Are you considered at elevated or high-risk for this pg? Come chat...

[Guinevere]

I noticed at least a couple of us who have had either previous pg complications or other reproductive issues which would make them high-risk.

I know for myself, watching most of my other gfs have lovely, worry-free pgs and fabulous homebirths has been hard at times, b/c it seems like all I do is jump through one medical hoop after another while pg. So many of the things I deal with during pg go against my natural inclinations, yet they are a necessary evil in order to ensure that everyone ends up relatively happy and healthy.

I thought it might be nice to share with others who have to deal with the stress and worry of a high-risk pg; it can be pretty isolating, at times. And unfortunately, I have often found that the specialists we're required to be followed by happen to be the people least able or willing to provide any emotional support; I've had some doozies of peris over the years!

I'll go first and give you my complications/risk factors for this pg:

* I'm now 36, so I'm officially AMA (aka over the hill, lol)
* I'm a major multipara, as this is my 6th pg
* I have had BP issues during past pg's, which have ranged from severe (pre-eclampsia and eclamptic seizures, fun, fun!) to mild (elevated BP from 30 wks. on, controlled by meds.) This will be my first pg where I start out already ON BP meds, b/c I have developed chronic hypertension in the past two years since Sophie's birth.
* 3 of my 5 children have been preemies, ranging from 31-35 wks. Even my 2 "term" babies were just barely term (36+6 wkrs.) I know far more about the NICU than any parent wants to, and measure my birth success by how few weeks we need to stay there, which I fully understand is not normal.
* I have a clotting disorder, which likely contributed to my pre-eclampsia. I now take baby aspirin throughout my pg's and will do Lovenox shots if necessary.
* I have now had a c/s, with my last birth, so I'll have to deal with all the concerns that go with that when laboring this time around.
* I have a child with a chromosomal anomaly (Down Syndrome.)
* I have gestational diabetes when pg, although it is extremely mild and easily diet-controlled. Frankly, it's kind of a footnote on my hx when compared to everything else.

So, that's my laundry list, lol! Despite all this, my last birth was a planned homebirth and would have been possible, had Sophie not gone into distress which necessitated an emergency c/s. This time around, I'm not yet sure who I want to see -- I have a great HB-friendly OB who is also quite capable at handling most of my complications. I could just go with him. But the care I received from my HB MW last pg, even though I didn't ultimately end up delivering at home, was phenomenal. It really showed me what prental care SHOULD be about, and I don't regret a second of that time with her, even if my outcome wasn't what I'd hoped for or planned. So a large part of me wants to have that level of care again, even if I don't birth at home. I'm still figuring it all out -- heck, I just POS this morning, lol!

What are your plans right now?

Guin

[munkeesmama]

If I go to an OB I'm high risk, If I go to a midwife, I think I barely skim through the radar so to speak. I've had 2 cesereans with a VBAC in the middle.MY first son was IUGR and was induced at 39 weeks. Got stuck and ceserean. My middle daughter was a twin and the other tewin vanished, and she was delivered one day shy of 38 weeks vaginally. My third child was born at 27 weeks 2 days from unknown causes. I do know that I do not make great placentas. I've had 3 miscarriages since my last daughter, and back to back. I'm also overweight and possibly "pre-diabetic" so there's another thing. I don't think i'm high risk though and I'm going with the flow on that one.

[carolhagan]

Originally Posted by munkeesmama

If I go to an OB I'm high risk, If I go to a midwife, I think I barely skim through the radar so to speak. I've had 2 cesereans .

Ditto all that.

I don't consider myself highrisk but I know the OB's would.

[MI_Dawn]

An OB would consider me high risk. I'm overweight, 38, a major multipara (I think? I forget all the labels! This is baby #5). I've had an IUGR baby (Zoe was 5 lbs at birth - term - born at home. I'm quite sure she would have been a NICU baby if we'd been in the hospital.) I had a 9 lb 12 oz "LGA" baby last time.

I am going to see an OB this time, at least at first, just in case I want testing since I'm getting old and all... I can't wait to hear what he says.

[jenholle]

Count me in here...

