[staceychev]

So, I'm seeing a midwife group, and have spent most of my pregnancy seeing one particular midwife. I've also seen an MFM MD for ultrasounds because I'm hypothyroid (totally managed) and 37 years old, so technically high risk.

This past week, I saw someone new (always fun for the GBS test...). I asked her what their policy was for going over EDD. She said they like to induce at 42 weeks, which I can live with. But then, she said, "Well, because of your thyroid, we'll actually go with the MFM's recommendation, and a lot of times they want to induce thyroid patients at 40 weeks."

40 weeks! WTF????

Anyway, what are my rights in terms of this? I'm kind of afraid they're going to pass me off to the OBs in the practice if I refuse and I really want to deliver with a midwife again. I also don't know what the MFM is actually going to say. I have an appt tomorrow with the MFM for my final growth scan, so I'll ask then. Plus, DD was born at 40 weeks exactly, so I may be getting stressed for nothing.

Oh, and any thyroid mamas have any data to help me out here in terms of going past term with hypo? I tried to Google search, but was coming up empty.

 

[womenswisdom]

WRT your rights, you always have the right to refuse to be induced. However, the practice has the right to transfer your care to their backup OB if they deem it necessary.

I would ask the MFM what s/he thinks when you go and ask why s/he feels that way if you don't agree. Ask for studies and data so the two of you can have a discussion about the true risks. Ask what kind of monitoring would be appropriate if you chose to go past their recommended "limit" and have them put all that in writing to your midwife group so everyone is clear on what has been agreed to. Be firm about your wishes, but not confrontational, I'd say.

 

[sbraz]

I also have hypothyroidism which has been completely controlled and TSH within normal limits for the entire pregnancy. I was under the impression that if you are on meds and it has been controlled and monitored that you are "euthyroid" and have no additional risks, it is unknown hypothyroidism which can lead to miscarriage, low birth weight, preterm labor, depression, problems with the baby's neurological development, etc. The most critical time in having your thyroid regulated is during the first trimester, and I believe I read that after the 14th week or so of pregnancy the baby's own thyroid begins to function. (I actually read this in What to Expect...) I had one midwife who wanted additional ultrasounds because of my hypothyroidism but I declined as I had a 12 and 20 week with good results and my TSH has been normal, though I did change synthroid levels a few times...

 

[autumnday]

I would think you could request they monitor your TSH level, if all is fine, I don't understand why they would want to induce because of hypothyroidism. If it's treated and you are responding normally, how is that different than having a normal functioning thyroid?

You can also definitely question them further about what the concern is, after all they should be providing the information for you to be able to provide informed consent to any procedure, especially one as major as induction.

Good luck, let us know how it goes!

 

[laughingfox]

I haven't found much googling about going post dates with hypo, either. I was diagnosed with hypothyroidism during this pregnancy, and I wonder sometimes if I might have had it all my life (I've certainly always had thin hair!), and if it could possibly have been a contributing factor to the late birth of my daughter (16 days late).

I find it odd that they're pointing to your thyroid condition as a risk factor, given that your levels are managed. My midwife didn't bat an eye when I told her about my diagnosis and meds.

 

[sbraz]

I remember seeing an thread around here with an article about low thyroid and long, hard labors, found it:

http://www.mothering.com/discussions....php?t=1176130

But that would only apply to mothers with low thyroid who have NOT been treated. Did you tell the new mw that your levels have been controlled the whole time? Maybe she just assumed it had been uncontrolled or just diagnosed in pregnancy?? I can see being concerned (although not with induction!) if you have undiagnosed hypothyroidism in the beginning of your pregnancy... or in the article in the thread it mentions a correlation between malpositioned babies and low thyroid levels at 36 weeks... but that doesn´t seem to be your case, if your thyroid has been controlled and is within normal levels than you are pretty much like any other woman who has a functioning thyroid.

 

[staceychev]

Thank you all for your feedback! I'm going to be calm and confident when I go see the MFM this morning. (And yes, it might just be the new midwife, because my other midwife has been totally chill about it all along, provided that I'm keeping up with my endo!)

 

[HappyMommy2]

I'm hypo and went 42 weeks with my HBAC.

 

[mediumcrunch]

What a load of c*ap. Controlled hypothyroidism is NOT a risk factor, treated and controlled not undiagnosed and uncontrolled, that of course is a problem. Yes, you need to have a thyroid panel at least once a trimester but beyond that it is total non-issue. Ask for documentation that shows hypothyroidism is a reason for induction.

I've had Hashimoto's since just after baby #3. Not once since with any of my many providers around the country has my hypothyroidism been any issue aside from keeping an eye on it. Of all my "issues", and they are many, my hypothyroidism is at the bottom of the pile. Honestly, I think most care providers are more concerned about the implications of my hair color (red) then they are about my thyroid status.

 

[staceychev]

Thanks for all the support, ladies! Turns out it was a non-issue, at least with the MFM. He said: "you're treated. This is a normal, non-high-risk pregnancy. You can follow normal procedures." So, I guess the midwife was a little panicky. I sure hope she's not the one on call when I go into labor!

 

[autumnday]

thanks for the update, I was very curious about it. glad it's a non-issue, but you feel better about that!

have a wonderful birth day!

 

[Kidzaplenty]

 

[GoBecGo]

Just a thought - did she think you were hPERthyroid? The words sound so similar and one causes more major issues for treating than the other (hypo being treated purely with replacement, hyper being trickier).

I'm hypothyroid, and was un-dx with DD, but suffering (goiter from 28weeks). She is fine. She was born at 41+4 but didn't look a minute overdue, let alone a week. I wasn't dx until i'd lost my hair and my milk at about 6 months PP.

This time i have been monitored for FT4 and TSH every 4 weeks since before conception (i'd just had a loss and was having 4 weekly monitoring already for that pg). This will continue for me until 8weeks PP, longer if i want (i organised it through my GP). I have an independent homebirth midwife (who will accompany me if i need to transfer) who is in touch with my GP regarding my care but neither are at all concerned about my thyroid, since my levels have been well-controlled so far. I had my levothyroxine dose changed at the very beginning, but i've been fine since.

I did a LOT of reading when i was ttc, particularly as i had 2 (unrelated, as far as we could tell) losses back to back before this BFP, and i found NOTHING which would indicate induction in the situation you're in. In fact even if you were un-dx and went overdue due to poor metabolic function the baby would still be completely fine until 42weeks (term).