with the midwife on the 15th so not spoken to them yet. Should I be taking extra?
Yes, you should be on the 5mg dose (rather than the 400mcg one) which is prescription only as your BMI is over 30.

@EarlGreyT thank you. I'm new to this and wasn't aware. I'll get in touch with my GP.

Congratulations on your pregnancy. I'm classed as high risk because of my age (44). In reality that has meant I saw a consultant at the 12 week scan and I was told to take aspirin. I get extra growth scans at 28 and 36 weeks, which is brilliant, because I'm quite anxious person.
I probably won't see a consultant again until around 36 weeks, as I will be having an elective section this time (due to previous emcs).
I like the reassurance of the extra scans and extra appointments.

@Helbelle17 thank you and congratulations to you too. I'm very anxious about this pregnancy so definitely feel that any extra scans or appointments will be a good thing x