1. I am also AMA- 35 but turning 36 this month(ug!!)
2. I have a possible clotting disorder and am on baby aspirin- possibly lovenox as well if needed. It's called APLS (antiphospholipid antibody syndrome) and I say I might have it as I had one positive test last year and two negative ones (although they were borderline). Guinevere: Is this what you have too??? You mentioned baby aspirin and lovenox.

Right now I have an OB and a perinatologist who I will meet with tomorrow. This scares me a lot. I had hospital births with both of my kids but had CNM's for both. OB's scare me a little...I have a CNM near me who I LOVE (but not the one who delivered DS and DD) and would deliver at a hospital closer to me than the OB but I'm scared about the clotting issue. I don't think it played a part in my previous pregnancies but it might have and I was just lucky. I'll see what the peri has to say tomorrow before I decide what to do. I do know that the OB is very unmedicated birth friendly. I have three friends who had him and all had unmedicated births. He is also a very kind man. The peri knows his stuff about clotting issues but seems like he's pretty cautious (meaning inductions early if he sees anything and a lot of monitoring). I know in the end what I really want is a healthy baby so maybe I shouldn't be so worried about how I get there but too much medical intervention/monitoring can be a problem...KWIM???

I'm really glad to see this thread!!!

[Guinevere]

While I'm not happy so many of us have potential issues to deal with, it's sure nice to know I'm not alone! Thanks for responding.

Jenholle, I have FVL (Factor V Leiden), which is simply another clotting disorder. Luckily, I'm heterozygous for it and not homozygous, which tends to be more serious. I've heard of APLS, I remember it was one of the things I was tested for, and there are other clotting disorders out there, too, like MthFR. I used to post on a pre-eclampsia board and a scarily large number of us ended up being diagnosed with clotting problems. Hopefully, the baby aspirin will do the trick and we'll both have smooth sailing on that front, with no need for nasty Lovenox shots!

Guin

[preemiemamarach]

Guin, I'm so happy you started this thread! I was actually logging in to start a high-risk april 09 support thread!

Let's see if I remember all of my risk factors:

1. AMA- I'm also 36
2. Preterm prodromal labor starting at 23 weeks last time.
3. Loss of one twin last time around 12-13 weeks
4. Premature birth at 33 weeks (he was gigantic, though- 5 lbs)
5. Pre-eclampsia (my protein only got to a +2 the day before I spontaneously had PPROM, though)
6. History of cervical cancer (2 surgeries)
7. Incompetent cervix (premature effacement, although I had to be manually dilated in labor)
8. History of endometriosis with severe scarring (2 surgeries and my uterus is very misshapen now)
9. DS has multiple medical issues (immune deficiency, FTT, developmental delays, feeding issues, malabsorption) that may stem from a chromosomal disorder (seeing a geneticist in 2 weeks for him)

I *think* that's it! Seeing a maternal fetal medicine specialist on the 19th. My big fear is that this is another twin pregnancy, and that my body won't be able to handle it.

I already spend so much of my time in doctor's appointments and therapy for my DS, I don't know when I'll have time to see the peri!

[Guinevere]

Rachel, I KWYM about the endless appts. Sophie's got her fair share, too, which I try and squeeze into our already very busy schedule, including hippotherapy, which I have to travel 50 miles round trip once a week to accomodate. I hope you find some answers when you meet with the geneticist. Hey, my 33-wkr. boy (first baby) was 5 lbs., too, lol! It actually made me feel better than at least if he had to be born early, he wasn't too tiny.

Did you know about the cervical problems before you got pg last time? Will you have to have a cerclage this time around? I'll be sending you good thoughts and hoping that twin dust stays far away from you (and me, too!) this time!

Guin

[Sundance_11]

I have FVL, as well.

Guin: Have you had clotting issues before? They didn't want to put me on baby asprin or lovenox with DD, and it scared me! Or do they do it because of your other complications, like pre-e? I was only on heparin for 6 weeks PP last time. Do you know any moms with FVL who have had HBs? I'd really like to have a HB, but never really considered it because of the FVL. I'm hoping for a midwife in a hospital this time, but midwives are next to impossible to find around here, and I'm not certain one would take me on, anyways.

