40+ Mamas trying to avoid the routine AMA testing and monitoring

[MarineWife]

I'm 40. I'll be 41 in March, so before this baby is born. This will be my 4th child (11th pregnancy). My main HCP is a MW and I'm planning my 2nd home birth. I've never been one for too much testing and screening and monitoring. Since my last 2 kids were born when I was in my mid to late 30s I was offered NT scans but declined.

This time I opted for a NT scan with a MFM doc that my MW refers to but not because I was concerned about chromosomal abnormalities. After so many miscarriages (one that took 3 weeks from the time the baby died to occur) I needed the reassurance that my baby was still alive. The NT scan was fine but then the doc went into his schpeel about all the things I'm at a higher risk for because of my age.

In addition to the Level II u/s that I was already planning to have to make sure everything looks good for my home birth since I've had a previous c-section, he wants me to come in for extra monitoring in the 3rd trimester. Specifically, he wants me to have periodic growth scans and either biophysical scans/tests or non-stress tests. He says because of my age and other risk factors (PCOS and RPL) I'm at a higher risk for IUGR, GD and early placental deterioration. Oh, he also wants me to have a 1 hour GTT next week 3 days after I stop taking metformin, which is an insulin resistance drug that used to prevent miscarriage in women with PCOS, even though I have never been diagnosed with insulin resistance, pre-diabetes or diabetes. That would be next week when I'll only be 13w5d. I don't really buy into the whole GD thing, anyway, and would normally decline the later testing.

I'm really confused this time about what's really necessary and what's not, mainly because of my age. Does a couple of years, being in my 40s, really make that much difference? I don't want to do anything that would put my baby at risk so I do want to have the testing and screenings that are truly necessary (if there are any). But I don't want to fall into that trap of having a bunch of unnecessary stuff done that leads to possible false positives or assumptions of more problems and on and on.

The MFM doc understands that and agrees. For example, he told me that since the NT scan was fine he recommended against getting any of the blood tests like the AFP or triple screen because the NT scan is the most definitive (other than amnio and CVS, which I will not get done) and the blood tests result in too many false positives. In other words, I wouldn't gain anything from the blood tests but might be subjected to unnecessary stress and worry. Because of that, I'm inclined to believe him when he says that I should do this or get that but then again, I'm not.

I'd love to get other people's opinions on all of this. If you are in your 40s and are normally disinclined to testing, screening and monitoring, what do you think of all the AMA stuff?

[Curlyfry7]

I feel I'm kind of middle of the road in terms of testing. I will be 40 in a few weeks, so will be 40 when the baby is born. My 1st baby was born when I was 35, almost 36, so I've been listening to the "AMA"...well, crap I'll say, LOL, for every kids I've had.I would say that so far, I've had healthier and easier pregnancies than many people I know that are 10 years younger than me.(fingers crossed that this continues.) I've been told some of the stuff you've been told, but not others. I do not have PCOS, so that would add something to your case that is not in mine.

I've had an early GD test with my DD and with this pregnancy (but not for my son-also an OB office, but it was not recommended to me although I was 35). For me, the 1st time (at an OB's office) the reason was my age. This time (with midwives at a birth center), it was due to my mother being pre-diabetic, so a possible genetic predisposition to having blood sugar problems. I agreed both times. To me, doing the test has no risk to the baby, and in the whole scheme of things is pretty non-invasive. If I did develop GD and it went undiagnosed, there could be risk to the baby. So although I didn't think there would be any problems, I figured that other than inconvenience, there was pretty much no downside to doing the test, and possible benefit.

I did not do the triple screen due to the risk of false positives at our "advanced age". However, I DID have an amnio with each baby, and have one scheduled for this one as well. I do feel there IS actual increased risk of chromosomal abnormalities with increased age, and for our family, we feel we need to know if there IS a problem to give us the best possible chance of dealing with it-pre-birth care, immediate post-birth care, research into treatments/further testing etc etc for whatever condition may show up. I also work part-time and plan to return after the birth again, and if our baby had special needs, we would need to make different arrangements in terms of my job and child care, although obviously we would have time after birth to do so for this. I know a lot of mamas say that finding a problem would not change anything in terms of their birth, by which I assume they are referring to terminating the pregnancy if a problem did show up. For us, the reasons are so much complex than that, and would only involve even the consideration of hat option in the most severe cases.

I have not had any other testing recommended that I can remember, other than routine bloodwork. I don't know if what I have written helps you, but maybe it can offer a viewpoint for you to consider. Best of luck deciding! and HH9M!

