Rejected! Please help me understand why!

[Jenne]

So, I did write back to the midwife and ask why she is telling me I'm too high risk for home birth. My RE thinks it is fine (which suprised me!).

What I told the midwife:

I have MTHFR and will continue on aspirin and Metanx for the duration of the pregnancy.

I have PCOS and will continue on metformin for the duration of the pregnancy.

I have hypothyorid and will continue on synthroid for the duration of the pregnancy. I am followed closely by an endocrinologist.

I am overweight. Not grossly but some. I eat a healthy diet of vegetables and meat and little processed foods. I walk daily.

------------
I guess I was just really shocked because the only thing that is different this time is the MTHFR which doesn't put me at risk for birth complications. Obviously, I don't want to be attended by someone who doesn't think I am safe but I am really, really upset and hurt. Gah!

Jenne

[isabchi]

Ask her why she rejected you. I have not idea about the medication that are you taking. I had me homebirth (HBAC) with MTHFR, but I don't took any meds,not even baby aspirin and don't have your other medical issues. Anyway, been overweight I don't think would a reason for the rejection.

[Manessa]

I know that my midwife wouldn't attend a homebirth of someone on metformin. Also, the baby aspirin can cause a lot of bleeding, so that may be another reason. I'm sorry
Have you tried any other midwifes in your area?

[Jenne]

She finally got back to me today with, "I do not take clients with medical issues. Some midwives may."

Okay. At least I know...

Thanks for the replies! I have found a couple midwives to interview who aren't freaked by my "issues!"

Jenne

[turnquia]

I think it would't be an issue to find a midwife to take you with one of the issues you mentioned but with all of them she feels nervous. Thankfully she was honest with you and you can look around for others

[mwherbs]

I am sorry that you are upset but as I read it-

MTFHR does equal higher risk of pregnancy related complications-

the metformin/PCOS alone would concern me , that she attended you with that level of complexity is comendable and asserts how much she has taken who you are underconsideration despite your illnesses -

[msmiranda]

Just curious, why would PCOS and metformin be concerning? I have not stayed on metformin in my two previous pregnancies but intend to stay on it next time to help prevent GD. I had two completely uncomplicated natural births, the second at home with a midwife who knew I had PCOS and GD (I am not overweight, however, my babies were small, and they came on the earlier side of normal). I do not think of myself as a particularly high-risk case. What is your concern, mwherbs?

Sorry to hijack, OP ... and what is MTHFR?

[mwherbs]

so metformin isn't really the problem but does point to the inablility to get this undercontrol via diet- so how much oxidative dammage has been done to the micro circulaiton?

here is one review you can read full text- they evaluate 15 studies

http://humupd.oxfordjournals.org/cgi...tract/12/6/673
-----------------------------------------

Methylenetetrahydrofolate reductase (MTHFR)- is a fairly rare genetic disorder- the genetic mutation inhibits production of the enzyme that metabolizes folic acid-which results in high amounts of homocysteine building up in the body- with risks of thrombosis, heart attack, stroke (in young people)- any of us with a degree of folic acid deficency can be at higher risk for these things- homocysteine is irritating to circulatory system -

[Theoretica]

So would Metformin itself be a reason not to HB then? I guess I"m not understanding it's relevance to a homebirth situation-not trying to be annoying or dense here LOL

[msmiranda]

Originally Posted by mwherbs

so metformin isn't really the problem but does point to the inablility to get this undercontrol via diet- so how much oxidative dammage has been done to the micro circulaiton?

here is one review you can read full text- they evaluate 15 studies

http://humupd.oxfordjournals.org/cgi...tract/12/6/673
-----------------------------------------

Hmmm. Well, I was able to control my GD fine with diet, I was just planning to stay on metformin to help prevent it from occurring next time ... I'm pretty sure my MW won't have a problem with that. I'm definitely aware of potential risks of GD, and that's why I'm very on top of my weight, diet, and exercise. I'm a thin PCOSer with no preexisting insulin resistance if that would make a difference.

[Jenne]

Hmm. Well, that's interesting that the intrepretation is that I'm on Metformin because of my diet. I honestly hadn't thought that that was what the inference would be. The inference I had was, here is someone who has read the research and is doing this preventive thing. That's very interesting. My doctor has had me on Metformin for *years* due to PCOS. My blood sugar hasn't ever been a problem from a GCT, using a glucometer for a month, nor A1C perspective, but she said it was important to be on it when I came off the aldactone and BCP. I have just stayed on it. Huh.