Melanie

[preemiemamarach]

Originally Posted by Guinevere

Rachel, I KWYM about the endless appts. Sophie's got her fair share, too, which I try and squeeze into our already very busy schedule, including hippotherapy, which I have to travel 50 miles round trip once a week to accomodate. I hope you find some answers when you meet with the geneticist. Hey, my 33-wkr. boy (first baby) was 5 lbs., too, lol! It actually made me feel better than at least if he had to be born early, he wasn't too tiny.

Did you know about the cervical problems before you got pg last time? Will you have to have a cerclage this time around? I'll be sending you good thoughts and hoping that twin dust stays far away from you (and me, too!) this time!

Guin

How awesome that Sophie is doing hippotherapy! My son's PT has lots of kids in her care doing it, and she thinks it's the greatest thing ever.

We are really hoping the geneticist (who is our 8th specialist, I think?) can help- even if we can get some concrete expectations. He has lower body hypotonia, for instance, and trouble cruising because his foot/ankle tone is awful. It would be good to know what's causing it, at least, and whether we should get him fitted for AFO's or wait and see what happens. I'd also love for him to gain some weight (he has only gained about 1.5 lbs net in 7 months). He has multiple severe allergies as well (corn, soy, dairy, pork, egg, just that we know of), so feeding is a challenge (he also can't chew because of low oral tone). He never nursed and I had to EP for him, but stopped on his birthday in July. He was even reacting to my EBM on an elimination diet by then.

Anyway, I knew I had a chance for cervical issues before my last pregnancy, since I had cancer 15 years ago- but my cervix measured fine up until around 20 weeks. I would like to do a cerclage, if it will help, but I'm not sure it would, since I didn't dilate, I just shortened. I'm hoping the peri will have some guidance on that- since I started contracting so early, it was really tough to know if it was uterine scar tissue or the cervical issues that truly started my preterm labor, KWIM?

Sticky singleton vibes to us both!

[racie0417]

I was not considered high risk during my last pregnancy, but had lots of problems, and might be considered high risk this time around.

-I am anemic when not pregnant and my iron levels dropped below 9 during my pregnancy (despite high iron diet and 2 supplements a day)
-I became hypothyriod during my last pregnancy and my thyroid levels never returned to normal.
-I had pre-term contrax requiring hospitalization and bedrest
-At term, I began regular contrax that came every 10-15 minutes 24 hours a day for 3 weeks
-DS went into distress during labor, was born by emerg. c-section, had APGARS of 1 and 7 and spent 4 days in the NICU due to breaathing problems and related problems from meconium ingestion.

My last pregnancy was monitored by military doctors who were morons (I was overseas). This time I'll see civilian doctors and hope that with better care I have fewer problems. My main issue last time was that the doctors didn't believe me and if they had listened to me sooner all of the above problems could have been minimized.

[claras_mom]

I'm 44 years old.

But otherwise healthy. So we'll see how it plays out with my OB--if he goes all weird on me just on the basis of AMA, I might seek out alternative care. Probably he won't; dd was born when I was 40.

[Fridaxsky]

Looks like I'm joining you here too.

I have Crohn's disease. My last pregnancy actually put me into remission and I haven't had any symptoms since. I'm also on an IV treatment every 8 weeks for it which I think has helped a lot.

Guin & Preemie - I also lost a twin last pregnancy at 27 weeks and delivered at 33 weeks. My girls was 4lbs. 2oz. and came home at 5 lbs.

Hugs and sticky vibes to everyone here.

[JenMidwife]

for you guys taking baby aspirin, do you know if they will have you take it for the duration of your pg or will you taper off @ some point?

I have wondered if I might have some clotting issue that effected the problems w/ my placenta last time, but my OB kind of swayed me against genetic testing. Sigh.

Originally Posted by racie0417

-I am anemic when not pregnant and my iron levels dropped below 9 during my pregnancy (despite high iron diet and 2 supplements a day)

I took a great prescription iron supplement when I got very anemic w/ all of the bleeding w/ my last pg. It's called Repliva.

I hope this pregnancy is easier for you all :

[nisafiin]

I have FVL, too. But have never had any trouble with it. Was planning homebirth before my first three mcs and finding out I am hetero for FVL (blood test after first mc) but most of the midwives I talked to were a little freaked by the FVL. After much searching I found a OB who doesn't consider me high risk and a midwife who might be up for homebirth if my preg goes well.
Cool to find a group w mamas who also have the factor V...

