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 mean, do you want to share, or do you want an advice, or an opinion?
45 yo here as well, it would be an immediate NO.

Not sure what you're expecting. Biologically you're are old to be pregnant. That comes with greater risks. Maternity services will be better equipped to advise you

I’m the child of a 46 year old mother. I don’t have any advice to offer really I just wanted to say it. I was 2lbs 2oz when born - my mum smoked all pregnancy and also developed pre-eclampsia so I was approx 2-3 weeks early. My mum was encouraged to terminate me due to all the potential health issues I would have.

yea…no advice just wanted to tell my story.

I think your GP was being pragmatic.

But, it’s unusual that he didn’t test.
Did you ask for a pregnancy test?

Great info, there, from Saladbar.
I talked to my midwife about these things.

I had DS at 44. Pregnancy, birth went well.
Didn’t have any genetic testing done.

But I was well looked after at all times.

To be fair GPs aren’t “experienced and trained” in pre-pregnancy or early pregnancy counselling which is what you need - specialist information about risks to enable you to make an informed decision. However, it’s a shame he couldn’t signpost you to a service that could help eg an early appointment with the local obstetric team.

This is not what GPs are for

If you've only just missed your period, the most likely outcome is loss unfortunately. I think worrying about things like preeclampsia or downs syndrome at this stage isn't very helpful.

I would try to get everything out of your head and really work out whether or not you you would want another child. If no, most people want to book the termination as soon as they have decided. If yes, you can do a NIPT at 10 weeks, and speak to your doctor about extra monitoring if the pregnancy continues.

I do think that the GP sounds really unhelpful and I would expect them at the very least to be able to signpost you to some further advice or reliable statistics.

It’s been dismissed on this thread, but in the absence of any help from the NHS I don’t actually think trying ChatGPT is such a bad idea… It’s infinitely more helpful than Google in my experience and you can put in information about your medical history for context.

The GPs response was poor they probably didn't want to feel responsible for you asking for an abortion

When I got pregnant with my first I went to the doctors I was very concerned about early bleeding I had no idea how far along I was and no clue why the morning after pill hadn't worked my doctor was very stiff and said if I wanted an abortion he would refer me across because he didn't like doing that sort of thing he could get me seen urgently by the end of the day when I said I didn't think I wanted one because the baby was clearly hanging in there so I wanted to try to keep it his attitude changed and he was great

So it could be something like that

I had an 18 and a 20 year old when I found myself pregnant at 44. Midwife arranged amnio plus private amnio which checks for more abnormalities. Both clear. He was 24 last week.

Life throws a curve ball now and again..

I agree with others that a gp isn't best placed for this. Midwives and obstetricians are the health care professionals you need- if your pregnancy progresses beyond these very early weeks.
Make an appt for your booking in clinic and the midwife can talk everything through with you then ( and will be more knowledgable than a gp).

I suspect that they thought you meant you wanted to request a termination. Which is obviously a reasonable use of an appointment.

Pregnancy counselling is not something a GP can do well in a 6 minute appointment. They are also not going to be able to give you a personalised risk for pre-eclampsia, DVT or gestational diabetes as it will depend so much on your history. Even generalist obstetricians might struggle with the finer nuances - that is why maternal medicine exists as a separate specialty. The risk to the fetus is an entirely separate issue.

Nobody is going to be able to tell you that the pregnancy is going to be fine. It is going to be high risk. You already know that. You’ll be under an obstetrician from 13 weeks, if you do decide to continue the pregnancy.

The GP can’t say “I think you should terminate”, and they don’t want to say “I think you should continue”, and they don’t have the time to do a counselling appointment - it is not the best use of a GP slot.

You'll get assigned a midwife but not until week 8-10. The wait it that long because apparently a lot of people miscarry before they get to week 8. Then at week 12-14 you will have chosen your hospital for prenatal and birth and they will do dating scan and also blood scan for down, Edward and patau. It's not a guarantee it's accurate but if the risk is high, they will offer additional test. So you will have enough information to make an informed choice. And yes GP is not very helpful.

This isn’t something to rush OP, why do you need to make a decision in the next week?

