What constitutes a low (or high) risk pregnancy?

[{sarah}]

The Maternity Unit provides services for women in the low risk category.

This quote is on the website of the hospital that I'd really like to go to for this birth. The question is, would I be considered high risk because I'll be having a VBAC? What constitutes a high risk pregnancy? Would a VBAC be enough for them to say I'm high risk?

I'm going to ring during the week, but wondered for the moment what to expect them to say.

[Willow]

Hmmm, I'm not sure Sarah? I hope not for your sake!

[doulacara]

It's my understanding that hospitals consider VBAC high-risk in terms of birth where they may insist on all manner of nonsensical conditions (EFM, time limits etc) but it shouldn't preclude you from having midwifery care if that is what you are seeking. Depending on the hospital, it may exclude you from a birth centre, where you would probably be most likely to achieve your VBAC (other than at home).

HTH,
Cara

[paradise lost]

Sarah i was high risk because of my weight and my BP during my PG with DD but i went and said to them that i wanted medical evidence pertaining to ME that i was therefore unsuitable for homebirth and they a) didn't produce any and b) got me my homebirth in the end.

I was over 100kg at delivery but given 79kg is a completely normal healthy weight for me (i'm 181cm tall) i pointed out that it wasn't outrageous and my BP i maintained (and still do) was partly white-coat (borne out by my only normal BP reading, taken during transition) and being in a hospital setting wouldn't help. They could see i was not a romantic iditoic hippy willing to risk everything for a far out birth, but instead a well-read self-aware woman who had considered the options and concluded that homebirth was the best and safest option for her situation.

My point of this rambling is that you should talk to the birth centre. If they say no VBAC then ask for a meeting with someone who can make decisions on who gets in and who doesn't. Take your notes from last time (showing suture pattern, labour notes etc. etc.) and talk to them. Tell them how important VBAC is for you. Tell them you'll be willing to transfer if they think you need to. Tell them if other things occur during your pregnancy which make you higher risk you'll be willing to discuss your options again.

If you don't ask you won't know. But don't be put off by an immediate "no" because policy is policy but those rules can be bent a little.

Best of luck

Bx

[aussienic]

I am classed as high risk due to Gd and 2 previous c/s. I asked why and she said nothing is wrong with me or baby but it just means I will see a Dr at each appointment rather then a MW.

[becmc]

There is a 'low risk' hospital in south east melbourne that will not take vbac's. However when I was looking for a hospital I rang a 'high risk' one with the same health network and I was not high risk enough to go to their hospital!!
As far as I know there are only a couple of birth centres in Australia that will accept vbac women.
You would probably be classed as medium risk or something like that, if they state they are low risk only I would be suprised if they take you. Let us know what they say though!

[Alan]

Sarah they will class almost that differs from a "normal" pregnancy as high risk. Elevated BP, GBS +ve, Large baby, Small baby, etc. It would depend a lot on the hospitals policy.

[visitor1]

My hospital class me as high risk cos of my BMI and that my DD was born via vac extraction last time.

[Berry]

I am booked into a hospital which only takes low risk maternity patients, and had the option to have a VBAC at this hospital if I chose to. As I understood it, I'm eligible to give birth in this low risk hospital provided baby didn't arrive before 34 weeks and didn't seem to need any high level medical interventions.

[Trish]

Yes, sorry to say Sarah your a "high risk" hun. I get the same label at my hospital too.

[Trillian]

Sarah, since all the drama with my hospital, I became classed as high risk for two reasons - the major one being a previous PPH and retained placenta and the second one simply because it was baby 4 and that carries it's own risk of PPH apparently. ATM the hospital I go to has basically become a low risk birth centre with a Dr attached until the other Dr starts practicing.

You'll find that they will all have different rules as to what they will and wont allow and that will determine how 'risky' you are as a patient.

[Tobily]

Sarah they will class almost that differs from a "normal" pregnancy as high risk. Elevated BP, GBS +ve, Large baby, Small baby, etc. It would depend a lot on the hospitals policy.

This is what I was told with my first baby.

Basically that if you're having a "normal pregnancy with no complications", and no problems in any previous pregnancy with all normal births - then you're low risk.

Anything else - ie. a health issue like GD or high BP in your current pregnancy, previous c/s, problems in previous pregnancy - you become high risk. It literally only takes one "issue" to push you into this category

[Inanna]

Sarah, I concur. You will be termed high risk. VBAC is given this most unfortunate of terms I am afraid.
Is this your birthing place of choice? I would be shocked if you could argue against this label with a vbac. I have seen a few women successfully argue out being high risk for weight reasons but not vbac.

I know you will be able to find a wonderful vbac friendly birthing place. You could always come up here and be welcomed with open arms!

[castle]

Sarah,
Sadly all these posts are correct. Whilst you may not be high risk, anything apart from the absolutely normal takes you out of the low risk category.
In general, a high risk pg is labelled as such because of: some kind of condition in the mother (usually but not always pre-existing, such as high blood pressure or diabetes) that requires more attention during the pg and/or delivery, and conditions that pertain only to that pg--for example, placenta praevia, or a prenatally diagnosed issue with the baby. Because of medico-legal considerations it's now usually an all-or-nothing deal...if you don't slot perfectly into low risk, you must be high!
I had my first VBAC in a freestanding birth centre. There was absolutely no problem doing that (10 years ago) and I was told at the time that whilst the risk was slightly greater than normal, it was still very tiny. When I was booking my second, in another state and some time later, I was told that I would not be allowed to use the birth centre. I made a big fuss and with permission from the consultant high risk OB, was able to book in there. In fact, on the day I could not deliver there because all the rooms were taken! I ended up in the normal delivery area, but in a room with a bath and the midwife with me who had done almost all my antenatal care. My biggest leverage, which unfortunately does not apply to you, was that I had already had one successful VBAC.
I would first of all try your best to book in to the unit you are looking at. If it's not possible, it would be worth asking about other delivery options at that hospital apart from the birth centre. They may have a room or two with a bath, for example. If you find out exactly what the guidelines are (and who is authorised to bend them!) you have made a great start.
Also, perhaps you can wangle care from the birth centre team even if you don't deliver IN the centre?? It depends what their setup is like...at the teaching hospital here, the birth centre not really separate, it is in a corridor of the normal delivery area...so a great deal of flexibility is possible.
Finally, keep in mind that you can bring the birth centre mindset with you even if you don't give birth in your first choice unit!!

[Janie]

Good question Sarah!

It hadn't occurred to me at all that I might be considered high risk for my next birth. I didn't have a CS, but it was far from an uncomplicated birth.........however I wouldn't have thought it would make me high risk! After reading these posts though, I'm pretty sure it will.

Sarah, I hope you get the answer you're hoping for!

[michmomm]

Best of luck Sarah!