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High-risk pregnancy


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  #1  
November 20th, 2009, 05:45 AM
Quantum_Leap's Avatar frequent flier
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This is a quote from the book I'm currently reading about the history of midwifery in America:

"Not everybody who gets pregnant can be a tall, well-nourished, Rh positive 24-year-old who has never miscarried or had a stillborn, never been sick except for rubella and toxoplasmosis many years before, and has given birth vaginally three years earlier to a healthy baby weighing between seven and nine and a half pounds. Yet virtually any deviation from this ideal makes a woman 'high-risk.'"

The implication, of course, is that 'high-risk' is a label that is overused, and that doctors may give out this label simply in an attempt to justify additional unnecessary medical interventions.

What do you think? Is high-risk pregnancy for real, or is the term too often used in situations where it's not suitable?
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  #2  
November 20th, 2009, 06:01 AM
WineKeepsMeSane's Avatar Platinum Supermommy
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Maybe "higher" risk pregnancy would be a better term? There are certainly things that put you into this category. It doesn't mean that you can't have a healthy pregnancy, just that maybe some things should be monitored.

I don't find it to be overused where I live, but there are certainly differences between countries and even regions within a country when it comes to the medical culture, for lack of a better way to describe it. For instance, everything I hear about the medical community in Calgary on this board is very different from my experience in southwestern Ontario. So maybe in Calgary it's overused and the medical culture is one of intervention, whereas the hospital I gave birth at is much more supportive of using intervention only as truly necessary (for instance, they are proud of their extremely low episiotomy rate)
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  #3  
November 20th, 2009, 06:22 AM
BonitaAppleBomb's Avatar ~African-American-Mommy~
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Well unfortunately, I'm the poster child for a high risk pregnancy-after 6 miscarriages/stillbirth. I don't believe it's misdiagnosed most of the time because I'd rather the doctor be safe than sorry and offer me additional support than be on the side of error.
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  #4  
November 20th, 2009, 06:43 AM
IAmMomMomIAm
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I think it's probably over-used to an extent, but so are most diagnoses (think of how many 6-year-old boys are diagnosed with ADD). I've only heard the term "high-risk" used to describe people who are actually high risk.. I've never heard it having anything to do with previous baby size, or even reasonable size of the mother. I was 275 pounds when I delivered both my babies, and will be again, and it's never been mentioned (I don't know what the weight cut off for "high risk" would be though). My kids were also 19 months apart, and nothing was mentioned. The one I'm carrying with be 14 months younger than his sister, and still nothing's been said.

I've only heard it used (by doctors) to describe women over 35, or women with a long history of miscarriage (like one miscarriage doesn't matter but four raises awareness), or with GD - things I would probably agree with. The internet, media, and word-of-mouth always makes things seem so much worse, in my opinion. My mother told me I'm high risk because I'm over-weight, but my doctor (who would officially diagnose it) said nothing of the sort.

Maybe it's just not over-used where I live though.

Last edited by IAmMomMomIAm; November 20th, 2009 at 06:45 AM.
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  #5  
November 20th, 2009, 06:43 AM
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I thought I would be high risk because I have an autoimmune disease and epilepsy. However, when I went to my OB she saw no reason for extra care because both diseases are under control. I saw my neurologist every other month, but those were always quick checkups.

So yes, I do think it's overused. Nothing any doctor told me led me to believe I would be high risk. It came from what I heard in the media and anecdotes from others. I came to my own conclusion, which was uninformed due to not consulting the proper sources!
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  #6  
November 20th, 2009, 06:49 AM
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I am also a poster child with 6 M/C and an eptoptic pregnancy. Yet no one ever took my worries seriously when I was carrying my 2 girls. To the point that my first was breech for 10 WEEKS with me telling them, and them not believing me.

So no I don't think its overdiagnosed, I do think that many people are in denial and think pregnancy and birth are supposed to be some beautiful easy experience. Things that should be watched are missed.

My friend for example had a still born at 24 weeks, months later she was pregnant again, knowing she had all sorts of complications AND a still bith they did not monitor her right, she should have had a serclage, but the doctor taking care of her didn't arrange for it, She didn't have an OB because it was a "Normal" pregnancy. She had the same signs and simptoms with the second one and had a preemie baby at 26 weeks. She's now been told she should not have anymore kids because she can't carry to term.