I will say, although I do have the hcmthfr, I have normal homocysteine levels from having blood checks over the past years. The baby aspirin and metanx are again preventative. At least that's how I think about them. It is really fascinating to get other perspectives though!

Anyway, I appreciate the input, and Theoretica I agree. I don't really understand why any of these things would hinder or interfere with my ability to birth normally. And to birth a normal baby. I am under the care of doctors and don't expect that a midwife would be my sole medical reference during pregnancy...

I'll let y'all know how the interviews go...

Jenne

[turnquia]

Originally Posted by Jenne

Hmm. Well, that's interesting that the intrepretation is that I'm on Metformin because of my diet. I honestly hadn't thought that that was what the inference would be. The inference I had was, here is someone who has read the research and is doing this preventive thing. That's very interesting. My doctor has had me on Metformin for *years* due to PCOS. My blood sugar hasn't ever been a problem from a GCT, using a glucometer for a month, nor A1C perspective, but she said it was important to be on it when I came off the aldactone and BCP. I have just stayed on it. Huh.

I will say, although I do have the hcmthfr, I have normal homocysteine levels from having blood checks over the past years. The baby aspirin and metanx are again preventative. At least that's how I think about them. It is really fascinating to get other perspectives though!

Anyway, I appreciate the input, and Theoretica I agree. I don't really understand why any of these things would hinder or interfere with my ability to birth normally. And to birth a normal baby. I am under the care of doctors and don't expect that a midwife would be my sole medical reference during pregnancy...

I'll let y'all know how the interviews go...

Jenne

I does't mean you won't or cant have a natural birth with no complications. What your midwife and some of the other midwives here think is that given everything your risks of complications go up.

If you had probably just one condition that was being treated and followed by aother doc it wouldn't be a big deal. But when you add on numerous health issues, the more risks you have.

You may have a slight risk of increased bleeding because of the meds from the MTHFR. Then having the thyroid issues may cause another set of complications, and same for the metformin. Sorta throw everything together and it no longer remains a very low risk situation for at home.

Its kinda like here. I have a great birth history, great health history. I am having twins... that is it two babies, two placentas and you'd think all of a sudden I've grown 4 eye balls. Monthly ultrasounds, NST, bioprofiles etc etc. It doesn't take much to tip the scale from being low risk and ok for homebirth, to still low risk but maybe too much is going on for a homebirth. (I am lucky in my area homebirth midwives take twins.... many states do not).

Also talk to other providers. Just because your midwife says no, does't mean they all will. She was being honest with you and saying she doesn't feel comfortable, and maybe you won't find someone else comfortable. But that does't mean you cannot have a wonderful natural hospital birth with an OB

[msmiranda]

Originally Posted by Jenne

Hmm. Well, that's interesting that the intrepretation is that I'm on Metformin because of my diet. I honestly hadn't thought that that was what the inference would be. The inference I had was, here is someone who has read the research and is doing this preventive thing. That's very interesting. My doctor has had me on Metformin for *years* due to PCOS. My blood sugar hasn't ever been a problem from a GCT, using a glucometer for a month, nor A1C perspective, but she said it was important to be on it when I came off the aldactone and BCP. I have just stayed on it. Huh.

I will say, although I do have the hcmthfr, I have normal homocysteine levels from having blood checks over the past years. The baby aspirin and metanx are again preventative. At least that's how I think about them. It is really fascinating to get other perspectives though!

Anyway, I appreciate the input, and Theoretica I agree. I don't really understand why any of these things would hinder or interfere with my ability to birth normally. And to birth a normal baby. I am under the care of doctors and don't expect that a midwife would be my sole medical reference during pregnancy...

I'll let y'all know how the interviews go...

Jenne

Based on the studies I have looked at, included in the link mwherbs provided above, staying on metformin is absolutely the right thing to do. I am kicking myself for going off it last time! I agree about interviewing other midwives -- you may well find someone who will take you. I can't see the PCOS/metformin thing as an issue at all to begin with. If you developed GD while on metformin and had to have insulin, then yes, you would have to be under the care of an MD (OB or endo) and would have to transfer care at that point, but there's no reason to assume that will happen. So really it's only the other issue to contend with ... good luck in finding a provider!

[Jenne]

Thanks for the variety of responses! I have 3 interviews lined up, having disclosed health "issues" already. I feel really great about that.

Jenne

[Manessa]

I'm glad you were able to find some midwives willing to work with you. I'm sure you'll find someone great.