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.

This isn’t diagnosis though. If the op wants a clear view on the risk a test would be better.

What is it you’re wanting from the GP, statistics?
whilst they don’t sound very helpful, they are probably trying to avoid swaying you one way or the other?
They are right, you could have a perfect pregnancy and healthy baby, or it might not go as well as you’d hope.
How old is your young child, do you have the energy and finances to have another child, that is what I would be thinking about.

Congratulations, wonderful news.
Are you in good health and have a healthy lifestyle and eat well and exercise ?
I think that is more important to consider than your age.

There are many women who are older than you that have had 1 or 2 children as they approach 50.
I think go with the flow , see if your practice has a women's health GP or see a private GP , I expect the midwife at your practice can tell you some wonderful stories of successful pregnancies she had witnessed .
What a blessing.What does your partner think ?

I was in a similar position to you and I paid for a private consultation with an obstetrician. It didn’t occur to me to ask my GP.

Get an OBGYN, get scans, blood tests, the works. I did that for my 2nd pregnancy and I was 38

You only get answers from these kinds of tests, not people looking through your medical history.

I had an unexpected pregnancy at 45 last year. Never consulted a GP. I was offered (and accepted) the NIPT after my 12wk scan - baby was clear of the three trisomies. Unfortunately the pregnancy didn't work out but that was due to a very rare pregnancy complication unrelated to maternal age, just random bad luck. A full genetic screen was done after the baby died and there were no anomalies, baby was completely normal. None of the midwives, sonographers or consultants batted an eyelid over my age.

Edited to add, I can't see how the GP can tell you anything useful unless you have a pre-existing condition. You need to have your 12 week scan/trisomy screening and if they are normal then, from what I was told, the pregnancy will usually then go well even at age 45 (assuming no additional risk factors). I wasn't one of the lucky ones, but as I say that was unrelated to age or genetics.

But he wouldn’t have that information to hand in a 10 minute appointment?

I know parents that were in your exact situation as my son is friends with their son.

Mum was 45 with older children and the dad was in his 50s. They went ahead with the pregnancy, no complications and one very energetic boy now at school. I think they paid for the extra NIPT testing early at 10/11 weeks to help calm the nerves

This is so unhelpful. Why not be kind. The op is looking for personalised medical advice. From who else if not her doctor?

People are being very harsh on you, OP. I don't know if they properly read your post. From the sounds of it, you didn't go to your GP just because you're an older mum. You have a history of miscarriage, a history of complicated pregnancies, and he's the doctor who knows that history. It's not so unreasonable to think you might be facing specific risks, that your doctor could talk through with you.

Honestly, most GPs are overworked. He may have just been too tired to bring the information you needed to mind. Or he may have jumped to the same conclusion most of this thread did - that your main concern is genetic abnormalities (which you can Google) or your own energy levels (which only you can judge). He probably didn't understand what you needed from him, and dropped the ball a bit as a result. Sorry. I know it's frustrating.

You didn't waste an appointment though. Your own doctor should be able to give you more tailored advice than Google. It's not crazy to ask.

I hope it all works out, and you can get some solid advice to help make your decision.

Hi, I am 61. I have a 17 year old and a 13 year old. They are pretty great actually, and definitely seem glad to be alive!

I am also medically qualified (not obs and gyne nor GP though). However, I think that there is a limit to what doctors actually can know; these issues around miscarriage and genetic abnormalities etc involve complex risks and much of the decision-making will be around how much risk you are comfortable with, and what you really want and can cope with in this situation, and a doctor can't tell you that.

At one point, after 3 miscarriages close together, an infertility doctor told me that, at 42, let's face it, I definitely would never have children. I didn't really absorb the tragedy of that opinion, because it didn't seem quite that cut and dried to me, although of course it had been awful going through all the miscarriages. By the time my next appointment came round, 3 months later, I was pregnant with my son (now 17). I'm 100% sure the doctor meant well, but I can see why a GP might be deliberately non-committal with their advice. I can also see that this hedging of bets might be frustrating to listen to.

My oldest has autism and ADHD, though is very gifted intellectually and copes pretty well socially now, after various difficulties in primary school. His cousins, whose parents were much younger when they were born, also have autism, so other genetic factors are in the mix here. Otherwise, our kids are pretty healthy and thriving.

I am rather enjoying having teens at this stage of my life (but was able to take early retirement).

I didn't have any other children; so was absolutely delighted if a bit surprised to have a family in my 40s.

My obstetrician said she would be really happy to support me through a third pregnancy, but we felt done with 2 at our stage in life. We were considering that we were lucky to have 2 healthy children, that the risks of problems would increase further with a subsequent pregnancy and what would the impact of having a third, disabled child be on our existing children (and on us)?

I was diagnosed with PCOS in my 30s and have a family history of diabetes, so I wasn't all that surprised to have gestational diabetes, which was very well controlled with quite a careful diet lowish in carbs and high in protein and vegetables.

I went for a scan at around 11 weeks with Prof Nicolaides in Harley Street, for my second pregnancy. One set of decisions is around which investigations to have, to get the information to manage the risks.

I found it very helpful to think that there was over 90% chance that nothing was wrong with the baby, for example, rather than thinking, oh there might be a 3% chance of Downs or whatever.

