45 and unexpectedly pregnant - GP less than helpful, am I harsh?

[StandFirm]

Bit of a shock this morning! We truly thought this was not on the cards and we had been very careful (well, obviously not enough). I can't take hormonal contraception and frankly pregnancies are always complicated for me. DH is older than me as well making this whole thing is even more of a surprise. Irony was that I had an appointment booked to discuss sterilisation as my cycles were always extremely reliable up until now but I've been worried about perimenopause making that method unreliable. Nature got me first.
Beyond the practicalities - I work for myself so on the one hand I have autonomy, on the other it's brutal chasing up clients at the best of times - I am really concerned about the health risks to the baby of course but also to my own health. We still have a young child (elder two are adults, one of whom is self-sufficient) so I have that to consider. I don't want to be reckless with my health and so I went to the GP to get the facts. All I got was 'it's your choice'. Not what I was asking! I need to know the likelihood of miscarrying (again, I did once after our third, and I was younger) and the full facts on the implications on my own health. Again, all I got was: things can go well, no one can tell anything and no one will tell you to terminate because you're 45. That was not my question. I'm clear it's my choice, but I thought his job was to give me the medical facts. Is there a reason why he would have been so unhelpful? I got out of the appointment absolutely none the wiser and just as anxious as before. I've self-referred to my local maternity but are GPs not qualified to give pregnancy facts? He didn't even test to make sure it was correct.

I think you’re actually asking the wrong questions OP.

Just presume there is a reasonably decent likelihood of adverse things happening… your health being affected, baby having a genetic condition etc.

Because as soon as you accept a statistic, you’re still accepting the small likelihood that things won’t go the way you hope.

This really is a heart and not head-based decision.

Do you have the space and money for an additional child now?

What would happen in the next 20+ years if the child had additional needs?

What would happen in the next 20+ years if you, or your DH, or both of you, became seriously ill or died?

How do you feel about the whole nursery / starting school / birthday parties / supporting a child right through school scenario?

Before you found yourself pregnant, what would you have said your plans and ambitions for the next 20 years were? Would any of that be affected by having this DC?

What do you existing children require of you? Would your ability to give that change if you had this DC?

What if several of the above scenarios arose in combination?

Only you will know the answers OP.

I just did some Googling and at 4 weeks for age 45, your predicated miscarriage rate is 57-80%, mostly which will happen in the first 8-12 weeks.

Just to say that try not to worry about is unlikely to come to pass. If all is well in another 4 weeks or so you can worry then, and there is still plenty of time for all the medical options then.

Did you have any complications in your previous pregnancies? I understand those to be the best indicator.

The GP should have sent you on to a medical professional who could help - can't believe people are saying just to Google stuff. I had my second at 44 and my husband was in his 50s. I think from memory I saw a midwife pretty early on and we were also under a consultant from the start, possibly because of previous miscarriage. Also from memory, they will test you for diabetes along the way - I was fine. They will not want you to go beyond your due date as the placenta can deteriorate in an older Mum - so C section or induction. On the Downs risk, it is higher but also the ratio calculation is based on various factors including your age. Your age alone is going to give you an overall high risk score but you can look at the breakdown of the score to see if any other factors actually suggest a higher risk or not eg blood test results, measurements etc. Best of luck.

Weird thread.

I'd expect the GP to know which sources of stats and numbers are reasonable, be able to say which facts from the OP's medical history will likely further influence the numbers and describe the standard next steps if the pregnancy continues.

"Advanced maternal age" i believe.

I was an "elderly primagravida"

OP - I am someone who had a successful and happy pregnancy, birth and subsequent childrearing , starting at 43.

Whatever the overall risk stats, no one can tell you what your individual risl within that general % is. You might be the one who is 100% healthy and happy, you might be the one who experiences health / chromosomal issues.

Most of the increased health risks wrt pregnancy for you can be managed, I think. Less so the increased risk, as we age, of developing other potentially life limiting illnesses which could affect motherhood.

In your shoes I would be thinking how badly do you want - or not want - to start the journey from babyhood again. Looking forward to when a child finishes Uni. How does that sound for the life you had planned / expected? How does that work financially? Pension wise / Uni support etc etc.

How would you feel if a 12 week or 20 week scan revealed anomalies? Would you terminate for a serious trisomy? Or proceed as the parent of a child with additional needs? The risk of non-detectable conditions increase with the age of the father, think.

In the end - how much would you welcome a second go at motherhood? If it is your burning desire - go for it.

If you feel daunted and see your life over the next 21 years taken over and it feels hard - maybe don't.

It was great for me - but I hadn't already done it all once before! I would have found starting afresh much harder.

But that's me. You are you.

