Are multips "high risk"... - Page 2

[mediumcrunch]

Parity does not make you high risk. Some providers are afraid of grandmultips because they don't care for them very often, if at all, depending on where you live.
Yes, we are at a higher risk for PPH but it is not a given and expectant management is sufficient.

I am a grandmultip (#9 in June), VBAC, GBS+, hx of preeclampsia, and I'm a redhead (gasp). Out of all that my multiparity is the least concerning to my careproviders. I have had providers in the past make more of an issue of the color of my hair then the number of babies I have birthed.

IMO, totally opinion not backed by any evidence-the younger the provider (especially OB's) the more trouble they will have with grandmultips. If you are in an more urban/suburban setting you will also have more issues finding someone comfy with grandmultips. Just my $.02

[mwherbs]

OP what is the maternal mortality where you live? I know that there has been a steady push to reduce maternal mortality in China and that it has dropped quite a bit from something like 60/10,000 births (the US had that maternal mortality rate in the 1920's-30's) to 17/10,000 births in more recent times but that there is still quite a bit of variation depending on resources , location and population- so it may very well be that your doctor is talking from experience when commenting about grandmultips being high risk in the region of the world you live in. Now it may not be true for you or not completely true but is something to consider when this doc is caring for you.
so some of the things that grand multips do run into, now we are talking world wide - hypertension as you have mentioned, pre-eclampsia, anemia and pre-term birth, higher incidence of twins,higher incidence of abruption, Uterine rupture on unscarred uterus. Most likely few of these will apply to you but when looking at world populations of birthing women these are the potential risks during pregnancy.

[Xiaohua]

Originally Posted by mwherbs

OP what is the maternal mortality where you live? I know that there has been a steady push to reduce maternal mortality in China...

You know, I have no idea. I suspect that there is a huge variance between rural and urban areas of China. In many areas of urban China the c-section rate is 60% or higher, if the patient has the funds to pay for it. But I don't think that is the case here. The OB I am seeing is an Australian, though he refers to his training as "British", whatever that means.

Originally Posted by mediumcrunch

IMO, totally opinion not backed by any evidence-the younger the provider (especially OB's) the more trouble they will have with grandmultips.

This OB is actually an older man. On the one hand I'd think that because he has more experience, he might be more hands off, but on the other hand maybe he's seen a lot of older, lless educated, less healthy (poor nutrition, no access to contraception - so perhaps pregnant unintentionally) gand multips and really has seen some bad complications. (I am not saying these things don't happen - they can and do. I just don't feel you can apply a blanket statement to a whole bunch of pregnant women based on parity.) He did mention that his last job was working on some Pacific sea island with an indigenous population and he saw some really scary things with grand multips who wandered in "from the bush" (??) after several days in labor. He specifically mentioned uterine rupture, so perhaps he has seen enough of that to scare him. (And I doubt we are talking VBAC situation here.)

I did a google search last night on the risks of grand multiparity and found some interesting stuff. You can basically find a study to support any line of thinking. The only one thing that everyone seems to agree on is that grand multips have a higher incidence of fetal macrosomia. The big problem with the studies I have found, is that many of the studies are outdated (not surprising, since grand multiparity is on the decline), there are a bunch of definitions of "grand multiparity" (ie. starts with 6th baby, 8th baby etc), and a LOT of the studies were done in developing countries where maternal health and the quality of healthcare varies greatly from current standards in western countries. It was kind of funny reading all the studies - some find increased risk and some find no increased risk for PPH, placental abruption, shoulder dystocia, uterine rupture, stillbirth, placenta accreta/percreta/increta, you name it. One study even had me chuckling because it claimed that CPD can occur in grand multips with a history of proven pelvis, because secondary pelvic contracture (I think that is what they called it) should never be ruled out. !?!?!

Anyway, I am less concerned (at this point) with the risks of delivery, and more concerned about the actual risks of PREGNANCY for grand multips. If I decided to UC again, then the delivery is in my hands. But I AM stuck doing prenatal care with this practice, and I do not want to go looking for problems where there are none. With my last UC I had a midwife for prenatal care, so I only saw this OB practice a twice to establish a file. I stopped going after 20 weeks, so did not have to fight them over anything in later pregnancy. My midwife, obviously, was great and we did not have disagreements over prenatal tests and interventions. With my first UC I did not have a midwife and did use this same practice for prenatal care up until the day I delivered. Toward the very end (after 40 weeks) it was really stressful, with them wanting NST's and ultrasound screening for low fluid levels, pushing for induction. Baby came at 41 weeks in a beautiful UC several hours after I left the hospital for NST. (I was lucky they didn't realize I was in labor already, because contractions were clearly showing on their fetal monitor...)

Anyway, from what I can tell grand multips are higher risk during pregnancy for pre-eclamsia, gestational diabetes and macrosomia. I am not at all worred about pre-eclampsia, but I am worried about the GTT. I have never failed one before (only did this with two of my pregnancies, with two others I did the midwife recommended 100 g carb breakfast thing), but I do not want to do this test. A woman on a healthy diet is NOT going to chug 50 g of sugar syrup at one time, so of course it's possible to get wacky results! I'm not sure if they'll "let" me opt out of this one. And the other risk or macrosomia, I guess that will be a fight to stave off induction, but hopefully that won't be so hard to manage.

Thanks for letting me ramble on; it may seem all jumbled to you but it really is helping me get my thoughts in order!

Serena

[mwherbs]

Serena, I am glad to talk with you. My maternal grandmother had 15 kids and many in my extended family have large families. I have also cared for many many grand and great grand multips. I didn't want to portray a terrible pic for you just some of the risks I have either seen myself or when talking with mws who have worked in other countries what they have encountered. I think that everywhere has to guard against the poor type of care America has fostered/exported all over the world yet on the other hand there are things to be wary of and find our own ways around them if possible. So your British trained OB could be a good one, I have worked with British trained midwives and one doc and really liked them, I felt there was more of a sense of normal in their views of birth.
as for glucose testing, carb loading 50-100 gms extra for atleast 3 days before the test nets a more accurate test with less false positive readings. Take care.

[Xiaohua]

mwherbs, thanks for the response. I just went back and reread your other post. The list of general risk factors is helpful to have summarized, and it's easy to rule certain things out right away (like twins, anemia). Once you have knocked a few things off the list, some of the other things don't worry me much (like pre-term birth, PIH). Then the rest (uterine rupture) are just those things that you have to accept as possible, but not likely risks. It just makes it easier to accept have a shorter list of "problems" than a huge list of things that are "likely" to go wrong.

Originally Posted by mwherbs

as for glucose testing, carb loading 50-100 gms extra for atleast 3 days before the test nets a more accurate test with less false positive readings. Take care.

And this is very interesting... when you say extra carb loading for three days, does that mean sugary or starchy carbs? And how much extra per day? Although I really want to decline this test, part of me wants to do it so that it can come back normal and it's one less thing they can try to "scare" me with. So any hints on how to not "fail" the GTT welcome. And on a side note, is it just here, or is everyone doing this at 24 weeks now? Back when I started having babies it was 28-30 weeks, but it seems to be getting earlier. Any benefits to doing it earlier?

Now if I could just figure out the best approach to the GBS screening...