Last edited by KimberlyD0; November 20th, 2009 at 06:52 AM.
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  #7  
November 20th, 2009, 08:13 AM
beck12's Avatar Platinum Supermommy
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IDK - I am over 35...this is my 9th pg with one living child - I am 5 ft 1in...far from the desc of "ideal health" and my Ob not only thinks I am not high risk, he has told me I am an excellent candidate for HB if I can find a midwife to do it.

So I am not sure if it is overused in the medical community - but it sure is in casual circles, as most people seem to think me turning 35 is an issue. Even with my losses, my Ob told me that I am a high risk for mc but that doesn't mean my pg is high risk per se....once I get past 1st trimester & have a good u/s & development appears normal, then I am at no more risk than anyone else....as our problem has been chromosomal abnormality.... Now that doesn't mean my baby couldn't be higher risk for having some health issues, but our larger risk seems to be catastrophic developmental issues.
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  #8  
November 20th, 2009, 08:19 AM
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I'm glad to see other people saying what I was going to, I was afraid I'd get boo'ed out of the building...

Yes, I haven't experienced in my own circle of friends or aquaintances that the term if over-used. I know very few people who have been considered high-risk, and they were cases that genuinely WERE high risk situations.

I do think that there are too many interventions, and too many c-sections (much more so in the US than in Canada) but I think there are also lots of situations in which women do genuinely need a higher rate of care and assistance during pregnancy and labour.

We forget that for pretty much the entirety of human existance, we have been getting pregnant and having babies largely between the ages of about 15 and 23. Well, these days it's late 20s, 30s and 40s. This inherently creates more situations where things don't progress according to the typical expectation.
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  #9  
November 20th, 2009, 09:27 AM
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Quote:
Originally Posted by ~Christina A~ View Post
We forget that for pretty much the entirety of human existance, we have been getting pregnant and having babies largely between the ages of about 15 and 23. Well, these days it's late 20s, 30s and 40s. This inherently creates more situations where things don't progress according to the typical expectation.
Good point. Also, I think, the fact that our diets are much different than they were historically. More sugary processed nonsense means more cases of GD.
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  #10  
November 20th, 2009, 10:24 AM
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I think a lot of women WANT to be high risk because it generally means more u/s. I had a placental abruption with my oldest and was afraid that it would mean something with my subsequent pregnancies. It didn't, and I wasn't high risk. My last two pregnancies were nearly perfect, except I went into preterm labor twice with my youngest. Shortly after having him I was diagnosed with Ehlers-Danlos syndrome. My OB (who has delivered my last two children) has upped me to high-risk. BUT I am still seeing him as my primary doctor. I will only see the high risk OB off an on during the pregnancy to monitor my cervix and uterus due to the EDS (I have a much higher chance of needing a cerclage due to preterm labor since your cervix is connective tissue).
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  #11  
November 20th, 2009, 10:32 AM
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Quote:
Originally Posted by frgsonmysox View Post
I think a lot of women WANT to be high risk because it generally means more u/s. I had a placental abruption with my oldest and was afraid that it would mean something with my subsequent pregnancies. It didn't, and I wasn't high risk. My last two pregnancies were nearly perfect, except I went into preterm labor twice with my youngest. Shortly after having him I was diagnosed with Ehlers-Danlos syndrome. My OB (who has delivered my last two children) has upped me to high-risk. BUT I am still seeing him as my primary doctor. I will only see the high risk OB off an on during the pregnancy to monitor my cervix and uterus due to the EDS (I have a much higher chance of needing a cerclage due to preterm labor since your cervix is connective tissue).
Yes, I think there's a mentality out there of wanting as many US as humanly possible.

This is a new one for me - where I am in Canada, most women only have one U/S at 18 weeks. In my first pregnancy, I had three - one at nine weeks because I was cramping and passing clots, the regular one at 18 weeks, and one at about 36 weeks because we thought he might be breech. That was VERY unusual to have three. Most people I know only have the one.

I've been surprised in my DDC how many people have already had multiple U/S, or are willing to bend the truth a bit in hopes of getting one. (Having said that, I too have already had one, at about nine weeks, due to spotting and cramping ... apparently this is something my body must do at nine weeks because it's happened both times, lol!)

