Apparently, I'm "high risk"...

[leaoness]

I had an OB appointment about a month ago that I was not happy with. The assistants in the office were just awful and it felt extrememly impersonal. I also had several questions they never addressed--specifically about birth plans and having an un-medicated birth. Later, my doctor called me and addressed some of the concerns: told me what WAS standard in the hospital and that she could not deviate from certain things. I told her I would consider this information. What finally pushed me over the edge in deciding on having a consultation with a midwife was that I thought my insurance would pay for more than they actually are with the OB. Where I live is basically a black hole for alternative forms of birthing. No centers, no CNM's. There are only 2 CPM's. I actually have a consultation with one today but prior to that I had to obtain copies of my blood work and test results from the OB. That wasn't a hassle at all *sarcasm*.

To my surprise the OB listed me as 'high risk'. I am completely furious with this--especially since she never mentioned this to me. In fact, over the phone she told me that she didn't see a problem with an un-medicated delivery as I was "pretty healthy". I do have some medical issues though, but they aren't extreme. I am a few pounds over what they consider the 'safe weight' for pregnancy. But as it stands, I'm 13 weeks pregnant and I haven't gained a pound. I've actually lost some. So, not a big deal. I also have asthma. The one and only time I can recall having an attack was 7 years ago under a strict coach in high school. I rarely need my inhalers and generally only use them when I'm severly sick with a respiritory infection. The other issue is that I have HSV1--the most mild form of the virus. Again I have only had one outbreak of it in my life, 4 years ago. This virus also typically rarely, if ever, sheds. I was planning on being given a HSV suppressant at 36 weeks anyway merely as a safety precaussion. I did my research after getting pregnant and none of these issues alone would qualify for high risk. I understand that someone with severe cases of each would definitely need a hospital birth--but I don't feel like I fall under that category.  

I do not have high blood pressure. I do not smoke or drink. I walk often and am signed up for a 6 week yoga class. I have read tons of articles on homebirths and I'm in the middle of reading Ina May's Guide to Childbirth. After all that I just can't see myself delivery in a hospital. I tend to be very hard-headed naturally and I can't imagine just rolling over and allowing people to decide things for me during labor. I am panicking. I want this child at home but I'm not sure what the midwife is going to think today when I show up with these records. Can I get a second opinion on being "high risk". Is it stupid for me to start thinking about having an unassisted birth? Are all these small medical issues really factors in delivering my baby? Any information would be great; I'm desperate.

[IdentityCrisisMama]

Originally Posted by leaoness 
 Can I get a second opinion on being "high risk". Is it stupid for me to start thinking about having an unassisted birth? Are all these small medical issues really factors in delivering my baby? Any information would be great; I'm desperate.

Yes, for sure. In fact, at 13 weeks, I would just see a HB MW with a clean slate - no need to bring these "records".  You will likely find a MUCH different vibe with a HB MW and that the concept of high risk is a slightly different animal when going that route. Good luck. 

[mamaharrison]

Originally Posted by IdentityCrisisMama 

Yes, for sure. In fact, at 13 weeks, I would just see a HB MW with a clean slate - no need to bring these "records".  You will likely find a MUCH different vibe with a HB MW and that the concept of high risk is a slightly different animal when going that route. Good luck. 

exactly ;) No need to report your previous appt. with OB. 

It really isn't indicated to take antiviral meds during pregnancy unless you are symptomatic of HSV-2, HSV-1 isn't a concern at all during pregnancy or birth--as many as 90% of the American population would test positive for HSV-1 and upwards of 75% would test positive for HSV-2. I had one outbreak of HSV-2 over a decade ago and didn't even bring it up with my MWs during either of my pregnancies.

If I were you, I would put a call in to the OB and ask her specifically what determinants she used to label you High Risk. That is ridiculous.

I am 5'11'' and was 190lbs prepreg with DD and gained 55lbs and with this one I was 230lbs prepreg and I decided that weighing myself wasn't important this time--I'm pregnant and I am going to gain weight and that is OK and normal. I am a very athletic, big woman and I am in better shape and have a healthier diet than most people I know despite what the charts say. In Florida, being overweight doesn't=high risk for a HB.

[tash11]

Maybe 'high risk' is just your drs shorthand for 'kind of a  bitch' (I don't mean bitch in a bad way, just that you were going against what she was recommending with drugs, and actually asked questions, etc). I have gotten that at more then one drs office ;)

I would say interview with both CPMs, and go interview another OB. Most CPMs like a 'backup' OB jic, and for things they can't do (like ultrasounds and blood work). fwiw I haven't ever had an OB, they just don't like me (probably due to the 'bitch' factor ;) )

[fayebond]

hehehee, I was labelled 'high risk' too, and I'm such a people pleasing type of person its not even funny.  But I wanted the OB to answer my questions, and abide by my birth plan, and that clearly was too much to ask.  At least tehy were honest that its too much to ask, but still, I'm paying them, tehy should be taking care of me, not me walking on eggshells around them.  Its funny, I would not be even considering homebirth if I could have gotten someone to respect my wishes in a hospital (ANY hospital, we live in a big city and I interveiwed FIVE).  I like hospitals, I just don't agree with the nearly medieval way their rules work.  Check out anyone you want to, but it sounds like homebirth is for you, especially if you are a my-way person.  You might not be as strong a personality in labor, and regret it if you let people walk on your birth plan for no reason.  I know I regretted it with my first hospital birth (and I wasn't asking for alot, like I said, I'm pretty easy going).