[MarineWife]

I've been hearing the AMA thing for a while, too, but it seems to be more pronounced now that I'm 40. For example, an OB I saw a few times said that at 35+ the risk of Down's Syndrome is something like 1 in 381 but at 40+ it jumps to something like 1 in 80. Those numbers might not be exactly right. That seems like a big difference. He did say, though, that I still had something like a 95-98% chance of having a baby without Down's Syndrome so it must not be that bad.

I did talk to my MW about the GTT. She said that since I always fail the 1 hour test, blood sugar problems are an issue for me in one way or another. I guess I'll do the test just to make sure. I'm not convinced that a diagnosis of GD and the subsequent treatment plans aren't harmful, though. Limiting diet and possibly taking insulin while pg bring a whole other group of risks whereas the supposed dangers that come with GD may not be all that serious. IDK

[matyja]

Hi Mamas!

I'm 41 and will be 42 when baby #5 is due. With the last two pregnancies, I had different tests done.  With one at 35 yrs, we had blood tests done which came back pos. for Down's and therefore cause us great angst and worry until we had the amnio which came back fine.  With one at 38 yrs, skipped the blood test (because of the false pos. the previous time) and just went straight for amnio - which came back fine.  Also last pregnancy I developed GD and had to be on insulin.  With the help of a naturopath and accupuncture, was able to lower the dose of insulin in the end.  With this pregnancy, we'll go straight for amnio again, and probably have to do some type of monitoring for GD - which I'm not keen on, but it's for the best health of the baby.  As for ultrasounds, etc. we had one done this week to confirm due date - which is accurate with my LMP.  Then tech comes back in and says we're going to measure NT - not because there's a problem, but because of my age and the timing is right for it.  I don't know that I would go on the results of the NT scan alone, which is why we're still going ahead with amnio (scheduled for Feb. 14th of all days!).  Once we get those results, we'll breathe a bit easire.  Also.. I'm just cuirous how old hubby's are for all of you?  That can also play a big part in what testing is done, because after all, half of the jellybean's genes come from them right? 

[MarineWife]

Because I've had so many losses, I'm not willing to take the slight risk of miscarriage associated with amnio and CVS. Neither of those tests is 100% accurate, either. None of the results of those tests would change anything that we'd do at this point. The only way a positive result would change anything for us would be if we had to change where we give birth. Any problems that would affect that can be detected on the Level II ultrasound, which is the only reason I'm having that done. If that were going to birth in a hospital, I probably wouldn't even have that.

My dh is younger than me but just by a few months so he was 40 when we conceived. I'm really not concerned about chromosomal abnormalities. While the statistics may say that older women are more likely to have babies with chrom problems, the actual likelihood of any one individual having them is still pretty slim. I'm more concerned with the idea that I need all this extra monitoring toward the end. I guess for me it's another one of those questions about whether or not there's really anything specific to me as an individual that makes those things necessary or if it's just a slight statistical increase in risk. KWIM?

[BHappy]

hey marine wife!

i am 43 now and will be when little one is born. oddly enough, i have not yet encountered the "ama schpeel" with my midwife or anyone in her practice (i just met one of the OBs the other day when i had my 20 week ultrasound. she mentioned nothing about ama either.). i declined all testing in the beginning, and the ultrasound i just had showed all is well, to the extent it can. the reason i declined was not because i don't think risks are statistically higher with older mamas, but from what i've read and understand, the tests are often "false positive" or the equivalent of that, and lead to further interventions, which i was not interested in at all. i would not choose an amnio, for example. that's just me. i am not sure what pcos and rpl are, and that might cause me to think differently if i had them. as for the age thing, i don't think that suddenly, once we cross that 40 mark, that we are necessarily at a hugely greater risk. it's just statistics. and the chances are still very small. like you said, 95%-98% fine.

as for the gd discussion. with my last pg, i declined gtt, and my girl was born large at 35 weeks, with shoulder dystocia. so this time, just to be safe, i took the one-hour test early on in the pg. i failed it moderately. i think my # was 140 or so. no biggie, but it pushed me over to the three-hour test. instead of doing that (which sounds horrible to me), i decided to consult with a dietician specializing in diabetes. i am currently testing my sugars once a week, monitoring in case they go haywire at some point in my pg. i feel that is a more accurate way for me to know how my body is handling what i actually eat. my sugars have been great so far (except that one morning i ate waffles with syrup for breakfast, lol).

i really wish you the best in making your decision. go with your intuition and what makes sense to you. hugs.

