pregnant with first...lots of questions

[River7]

Hi everyone,

I just found out tonight. Maybe I'm jumping the gun by posting already...but I'll go ahead.

I'm in my early 30s and this is my first. I have one sister who has had a child and a few friends who have, but I still have a lot of questions. My sister and friends have opted to go the more traditional route with their pregnancies. By traditional I mean that none of them had midwives or doulas, all of them except one delivered with doctors in hospitals.

I would really like to have a midwife and I've lurked on this site for a while and read about all of the people who have. However, because of health condition I have, I was told that I am considered high-risk. My health condition is not life threatening, but it still makes me "high-risk."

I don't know if anyone can give me advice about how to advocate for a more "natural" birth when you are told you are "high-risk." Again, my condition is not life threatening. Is there anyone out there who might have some advice?

Thanks so much.

[Rivka5]

I would really like to have a midwife and I've lurked on this site for a while and read about all of the people who have. However, because of health condition I have, I was told that I am considered high-risk. My health condition is not life threatening, but it still makes me "high-risk."

I don't know if anyone can give me advice about how to advocate for a more "natural" birth when you are told you are "high-risk." Again, my condition is not life threatening. Is there anyone out there who might have some advice?

It's hard to give concrete advice without knowing specifics, but I can talk a little about my own situation.

I've had ten different operations on my hips, which have given my pelvis a funny shape - for example, there's a bony obstruction on one side of my pelvis that reaches practically to the midpoint. Probably the majority of women who have had these pelvic surgeries wind up with C-sections. An orthopedist I saw while I was pregnant with my first baby told me "in this litigous society, there's no way that any doctor will let you try to deliver vaginally."

I knew that I had a very high risk of C-section, but I wanted to have low-intervention prenatal care and as much of a low-intervention birth as I could. I chose an independent CNM practice, meaning that they aren't part of an OB practice and aren't supervised by OBs. They agreed that I had a strong chance of needing a C-section, but were willing to do everything possible to prevent one. Even in the worst case scenario, if I needed a C-section, an OB wouldn't appear on the scene until my midwives and I had already decided what needed to be done.

My midwives told me that if at any point in my pregnancy I became "high risk," they would send me for a consultation with an OB. But the midwives would still be managing my care. They didn't kick people out of their practice for being high-risk - they worked with a physician to manage whatever the problem was.

My happy ending is that I managed to get an 8lb, 4oz baby around the bony obstruction in my pelvis, for an unmedicated vaginal delivery. My midwife worked a lot on my positioning to guide the baby through.

I think you'll need to talk frankly with prospective midwives about what your situation is and what they can offer you. Some may not be able to take on a high-risk pregnancy, especially if they're direct-entry or homebirth midwives. Others may have a policy more like my practice did. Shop around.

Edited to add: In order to be the best advocate for yourself, you may need to do a lot of your own research. I went to a medical school library and searched for journal articles about pregnancy after the kinds of pelvic surgeries that I had. I made copies of articles and brought them in with me. It can be very helpful to know *for yourself* how often various negative outcomes occur in pregnant women with your condition, and what the research evidence is to support various interventions and practices.

[River7]

Thanks, Rivka5.

Your story is v. helpful, and I'm glad you were able to deliver the way you wanted to, regardless of your previous surgeries.

I've done some preliminary research and discussed my condition with my endocrinologist (who is the one who said I was "high risk"). I had a benign brain tumor removed several years ago and have been on maintenance medication in order to suppress any leftover tumor (the surgery left a very tiny amount as it was too dangerous to try to extract this last tiny piece).

The major problem here is that the kind of tumor I had is very uncommon and there is very little out there regarding women who are pregnant and have had this kind of tumor. In fact, when I met with my endo, I had already done a fair amount of research (my husband and I are both academics, so research--even when far from our fields-- is in our blood...it's kind of our idea of fun). I had found all of the articles on the web that she had been referencing...there were four cases of women in my situation who have given birth. 2 of these women remained on the drug during pregnancy, one did not, and one was diagnosed during pregnancy. all had normal deliveries.

I stopped taking the medication that suppresses any residual tumor 3 months before even beginning ttc. I was told that I did not have to, that I could wait until pregnant, but there was no way that I wanted any trace of the med in my system when I got pregnant. The kind of tumor I had was extremely slow to grow (one can have it for several years without knowing it) and, again, was benign. However it was growing near my carotid artery and was beginning to wrap around it, which, or course could have been very bad. So, going off my medicine is not as big of deal as it might sound, and I recently had blood work done that shows all is normal--no sign of regrowth.

This might sound horribly arrogant to say, but I often feel that while my endocrinologist definitely knows what is best for me regarding the tumor/maintenance/suppression, they do not necessarily know that much more than me regarding pregnancy and having the kind of tumor I had/still have trace amounts of. My old endo sent me to a high risk pregnancy consultant who basically seemed to imply that her main concern would be gestational diabetes...

Anyway. I'm sorry this post is so long. I really like the description of your birth plan/the center and the kind of midwife you had. I am hoping that I might be able to do something along these lines.

Thanks again.