High Risk - Reasoning...?!

[lea-marie]

I've just been mulling over parts of mt midwife appointment on Monday and wondered if anyone could shed some light on parts.

As I suspected previously, I've been put straight into the higher risk category, but they've given more reasons than I thought, and some of them actually confused me a little...

As I originally thought, Charli's attempt at pre-term and previous losses are part of the reason, but they've also said that my history with eating disorders is a factor (have been referred to an additional consultant/NANA?!) and that my arthritis cause a risk too? Neither of these two things were brought up as an issue with previous pregnancies, and when I asked the midwife if there was a chance that if I went to a certain point with no issues could I be moved to lower risk and she said it was unlikely, mainly because of the arthritis?!

Has anyone ever heard of this before?

[weezypops]

Perhaps the eating disorders is because they're worried the weight gain could trigger some old habits and it might affect the baby's nutrition?

Just googled about the arthritis and found a few things:

http://arthritis.about.com/od/preg/a/pr ... advice.htm
http://www.arthritistoday.org/daily-liv ... hritis.php
http://pregnant.thebump.com/getting-pre ... MsdVisit=1
and this pdf

Sorry, I'm sure you could have googled that yourself but it does seem that it's pretty common. Maybe it's worth asking in the Ask the Midwife section on here, she might be able to give you some answers.

[lea-marie]

Thanks Louise... I have done some reading up and it's generally for those that take particular medications, however, I only use nonsteroidal medication (brufen and/or naproxen) and my flare ups aren't a constant issue. The only issue I can see is the additional baby weight causing pain and the meds should really be avoided if possible.

I can understand the eating disorder bit to a point, but it's not been an issue with pregnancy before, as I have a strong mindset that baby comes first. I was quite severely anorexic when I fell with Charli and managed to put on 3.5 stone to ensure that it went as well as possible! I will be seeing an additional midwife for this too, so it shouldn't cause me any issues.

She has said that I will be under shared care (midwife and various consultants) and that they may decide towards the end to change to low risk, but she doesn't think it will happen.

[nubs]

Once you get put in high risk or low risk you will not be moved as you are given a certain pathway for your care to follow in relation to the DoH guidelines

For them not to do this they could be at risk of negligence as they have to take into account all previous medical history

I was high risk because of a previous c section and had extra appointments because there were no case note for my previous pregnancy it was hard to piece together why everything happened but seeing the consultants is just to ensure that you will get the best care that you require x

[Schmushe]

Over the years criteria has changed to what is high risk and what isn't. More attention is paid to certain ailments now just to ensure you get the care needed in your pregnancy and the support you need. I know being classed as high risk isn't ideal but apart from extra appointments there usually is no difference in your care. You may be offered more scans too (which is always a plus).

[nubs]

It's whatever the midwife puts on your form nothing to do with consultant - you will follow the high risk category but after discussions with the consultant they give you a plan of care but you will remain in the high risk category, basically if you get put in high risk category and you are not given what the pathways say then when the care is audited the hospital could get fined - they have to provide reasons and explanations for everything

[weezypops]

My midwife put me as low risk but the midwife after the 12 week scan changed it to high risk because of BMI. Then when I saw the consultant she said she was happy to not see me again and for me to go back to community care, though I think I still stayed as high risk on the forms etc. Of course now I do have to see the consultant again because of the GD!

[nubs]

I will see if I can find the guideline as it maybe from the new year though it has been a heated debate recently regarding this

[weezypops]

I will see if I can find the guideline as it maybe from the new year though it has been a heated debate recently regarding this

I wasn't disagreeing with you Kris, just saying what had happened to me. It seems to me that they don't do the proper risk assessment (for want of a better phrase) until your 12 week scan when they also do your weight etc. so maybe my midwife's original assessment didn't really count.

[lea-marie]

The idea of being 'high risk' itself is not a massive thing, in that I'm more than happy to have the extra care etc (as I'm sure I've mentioned already, I like to have the extra reassurance etc), I think what got me was that I wanted to give birth in a midwife-led unit, but due to the high risk factor, I can't - and she said that it was the arthritis, not my previous history with pregnancies, that was making that the case...

[nubs]

Oh I didn't think that Louise - just thought that things I had heard don't seem to be happening

Lea - is the unit attached to a hospital like on site?

[weezypops]

The idea of being 'high risk' itself is not a massive thing, in that I'm more than happy to have the extra care etc (as I'm sure I've mentioned already, I like to have the extra reassurance etc), I think what got me was that I wanted to give birth in a midwife-led unit, but due to the high risk factor, I can't - and she said that it was the arthritis, not my previous history with pregnancies, that was making that the case...

I wanted to have a homebirth or at least a midwife-led unit but think it will be the hospital. It's disappointing, isn't it?

[lea-marie]

Lea - is the unit attached to a hospital like on site?

The Chelmsford one is - The new hospital there have a birthing unit and the labour ward, but I really didn't want to go to Chelmsford (have had a couple of unpleasant experiences there).

I had hoped for St Michael's in Braintree, but they're low risk only, as are St Peter's in Maldon, and Colchester isn't close enough really (30-40 minute drive as opposed to the 15 minutes to Braintree, Maldon or Chelmsford).

And Louise - disappointing isn't the word, for so many reasons. I had pinned my hopes on a birthing unit