[jenholle]

[QUOTE=JenMidwife;11903445]for you guys taking baby aspirin, do you know if they will have you take it for the duration of your pg or will you taper off @ some point?

I have wondered if I might have some clotting issue that effected the problems w/ my placenta last time, but my OB kind of swayed me against genetic testing. Sigh.


Jen:

At this point I will take baby aspirin throughout the pregnancy. I tested positive once for Lupus Anticoagulant ( which indicates a clotting disorder called APLS-antiphosipholipid antibody syndrome). Testing for that doesn't require genetic testing so maybe it's something to look at if you are concerned about clotting. It's an autoimmune disorder and is relatively common. If I come up positive again or if my platelets drop too low I may have to take Lovenox as well. I'm hoping to avoid that if at all possible. Good luck- you can also request any testing you want even though you are already pregnant...so if you're concerned it couldn't hurt to test
Good luck!!!

[Guinevere]

Hi again, everyone! How are you all feeling today? For me, it's tired and nauseous as usual, lol.

I wanted to address a couple of questions/things about FVL and taking baby aspirin.

My FVL was discovered during testing after my second pg, which ended at 31 wks. in eclampsia -- I was hospitalized for almost 3 wks. before that with severe pre-eclampsia. Hanna was just under 4 lbs. at birth, but I didn't get to see her for almost 5 days afterwards b/c I was still very sick in the ICU. It was not a fun time for either of us.

Since I also had pre-eclampsia with my first pg (which ended at 33 wks.), and statistically, you're not necessarily supposed to get PE again, or if so, even later and milder, I really wanted to know why I was so out of the norm and whether or not I should even consider having more children. Of all the tests I had, FVL was the only one that came back positive, but even then, no one could tell me for certain that that was what was causing my problems. I don't have any of the other issues that can go along with FVL, like DVT (deep vein thrombosis) or recurrent m/c. Still, at least it was a theory, and taking baby aspirin felt like something concrete and positive that I could do next time around.

So I began taking it before conceiving baby #3, stayed on it my entire pg, and didn't develop high BP until 30 wks., never developed PE, and delivered at term with no complications. Hooray! That convinced me wholeheartedly that the aspirin was worth it, and I've taken it in every pg since then, with good results. I try and stop it a couple of weeks before birth, but with Sophie, since she was unexpectedly early, there was just no time -- I ended up with an emergency c/s with her, but fortunately the aspirin did not cause any bleeding issues for me or her, which can be a concern.

There is also a risk in taking it of your baby dealing with ductus arteriosis (where a duct in the heart that is supposed to close at birth doesn't, it's called a PDA for short), but the docs and I felt that the potential benefits of my taking the aspirin outweighed the risks. PDAs are also very common in preemies, and my first two babies had them when I wasn't taking any aspirin (both closed with meds and didn't require surgery.) Sophie had one, too, but it also closed with meds, and was more likely due to her prematurity than to the fact I was taking baby aspirin.

When I was planning for a homebirth with my last birth, my homebirth MW was very cautious overall with me (I had dual care throughout with an OB, for example, and we had an understanding that if my BP went over a certain level that I would be risked out of a homebirth, period), but she didn't automatically turn me away b/c of my history and the aspirin or BP meds issue, for which I was extremely grateful. It was a rare situation, b/c I interviewed several other HBMWs who stately frankly that they wouldn't touch me with a ten-foot pole. And she happened to have a good working relationship with this OB, which is also rare, since the two camps often are very mistrustful of one another. This OB supports homebirth and minimal intervention, though, which is, in and of itself, rare. He's a really good guy, and the first OB I've ever been able to say that about. If I can't deliver at home this time around, I know I'll still be okay b/c he's on my team. During my PAP a few months back, when I mentioned that we'd like to have one more, he said to me, "You know, in New Mexico, you are still considered safe to birth at home after a c/s, if you want to." I was floored -- I don't know many OBs who would endorse this, let alone inform me of my rights regarding it, do you? Good man!