Theres so much to consider other than health risks - affordability, if it’s fair to your child that when they are an adult their dad will be in his 80s, how your other children will react etc

If it helps I am 45 and have just had my second born.

Both my pregnancies were straightforward barring first trimester exhaustion and nausea. I had complications with the first birth so for the second I wanted a C-section and was advised to have it a week before my due date because of the additional risks due to my age. That also went well. Recovery has also been straightforward. She came out healthy but also developed jaundice which was a big worry for the first month.

The hard part is I definitely feel older - picking baby up off the floor, up and down stairs, whilst also picking up toys, preparing meals and getting my older ready for school. And she’s a harder baby, lots of teething and inconsolable crying which I hadn’t really expected as my first was fairly easy until 1y. I thought briefly in the elation of her birth that I could do a 3rd, but after a few months I don’t think I could! I can’t contemplate going back to work, and I’m trying not to think too much ahead as what I remember from my first born is things seemed to get harder with every year

I miss sleep. My first born was a terrible sleeper and I didn’t get a single full night from birth until he was at school. Now I’m back to sleeping lightly and waking up every couple hours again.

I’m happy but I’m exhausted.

GPs have very little to do with the care of pregnant ladies, they're not commissioned to do so and would probably be worried about giving you misinformation.

When I did GP we don't ever '"check" someone is pregnant chemist tests are as good/better than ours...we would just give you the self referral phone number for the midwifery team. You're much better speaking with them. Or maybe bpas ?

You unexpectedly found out this morning you were pregnant, at 45, and understandably panicked and booked gp appointment as you want to know all facts.

I feel your gp was a bit unhelpful. He could of given you information of health visitor or midwife to call.

On the plus side, a sibling has been wonderful for my older one - a real positive.

What I was trying to say was that the statistical risk at a population level is not the same as the risk for any given woman who is pregnant, eg not the same as on a personal level. That risk can vary hugely from woman to woman -the risk is already a variable depending on many factors for that unique individual pregnancy, including the father, and testing will probably give you a different level of risk from the overall population, (or amniocentesis an accurate picture of the status of the baby). On an anecdotal level I know half a dozen women who got pregnant in their mid forties, and none tested positive for Down’s, so among my social group, far fewer than 30% of us. Statistics are not terribly meaningful on an individual level.

The GP probably did do the appointment thinking you wanted next steps but not risks.

That’s more individual or personal research. Even here might give you some info.

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.

So as a GP, I can tell you off the top of my head that the chances of congenital abnormalities and miscarriage are significantly higher at 45 than at, say, 30. And that the rates of most pregnancy related complications are also higher.

I can't, without looking it up, tell you numbers on any of these - I could look it up with you in the room, but I think to expect your GP to have full details on this is possibly expecting a bit much.

I am aware of very very unpleasant complaints that have been made when a woman perceives that a GP has been trying to talk her into having an abortion, when that was clearly not the case, and I suspect the 'it's your choice' mantra was driven by not wanting to influence you either way. But in the end, you're not going to know your individual risk until a hospital consultation, which of course will be in some time. I would suggest that you contact one of the abortion providers for the NHS as they all do non-directional counselling and will have more time and information.

health visitors don't deal with pregnant women and you can't speak to a midwife unless you're under the care of the antenatal team at the hospital.

Your chance of miscarriage is extremely high. I would be doubtful you'll stand a decent chance of carrying to term- the odds are stacked against you. The risk of Downs syndrome is also 50% (that must be factored in)

I know it's an uncomfortable fact, but the reality is - 45 is very old to be pregnant and giving birth.

I'd think about your existing children and their lifestage and ages, whether your marriage (and older husband) are going to be able to withstand the strain of a high risk pregnancy and newborn. Lots to think about it.

Plenty on here will have stories of their nans neighbour who has twins at 48 probably their teen daughters children and treat older maternal age as a blase. But it's not really something to go into lightly. It's risky.

Good luck

I don't think that 50% is correct. It's 1 in 50 https://patient.info/pregnancy/pregnancy-screening-tests/prenatal-screening-and-diagnosis-of-downs-syndrome