[MarineWife]

Thanks, BHappy. My midwife hasn't made a big deal of my age. It's the doctors that do. That's part of the reason that I question what they say. If it were really that much of a concern, my MW would be concerned as well. PCOS is polycystic ovarian syndrome. As far as I know, it's not something that would affect the health of the baby. It can cause infertility and a higher risk of early miscarriage. It is associated with insulin resistance and diabetes so can put women at a higher risk of GD. However, I think that's if one has blood sugar issues to begin with. I don't so I'm not sure that I am at a higher risk for GD than anyone else. My MW did tell me that, since I have always failed the1 hour test, it is a part of my medical profile so I should have the test done. The 3 hour test is awful. Every time I've done it, I get so sick. I can't imagine how that could be good for a pregnancy or a growing baby, even if it is for a relatively short time.

RPL is recurrent pregnancy loss. I have had 7 first trimester losses. The OB I was seeing said that he considers me high risk only for the first trimester since I have had 3 healthy full term babies. Once I get past that I should be good to go. The MFM doc I saw said I'll be at an increased risk for fetal loss at any time because we don't have a definitive reason for my losses. If I understood what he was saying, he's concerned that I might have an undetected blood clotting or autoimmune disorder that could damage the placenta at any time. I think that, in addition to the GD stuff, is the reason he recommended more monitoring in the 3rd trimester, to check the health of my placenta.

I'd love to hear everyone's understanding of the dangers associated with GD. A larger baby and shoulder dystocia certainly is a big one. I've read and been told my a MW that if a newborn has blood sugar crash at birth from withdrawal from the mother's high blood sugars, immediate and continued breastfeeding will fix that. I don't know if you would be allowed to do that in a hospital. They might whisk the baby away to the NICU for an IV and sugar water in a bottle. Since I'll be giving birth at home, that won't be an issue. My MW is also very experienced with dealing with should dystocia without breaking baby's clavicle. Again, I think a lot of the time the problem with that is the hospital setting where the woman is stuck in a birthing position that does not allow full widening of the pelvis. The last issue I know of early placental deterioration. I don't really know how likely that is. Do you all know of anything else or have info that refutes my understanding? I would really appreciate reading it. Thanks.

[greenmama66]

44 here, - did 1st tri  NT screening- fine as there were 0 markers and free beta test fine- having 2nd tri US in 2 weeks, they said amni was up 2 me t decide if I wanted it- my ND did scare me a bit regarding DS- suggested I get testing- and I did- didn't get an amni - just the NT and beta tests

[awallrising]

If that Dr that is screening you takes-on high-risk patients, say NO unless your MW really thinks it's necessary.  The perinatologist I saw for my NT, told me that something was going on with the umbilical cord & that it could mean pre-eclampsia later.  My MWs were pissed & said that they literally have never heard of that prediction, that this practice takes patients & tends to find remote things that are wrong to make Moms "high-risk" AND that I need to go somewhere else.  I am definitely going elsewhere for future tests where they do not take on patients & just do testing.

[MarineWife]

I go to the peri that my MW recommends. He's good and he totally understands that I'm very hands off and don't want a bunch of unnecessary monitoring and such. He doesn't do regular prenatal care or deliver babies. He may do any subsequent ultrasounds but I don't think he does the NSTs. He just does the initial testing and makes recommendations. Not sure if that's what you mean by "taking on high risk patients".

I did discuss it with my MW. She and her assistant both said that none of the extra ultrasounds or monitoring were necessary for me unless I developed complications specific to me. The peri was just doing his job by offering me all of the "bells and whistles" that go along with general medical care for women in my age. After discussing everything with my MW, I am fully confident that she or her assistant would pick up on any issues like IUGR or possible placenta deterioration and refer me for further monitoring if necessary.

My MW did also warn me that following all of his recommendations would be setting myself up for them to find a problem, which is what I was worried about and what I think you were getting at, Amy.

[awallrising]

I didn't mean that the peri just does future tests, they can actually take over the care of "high-risk" pregnant woman.

[MarineWife]

Originally Posted by awallrising 

I didn't mean that the peri just does future tests, they can actually take over the care of "high-risk" pregnant woman.

Ok. That's what I thought. This doc doesn't do that. He only does testing and genetic counseling. He doesn't provide prenatal care or attend births anymore.