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This doesn’t sound like a particularly controversial topic, but it can arouse a great deal of heated debate between obstetricians and their patients. I experienced this at first hand as I was both the “Person Responsible” of an assisted conception unit and a consultant obstetrician running my own NHS “Infertility Antenatal Clinic”. As a result, I was in the privileged position of being able to offer personal follow-up care to all who became pregnant through any infertility treatment and particularly through assisted conception.
Some obstetricians feel that once pregnant, ex-infertility patients should be treated like all other pregnant women. I was surprised that a small number of women who had undergone IVF felt the same. They had had enough of high-tech medicine and now wanted to enjoy their pregnancies and labours and “be normal” again.
Yet for many women, this might be their only opportunity ever of having a baby. I am a passionate supporter and admirer of the skills of midwives, but in this situation I believe that antenatal care should ideally be total consultant care. That does not mean just attending a hospital antenatal clinic, but seeing an informed consultant obstetrician at every visit. Trust can then be built up and a careful plan of management discussed and agreed and documented clearly in the records.
I feel that on the basis of “only opportunity ever”, an IVF pregnancy plus any problem is an indication for a planned elective Caesarean section. That problem might be the older patient pregnant for the first time, twins, a breech presentation, previous surgery for fibroids, or any subsequent antenatal complication sufficient to cause concern. No prizes are going to be awarded to the 38 year old patient who after a number of years of infertility and eventual successful IVF, then tragically loses her baby or has a baby that is handicapped as a result of complications arising in labour. An elective Caesarean section is not a guarantee of a live healthy baby, but is safer than an emergency section in labour or a prolonged and difficult vaginal delivery.