My midwife is a computer - feeling deflated about decisions and information

[redxlondon]

I’d love to get perspectives on this. I’m 15w+5d pregnant with first child, I’m 36 and have uterus didelphys, which can lead to restricted growth. At 12w scan I had a notch on one artery and very high artery pressure on one. Midwife said they see this a lot so they’ll monitor to see if it normalises. I had my screening test results back and my PAPP-A was on low side at 3.5.

This could all mean that my placenta might not function as it should. So I called midwife today and asked if I should start taking aspirin. They said no, and when I asked why the only answer was “The Tommy app says your low risk. We put all your results in a computer and it says you don’t need asprin”.

I’d feel better if I knew how the computer had been coded to take into account all my risk factors. I’m seeing my obstetrician again next Friday so can ask them for another opinion, but worried it will be too late to start aspirin by then, if it turns out I should have been taking. I read it’s most effective when started before 16 weeks.

I just worry I’m not having the best possible care and keep wondering if I’m making a mistake not to find the money to go private.

Other than this, is there anything about your midwife/hospital unit that makes you think you're not receiving the best possible care?

Have you had a google to see what this Tommy's App is? Maybe there is more explanation around it online that will help you? I had a quick google and found this (but didn't read it) is it referring to the same app? https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04867-w

It's completely different but I had breast cancer a few years ago and an oncologist plugged my situation into a computer and calculated my chance of recurrence in front of me. I have absolutely no idea how that worked but the fact it was used in a medical setting by a doctor gave me some reassurance - it has presumably been tested and found that whatever formula or algorithm they're using is relatively accurate.

Or, can you ring your midwife again today and ask? Make a list of all your questions and just ask someone straight out until you are satisfied with the information given.

Not that you should have to - but could you have a Google of the NICE guidelines for when they would recommend aspirin in pregnancy?

You can also request a different midwife x

If, as stated by the NHS, a low dose of aspirin is considered safe in pregnancy could you start this yourself and then check this with your consultant on Friday?

Thank you for sharing. I did try call my midwife but she couldn’t answer and hasn’t called back. I have my obstetrician appointment next Friday so worst case I just wait until then and hopefully won’t be too much of a problem if I do need to start aspirin and start two weeks late.

This is where I’m taking it from that I think it could benefit me. But the criteria are open to interpretation so must be the way the Tommy app is coded that I’m maybe on the cusp but they say not necessary. I just want to know if any harm in me taking it. As I’d rather just take it if there could be positives and no negatives. I don’t understand enough to know why they wouldn’t suggest I start it.

I thought that but because they’ve said no, I’d rather now wait to get the okay from obstetrician. When midwife calls me back, perhaps I ask the question in a different way “Is there any concern if I buy 150mg dose and take daily?” - might get a different answer to “Should I take aspirin?”

When my midwife looked at whether I needed a low dose of aspirin she said there were multiple factors, age, BMI, time since last pregnancy, PAPP-A score, diabetes etc. She manually counted the "score" and then checked on her computer too.

Thanks that’s really helpful, sounds like they’ve put in my factors and it’s not hitting a high enough score. Which on one hand is very positive. On the other…would it hurt just to take it if it would have some benefit…

hi OP
The consultants also use the Tommys app (or they did at my trust) so would more than likely go in line with what the midwife has said.
From what was explained to me all your information such as age, number of pregnancies, screening results etc are all combined to calculate overall risk using the app x

My only concern with the app / computer is there’s no option to enter uterine anomalies. So I keep coming out as low risk and they occasionally have to override that, like referring me to a specialist obstetrics team. So I don’t trust it on the aspirin decision, but guess I just need to be patient and wait for the next obstetrics appointment.

Do you have paper or electronic notes? I have paper notes and the score sheet is in there.

I'm 38 and was told that my age makes me at increased risk of haemorrhage after birth, so I would prefer to avoid aspirin if I can. I asked the midwife about this and she said that if I did need to take it I would have to stop 'closer to the birth'. There's not much detail for you to work with, sorry, but might be one reason to avoid aspirin.

Thanks, really important then to wait and see what consultant says.

It’s a mix, which means they never bother writing anything in my book but I don’t have access to electronic records. Really annoying, especially for my OCD that wants the book filled in as it should be!

I had similar situation this pregnancy. A notch at 12 weeks, a midwife who wasn't bothered by it. Then at 18 weeks I was seen by head of midwives and she was VERY worried that I haven't been put on the 150mg aspirin. I was immediately given an appointment with the consultant who said sorry multiple times and gave me a prescription for the aspirin saying that it may not work as recommendation is to start before 16 weeks. I also had an ultrasound every 4 weeks after that.

I am now 35 weeks pregnant and so far my baby develops as expected. I do still have a high resistance in arteries but no growth restriction and at 32 weeks the estimated weight was 2.2kg.