I get where you're coming from. In my second pregnancy, the scan came back relatively high risk for Downs, but not above the threshold for further tests. The midwife just shrugged (metaphorically speaking) when I asked for guidance (which, with hindsight, is all she could do). I didn't like this uncertainty, so paid for a private scan and it was the best £150 I've ever spent. After a thorough ultrasound assessment of me the baby, plus blood tests etc, the risk went down to close to zero.

However, for this kind of thing, there was a clear protocol for assessing risk. Things get infinitely more complicated when factoring in the risk of miscarriage, eclampsia and other health effects. The only thing I could suggest is to see an obstetrician, and I guess this would be very expensive. I wish you the best, whatever you decide

Oh god, I didn’t not need to see this lol

Well yes, I left very confused and feeling basically fobbed off. Like I said, he didn't even bother testing (which they always did before). He only wrote down the link to the local maternity (and I already know the way, thanks very much). It was odd and very much 'not his business'.

I had pregnancies at 43 (twins) which ended in miscarriage at 13 weeks and at 47 had what I assumed was a missed miscarriage but might have actually been just perimenopause hormones as it quickly went away. My GP never asked to see me once after I informed them I was pregnant. I had to go to the EP unit with the first pregnancy as I was considered at risk because I have a blocked fallopian tube due to endometriosis. Again, my GP never organised this and I was asked to contact them myself. No advice or anything. The EP unit were lovely though and I don’t think the GP would have been able to provide as much help as they did.

I appreciate you are anxious and in shock but nobody can give you the exact information you want to make an informed decision. The GP doesn't have a crystal ball. Any pregnancy resource will tell you that advancing maternal age increases the risk of all the negative things. It would be impossible to pinpoint even an approximate risk until the baby is further along and tests can be performed, or medical conditions become apparent for you. Even then, a high risk score doesn't mean you would definitely experience that negative outcome. You want certainty that unfortunately no one can give you. It's not like you can decide to go back and have the baby 10 years ago to improve your odds - the dice has already been rolled for this baby.

Yeah OP, don’t dare to use the public health service that you pay for. Just get yourself on Google. Don’t think for a minute that talking to someone might help. In fact, isolate yourself completely and neglect yourself, because someone is always there to remind you that someone else is more important 🙄

GP wasn’t unreasonable when there is quality information available online about all the things you mention. The kind of personal service you talk about would need to be paid for privately in the UK.

Yes, GPs love it when patients use Google for medical stuff

Just being devils advocate op , but would it sway you if the poster said she had a fab pregnancy?

After this, hopefully your dh may be open to a vasectomy. Sorry you're having to go through this op. I'm 40 with dcs, and couldn't imagine! I admire women in their 40s with babies; I wish I had their energy!

You do have to also factor in your ages when baby is a teenager too, which will come with more challenges.

Risks to mother:

• Gestational diabetes
• Preeclampsia (high blood pressure in pregnancy)
• Placenta previa or placental abruption
• Preterm labor
• Cesarean delivery is more likely
• miscarriage risk over 50%

Risks to baby:

• Down syndrome risk at age 45 is about 1 in 30 (compared to 1 in 1,200 at age 25).
• Risk for other trisomies (like Trisomy 13 and 18) also increases.
• higher still birth and preterm birth rate
• As men age, the number of spontaneous mutations in sperm increases.
• This can raise the risk of:
• Autism spectrum disorders
• Schizophrenia
• Certain rare genetic conditions

You also have to social components of your child will be 20 when you are 65. I have a few friends born to older parents and I’ve also worked with a lot of children born to older parents. I’d be interested in the age of your partner because his age is a big risk factor too, the older he is the more likely baby is to have issues.

Can you ask and pay for a NIPT? This will screen for issues a lot sooner. My friends baby was detected as having DS this way.

No it wouldn't necessarily but it would be a positive note - you know, if you're anxious, it's the kind of thing that can actually help...

Other than health concerns, my husband and I were both conceived very late by our parents and we’ve both lost our parents very young. Our children did not experience having grandparents, which is also very interesting every year when it’s grandparents day at school. I think it’s a little crazy to go into it knowing you might not be part of their life for too long.

Not harsh at all, you're dealing with a huge shock and deserved empathy, not dismissal. You did the right thing reaching out.

risk of Down’s is not the same for everyone. When I had the tests, I had a risk of 1:50,000 for dd1,and 1:120 for dd2 , I had both in my 40s. Neither had Down’s. Risk will vary with each pregnancy and although it is higher the older you are, it’s not a given that your risk will be that high with your own specific pregnancy.

Pre eclampsia risk also goes up with age, but as this is not your first pregnancy, the risk is mitigated by that.
Pm me if you like OP, I had my second baby at 43. It was fine, I had no issues other than needing a c-section which wasn’t related to my age.

Statistically, the risk of Downs in a 45 year old woman’s pregnancy is 1 in 30. That is not incorrect. That risk changes when an individual has more specific testing, as you did. I’m not really sure what you’re saying here. The GP couldn’t have told the OP anything other than her general risk.