Hey, for those of us considered "old and decrepit" by the medical community, I was wondering what, if anything, you were considering regarding testing this time around? Sophia's Down Syndrome was a complete shock to us (I was 33 at the time, and not at high risk), and while I don't regret not knowing ahead of time (we wouldn't have done anything differently, I don't think, except perhaps have gotten a fetal echo to check on her heart), I'm also not sure I want to be completely unprepared a second time. We still wouldn't terminate, but if our child had a heart defect or other major problems, it would influence where I would want to give birth. So I'm considering doing a nuchal scan at 8-10 wks. and then, if the results come back questionable, requesting a fetal echo mid-way through the pg. I wouldn't do amnio or CVS, so I won't know anything for sure, but I think this time around I'd like a bit more heads up if there's something I should be concerned about.

What are your thoughts?

Guin

[claras_mom]

Originally Posted by Guinevere

Hey, for those of us considered "old and decrepit" by the medical community, I was wondering what, if anything, you were considering regarding testing this time around? Sophia's Down Syndrome was a complete shock to us (I was 33 at the time, and not at high risk), and while I don't regret not knowing ahead of time (we wouldn't have done anything differently, I don't think, except perhaps have gotten a fetal echo to check on her heart), I'm also not sure I want to be completely unprepared a second time. We still wouldn't terminate, but if our child had a heart defect or other major problems, it would influence where I would want to give birth. So I'm considering doing a nuchal scan at 8-10 wks. and then, if the results come back questionable, requesting a fetal echo mid-way through the pg. I wouldn't do amnio or CVS, so I won't know anything for sure, but I think this time around I'd like a bit more heads up if there's something I should be concerned about.

What are your thoughts?

Guin

We'll do the detailed ultrasound at around 20 weeks--whenever it's scheduled--and see what the perinatal specialist says, but that's pretty much it. We wouldn't terminate, and I don't care for the risks of invasive testing.

My biggest thing is going to be to try to get good information on VBAC from my OB, considering that the only hospital the clinic doctors use (and the only one in town) has a general ban in place. :

[Guinevere]

Originally Posted by claras_mom

My biggest thing is going to be to try to get good information on VBAC from my OB, considering that the only hospital the clinic doctors use (and the only one in town) has a general ban in place. :

: That stinks! Policies like that are becoming more and more common, and they make me really mad now that I've become a c/s statistic myself, with my last birth. I don't know exactly where you are (PM me if you're not comfortable sharing here), but I noticed you're in central Cali. :

I went to grad school there and lived in Monterey and PG for almost five years, gave birth to my first baby in Santa Cruz (supposed to deliver at Sutter, ended up at Dominican,) DH lived in SLO for years, and my BFF lives in Castroville and gave birth at CHOMP. So of course I'm curious just which hospital this is you're referring to.

Guin

[preemiemamarach]

Guin, I will be doing pretty much all prenatal testing, including the 11 week nuchal scan. All of my levels were messed up last time because of my twin loss, and invasive (CVS or amnio) testing was considered high risk because I had so much bleeding during the pregnancy (including well after my twin miscarried). So we were really nervous about the 'what if' factor. I know (we discussed in the other thread or upthread here) that so much can be missed, but I also know that there are steps we need to take if we have a baby that will have severe issues (like a major heart defect). We live on the side of a mountain, and the closest hospital with a level III NICU is 35 miles away. Denver Children's is 100 miles away, and I would rather have a scheduled c-section in Denver so my baby could get treated there if it looked like we had severe issues.

I know it is not a popular opinion, but there are situations where I would consider termination (anencephaly, for instance), but it's probably because I saw so many awful things as a PICU nurse. I don't know- part of me thinks that intellectually, but the mama in me would probably just do comfort care at birth. I've worked with families who had babies with disorders that are 'incompatable with life', who were on ventilators and in a tremendous amount of pain. Nobody (parent or child) should have to go through that.

Sorry for being such a downer. I'm having so much nausea this time, and it makes me nervous. I'm terrified of multiples. And I keep having that weird, guppie-flipping sensation in the right side of my uterus. EXACTLY like I felt with DS, but it's far too early for that (5w3d). My uterus is also larger than it should be right now, but I guess that could be due to giving birth only 13 months ago, right?

I will feel a lot better after my u/s on the 19th, that's for sure- I need to see just one tadpole, please.