I would go ahead and show her the records if there is anything there like bloodwork that you want her to see, otherwise, feel free to forget them.  And she shoulldn't need a backup OB to order labwork or a US, my MW just orders it herself. 

[trimommy2009]

I was labeled "high risk" by two different midwife groups that practiced in hospitals because I was trying for a VBAC, because of this I would have been forced to have an IV, continuous fetal monitoring and sign a C-Section waiver the second I walked through the doors.  I refused and started interviewing homebirth midwives, for me I was very open and honest with the midwives because I wanted them to have all the information.  All three that I interviewed told me flat out...No, I do not consider you high risk.  Emotionally and mentally I needed to hear that.  However, I do agree with the previous posters, provide as much info as you are comfortable giving and then let them pull their own blood work and make their own assessment...then trust your "mommy-self". 
 

[fayebond]

Originally Posted by trimommy2009 

I was labeled "high risk" by two different midwife groups that practiced in hospitals because I was trying for a VBAC, because of this I would have been forced to have an IV, continuous fetal monitoring and sign a C-Section waiver the second I walked through the doors.  I refused and started interviewing homebirth midwives, for me I was very open and honest with the midwives because I wanted them to have all the information.  All three that I interviewed told me flat out...No, I do not consider you high risk.  Emotionally and mentally I needed to hear that.  However, I do agree with the previous posters, provide as much info as you are comfortable giving and then let them pull their own blood work and make their own assessment...then trust your "mommy-self". 
 

+1

[mwherbs]

Do you take any medication for asthma, like a pill? I would call the doctor and inquire why "high risk" was put on the chart... Yes i would recommend confronting and finding out what she has to say, maybe high risk because you are going to see a midwife...
If there is another concern you should have been told.
And i would recommend being frank with e midwives you interview. Best to be prepared snd to care for you properly...

[Buzzbuzz]

The magic of google: 

Potential asthma complications:  "may include high blood pressure and preeclampsia, a disorder that occurs when high blood pressure is accompanied by fluid retention and leaking of protein into the mother's urine, potentially damaging her kidneys, brain, liver and eyes. If the condition results in seizures, it can be deadly for both the mother and baby. Other complications for the baby include an increased risk of premature birth, low birth weight, slow growth and stillbirth."

Also, your history of asthma prior to be pregnant may not determine how your asthma is while pregnant:

"Your asthma may become worse during your pregnancy, especially if your condition is considered severe. On the other hand, about a third of asthma patients improve during pregnancy, especially if their disease was mild before they became pregnant. Another third experience no change. If your asthma or asthma attacks become worse, it will most likely occur during 24 to 36 weeks of your pregnancy... The hormonal changes that occur during your pregnancy may affect your nose, sinuses and lungs, causing congestion and shortness of breath. Your doctor will help you determine if these symptoms, which may be confused with your asthma or may trigger your asthma, are actually caused by the disease."

And finally,

"Electronic heart rate monitoring, called "non-stress testing" or "contraction-stress testing," and ultrasound may be used in the third trimester to assess your baby's well-being. If you are experiencing significant asthma symptoms during this trimester, the frequency of the monitoring may be increased. All asthma patients should record their baby's activity and kick counts daily to help monitor the baby, according to their doctor's instructions."

"If you experience a severe asthma attack during your pregnancy in which your symptoms do not quickly improve, there is a risk you may experience hypoxemia, or a low oxygen state. This is an important time to assess your baby's health, and continuous electronic fetal heart rate monitoring may be necessary, along with measurements of your lung function.  Fortunately, the majority of asthma patients do well during labor and delivery, although careful fetal monitoring remains very important. If you are a low-risk patient with well-controlled asthma, a fetal assessment can be accomplished by 20 minutes of electronic monitoring shortly after you are admitted to the hospital."

From the American College of Allergy, Asthma and Immunology's website:  http://www.acaai.org/allergist/liv_man/pregnancy/Pages/pregnancies-and-allergy-asthma-management.aspx

[knittinmama82]

Midwives have different standards than OB's when it comes to risk I'm finding. I have had two csections, two miscarriages, a history of elevated blood pressure in pregnancy, by the time I have my baby I will no longer be in my 20's, and I'm sure there are plenty of other factors that would make me high risk.  Heck, the two sections are enough to send an OB running from the room screaming.  I was actually very nervous to even begin interviewing midwives because I was already told that I would never be able to VBAC.  Imagine my surprise when I told my midwives my history and they said that I was going to be fine and that they were going to treat me like a normal pregnant mama even if I've had two sections!