To each their own, I guess... but I figure the less often you have to have ANYTHING done, the better.
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  #12  
November 20th, 2009, 10:35 AM
IAmMomMomIAm
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Originally Posted by frgsonmysox View Post
I think a lot of women WANT to be high risk because it generally means more u/s. I had a placental abruption with my oldest and was afraid that it would mean something with my subsequent pregnancies. It didn't, and I wasn't high risk. My last two pregnancies were nearly perfect, except I went into preterm labor twice with my youngest. Shortly after having him I was diagnosed with Ehlers-Danlos syndrome. My OB (who has delivered my last two children) has upped me to high-risk. BUT I am still seeing him as my primary doctor. I will only see the high risk OB off an on during the pregnancy to monitor my cervix and uterus due to the EDS (I have a much higher chance of needing a cerclage due to preterm labor since your cervix is connective tissue).
Side note: I think the number of ultrasounds women want/expect is pregnancy is ridiculous. I understand wanting to see the baby and all, but getting unnecessary medical tests done because your OB won't do an ultrasound under other circumstances? If you want an ultrasound to see the baby, go pay $75 at the nearest med school, rather than ordering an expensive genetic test.

That's all a general you. And no, this had no relevance or bearing to the debate whatsoever, I just wanted to rant for a second. Moving on.

Quote:
Originally Posted by ~Christina A~ View Post
Yes, I think there's a mentality out there of wanting as many US as humanly possible.

This is a new one for me - where I am in Canada, most women only have one U/S at 18 weeks. In my first pregnancy, I had three - one at nine weeks because I was cramping and passing clots, the regular one at 18 weeks, and one at about 36 weeks because we thought he might be breech. That was VERY unusual to have three. Most people I know only have the one.

I've been surprised in my DDC how many people have already had multiple U/S, or are willing to bend the truth a bit in hopes of getting one. (Having said that, I too have already had one, at about nine weeks, due to spotting and cramping ... apparently this is something my body must do at nine weeks because it's happened both times, lol!)

To each their own, I guess... but I figure the less often you have to have ANYTHING done, the better.
I never got my first until 20 weeks, give or take. After that they were necessary to check position or because they wanted to confirm or deny something on the previous ultrasound. I think I got 3 and 5, respectively, because Lauren kept spinning around between breech and head down.
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  #13  
November 20th, 2009, 10:53 AM
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Kes, we're in the same DDC, have you been surprised at how many people have already had like three or four U/S? I was! We're all 13 weeks and under still.

I totally think that if things need to be checked out, you should absolutely get an u/s, but it seems like a lot of people sort of "trick" their way into getting them.

I'd never give someone heck for it, it just seems strange to me.
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  #14  
November 20th, 2009, 10:54 AM
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Quote:
Originally Posted by ~Christina A~ View Post
This is a new one for me - where I am in Canada, most women only have one U/S at 18 weeks. In my first pregnancy, I had three - one at nine weeks because I was cramping and passing clots, the regular one at 18 weeks, and one at about 36 weeks because we thought he might be breech. That was VERY unusual to have three. Most people I know only have the one.
Wow, that is so weird to me. This is a total sidenote, but in Kuwait, where I had my first pregnancy, they gave me an ultrasound at pretty much every doctor's appointment. It was all covered by insurance. We didn't even ask for them, they just did them. (And I was not at all high-risk). Guess I was spoiled...
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  #15  
November 20th, 2009, 11:17 AM
IAmMomMomIAm
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Originally Posted by ~Christina A~ View Post
Kes, we're in the same DDC, have you been surprised at how many people have already had like three or four U/S? I was! We're all 13 weeks and under still.

I totally think that if things need to be checked out, you should absolutely get an u/s, but it seems like a lot of people sort of "trick" their way into getting them.

I'd never give someone heck for it, it just seems strange to me.
I think a lot of it is fear though. The first sign of spotting and a lot of women are at the ER. Me personally? going to the ER costs $250 that I don't otherwise have. If there's something the doctors can do (i.e. if I go into labor at 22 weeks or something) then I'll go and spend the money. But to be brutally honest, there's NOTHING we can do at this point, and I'm not one to freak out. If I start spotting, I wait and see what happens. If I start bleeding, THEN I'll consider the ER. But I see no point in spending money that we need for bills and food on something that won't effect anything. That's just me, of course. If my doctor suggests I need an U/S then of course I'll get one. But I don't expect one. I don't even get an early dating ultrasound.
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  #16  
November 20th, 2009, 11:28 AM
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If you are rh negative you are strongly advised to go to the ER if the dr's office isn't open.