I hope these random thoughts might be helpful and wish you all the best of luck, whatever you decide x.

I think she is stressed to ribbons and wanted the GP to say something to take the decision out of her hands, in effect. Clearly this was an unreasonable expectation but we can all sympathise with why she feels like this. She needs to speak to the FPC for some stats etc but even then, it won't help what is clearly a difficult decision. I wish her well, it is a heartbreaking decision to make, either way. We can be a little kinder, yes?

I was in your position at 42, totally shocked to be pregnant, first and only child. I have heart disease and so wasn't sure I could keep it, however my Gp was very good, got me an emergency scan appt where I found out I was actually 20 weeks pregnant, no symptoms at all. Unfortunately that's where things came to a halt and I had to actually chase midwife myself to carry out a ' booking in' visit. Keep chasing the midwives to get an appt as soon as possible to help your decision. Btw pregnancy was fine, C section and sterilisation at 37 weeks, DD is absolutely fine. Good luck

You said you still have a young child - I wonder how old the child is, because it must have been a while ago that you used maternity services. They (and the NHS) have deteriorated changed a lot over the years.

I can sort of understand why you hoped for some information from the GP but that was unrealistic I'm afraid. I do think that it's a potentially sensitive area, and if the GP talks to pregnant women in their 40s about the risks, there is a risk that they would feel judged for getting pregnant and unsupported by the GP - I don't think they can win really and the only safe option is to be on the fence. Some signposting could have been helpful (eg suggestions about pregnancy choices counselling, where to find info, etc). But GPs don't do pregnancy tests, there is absolutely no need when women can and do get their own very accurate tests.

There is a book called "Expecting Better" by Emily Ostler that I read in my first pregnancy - years ago!! And she might have written other relevant books since then. She presents it as evidence-based info about pregnancy.

If you want opinions/advice about what you should do, there is a "pregnancy choices" board where you'll hopefully get reasonably balanced responses.

And do ask your DH to consider a vasectomy, he is surely too old to father another child.

I agree.GPs are overwhelmed with actual ill people. There just isn't the capacity for pregnancy theoreticals. It isn't hard to find info but it's too time consuming to expect your GP to do it. Either do it yourself or pay privately.

Every pregnancy is different, even in the same person. GP’s don’t have a crystal ball. If someone is pressing for answers to specific questions, they’re
the type that gets in the huff when something different happens. You need
a midwife appointment for maternity advice not a general practitioner. They also don’t have crystal balls either though.
If you’re asking for statistics/odds then googling is as good as anything Google scholar for facts).
At the end of the day, there’s an increased risk of many things but everything could also go 100 ok. I suspect you know this full well. YOU need to decide what you want to do, not expect others to help you decide 🤷🏼‍♀️

Pregnancy at mid 40s seems very common nowadays and it’s probably too early to tell how yours will develop. My friend also had a similar thing happen unexpectedly and she is now 8 months pregnant at 45 having already a teenage child, all going well under the watchful care of a close relative who is an obstetrician and told her that as long as she felt well and the baby developed healthily, there was nothing to worry about. The fact that you were planning sterilisation probably makes you doubt even more but at the end if the day statistics are just that and can’t predict what will happen to you. All the best!

https://eu.usatoday.com/story/news/nation/2023/07/30/pregnancy-after-40-a-rising-trend-over-past-3-decades-5-things-podcast/70491478007/#

I was unexpectedly pregnant at 44 with now DS (21). I had an amniocentesis test because the risk of Downs was high, and we were prepared to terminate on the grounds that when we were older, care might fall to our DD who didn’t deserve that possible burden. As it turned out, there were no issues, the pregnancy and birth were easy and I have been fit and well.
I hope you get all the information you need.

If it helps, I had my youngest at 43, my husband was 50. I had gestational diabetes.
I was under the care of a consultant due to my age and had to be induced 2 weeks before due date to the risks to baby due to my age & gestational diabetes. Baby was fine and years later is fine. Being induced wasn’t nice for me, I prefer a natural labour. But the consultant felt it was necessary to reduce risks to baby. It worked out fine. It was my hardest pregnancy & birth but that’s how it goes sometimes.
I think you have to do what feels right for you.

Good Lord, my hospital is busy but I'd hate anyone to get the message that you should make decisions about a potential termination based on your Google search.

OP, I had gestational diabetes in all my previous pregnancies, post-eclampsia and my DH was 50 when my youngest DD aged 5 was conceived. I was 39 when I had my youngest daughter, and my last two pregnancies were consultant led.

My point being... it was possibly a risk in each pregnancy, but i went ahead anyway. Nobody could say that it might go wrong. I was pretty anxious occasionally but took it a day at a time.

Yes you may well find they are less than thrilled if you continue.

Problem is GP will not want to be seen as encouraging you to have an abortion.
A preganacy at 45 will come with increased risks but no once can say if you will be affected
Chromosome abnormalities
Gestational diabetes
Pre term birth
Still birth
Pre eclampsia
Perhaps only more definite indictor is that if you have high blood pressure or suffered from any other ailments in previous pregnancies.
I would suggest pushing for cvs or amniocentisis as soon a medically possible

A bit younger at 43 but I had my dd and had a great pregnancy, no bother at all. Straightforward birth. She is now 14. All positive.