Start looking around and interviewing and I think you will be pleasantly surprised :)

[tonttu]

Yep same here , I had 2 cs , one after a complete rupture , afterwards 2 natural deliveries , then another cs with a scar any doc would consider a no-no to vbac , but still delievered a healthy baby via vbac only 18 months after the last ( oh so " dangerous " ) cs .

Honestly , most docs go way overboard when it comes to labeling women " high " risk . Seems to me , that nowadays almost anybody is by their standards .

You are so early in your pregnancy , you have plenty of time to explore your options and like some of the others said , you will probably be pleasantly surprised by  the reactions you will get by different midwifes
 

[fairydoula]

Originally Posted by IdentityCrisisMama 

Yes, for sure. In fact, at 13 weeks, I would just see a HB MW with a clean slate - no need to bring these "records".  You will likely find a MUCH different vibe with a HB MW and that the concept of high risk is a slightly different animal when going that route. Good luck. 

This is such irresponsible advice. You just told her to LIE to her potential homebirth midwife, who will then be responsible for her and her baby's health and well-being. I am so SHOCKED. What could you be thinking?! As a former apprentice, I would be appalled and extremely concerned to have a client whom I discovered later obscured important medical records! Of course it's important to know these risk factors! They are RISKS! Mom -DO you really want to put your baby's life in danger because the OB and their staff was impersonal and brisk with you? Because they labeled you "High Risk"? Perhaps they labeled you high risk, because, my dear, you ARE high risk. Having that designation does NOT mean that anything bad is going to happen to you! It just means that there is a higher statistical probability that something might.  I would highly recommend that you find a good, experienced Doula who can help you discover exactly which things are most important to you during labor and delivery and get really comfortable with her. She will be there for you and your partner and help you have a great experience even in the hospital. There are a lot of benefits to being there, especially when you are dealing with several different potential problems. LIke I said, it's unlikely that ANYthing will go wrong, but a responsible homebirth midwife will tell you, if you give her all the information you have so far on your health and risk factors, that you are not a good candate for homebirth, and that a doula is a great option for you in the hospital. Best of luck and congrats to you on your impending bundle of joy!

[Sharlla]

Really?  i didnt see anything in that post telling the OP to lie.  

[kgdg]

not providing a caregiver with health recrods or information you know is relevant is a lie of omission surely

[IdentityCrisisMama]

Quote:

Originally Posted by fairydoula 

This is such irresponsible advice. 

 

Quote:

Originally Posted by kgdg 

not providing a caregiver with health recrods or information you know is relevant is a lie of omission surely

Oh, no!! You misunderstood some previous posts (mine and others) - or I did not make myself clear. Sorry. I did not mean AT ALL that the OP should not tell her new provider her medical history. I just meant that she does not need to dwell on the other provider's "diagnosis" of high-risk. This is a consultation visit opinion, not medical history, imo. I liken this to getting a second opinion. If it were me I would start with the MW and a clean slate - discuss all my medical history and then ask the MW if she thought I was high risk. At that point, I may let her know that I was labeled high risk by a Dr. and see what she had to say. What we know is that the definition of high risk is somewhat variable and it's really something up to you and the provider you settle upon. I hope that clears things up. 

[mamaharrison]

Originally Posted by IdentityCrisisMama 

Oh, no!! You misunderstood some previous posts (mine and others) - or I did not make myself clear. Sorry. I did not mean AT ALL that the OP should not tell her new provider her medical history. I just meant that she does not need to dwell on the other provider's "diagnosis" of high-risk. This is a consultation visit opinion, not medical history, imo. I liken this to getting a second opinion. If it were me I would start with the MW and a clean slate - discuss all my medical history and then ask the MW if she thought I was high risk. At that point, I may let her know that I was labeled high risk by a Dr. and see what she had to say. What we know is that the definition of high risk is somewhat variable and it's really something up to you and the provider you settle upon. I hope that clears things up. 

this exactly!

[kgdg]

where were you when you had a complete rupture? sounds like a horrible experience.

[IdentityCrisisMama]

Originally Posted by kgdg 

where were you when you had a complete rupture? sounds like a horrible experience.

Kjdg - because tonttu's post about rupture is several above this (and from a couple of weeks ago), you may want to use the quote feature (just to the left of the "reply" button) to highlight the comment you are referring to. This helps keep the discussion easy to follow. 

[Ratchet]

Just bevause soe doctor arbitrarily labeled your "high risk" it doesn't mean a midwife would look at those same factors ad say the same thing.  So the OB can lanel you whatever they want- the midwife will take the facts into account and make her own decision.

[tonttu]

Originally Posted by kgdg 

where were you when you had a complete rupture? sounds like a horrible experience.

I was at the hospital ! They talked me into inducing , b/c I was " overdue " and since I was young and clueless , I consented , not knowing better  ! 

And after 4 days of hell , my son got stuck on the way out and the mw pushed on my stomach to try and get him out , rupturing my scar from cs 1 . 

But a little over 2 years later , I had a vbac without problems and then another one 2½ years after that ! Only difference that time was , that I wouldn´t let anybody mess with my birth anymore .