ETA: If you are bleeding. Left that part out! oops
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  #17  
November 20th, 2009, 11:51 AM
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Veru true, Jillian. But at this point in a pregnancy, at lot of women have no idea if they're Rh negative or positive. I'm sure some do, of course, but not all of them. I don't judge them, or care really - if you (general) want to weasel your way into an ultrasound, or worry about every single spot of blood that's totally your prerogative. I see it in all the DDCs though.. "there were some pink spots on the TP after I had a really rough bowel movement. I got my doctor to schedule an u/s for later today." Paraphrased of course. It's just not in me to worry like that. Then again if I ever manage to go into labor on my own I'll probably assume it's BH and stomach cramps until the baby starts crowning.
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  #18  
November 20th, 2009, 12:52 PM
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Veru true, Jillian. But at this point in a pregnancy, at lot of women have no idea if they're Rh negative or positive. I'm sure some do, of course, but not all of them. I don't judge them, or care really - if you (general) want to weasel your way into an ultrasound, or worry about every single spot of blood that's totally your prerogative. I see it in all the DDCs though.. "there were some pink spots on the TP after I had a really rough bowel movement. I got my doctor to schedule an u/s for later today." Paraphrased of course. It's just not in me to worry like that. Then again if I ever manage to go into labor on my own I'll probably assume it's BH and stomach cramps until the baby starts crowning.
Well, if you don't know your blood type, I guess you don't know. If you haven't been to the dr. yet then you don't know.

I knew my blood type before I got pregnant but I had a blood draw before my first visit so they were aware too. Plus you really can't blame a person who has never been pregnant. It is a scary time. When I had bleeding at 8 weeks it scared me to death. I knew there was nothing that could be done but I needed to know if the baby was still there. If they have the equipment then I don't see the big deal in easing a person's mind.

If I had no scares I wouldn't be as concerned and I would just wait for my u/s life everyone else.
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  #19  
November 20th, 2009, 01:03 PM
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Well, if you don't know your blood type, I guess you don't know. If you haven't been to the dr. yet then you don't know.

I knew my blood type before I got pregnant but I had a blood draw before my first visit so they were aware too. Plus you really can't blame a person who has never been pregnant. It is a scary time. When I had bleeding at 8 weeks it scared me to death. I knew there was nothing that could be done but I needed to know if the baby was still there. If they have the equipment then I don't see the big deal in easing a person's mind.

If I had no scares I wouldn't be as concerned and I would just wait for my u/s life everyone else.
I don't object to their behavior on a normal scale. On a very minor scale, they charge their health insurance for pretty much unnecessary procedures, and the health insurance companies raise their rates, yadda yadda. But it's not like I think these women are single-handedly responsible for the rise in health care rates, lol. And like I said, I'm sure that some know their blood type, but I'm guessing that a lot don't, and that's not why they head to the ER or to their doctor's office.

It doesn't bother me. I just find it somewhat odd that people EXPECT ultrasounds. Women think it's weird that I don't think I need one until the middle of the pregnancy. They wonder why I haven't had one, why I haven't asked for one, because they're already had 3 or 4.

I don't care what other women do, but I do smile and shake my head at worry worts sometimes. Not just about pregnancy but about everything. I'm not a worrier because I don't think it's healthy to constantly dwell on negative thoughts. I wish more women were positive thinkers. I guess that last sentence is the gist of the last several posts I made.
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  #20  
November 20th, 2009, 02:36 PM
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I have a lot of opinions regarding this sort of thing, but I think I'll keep it short and sweet, and say that what I really think is that a lot of people with absolutely NO medical training spend a lot of time second guessing those who have spent 12 years of their lives TRAINING to be medical professionals. I'm not saying all doctors are perfect, and all interventions are always necessary, but a lot of them are, and I think people need to find providers they trust, rather than hoping Ricki Lake can handle their care.
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