Pregnant and frustrated

So, I am pregnant with my 3rd child. My first 2 pregnancies were before I was diagnosed with UC (although I had experienced symptoms on and off for several years before that). Both babies were born on time, healthy weight (approx 7.5 lbs) , with a very simple, straightforward, quick, and (relatively) easy home births with midwives. Little to no medical intervention, and everything went smoothly.

Now, fast forward to this pregnancy. I'm 24 weeks along. Everything is proceeding well. My UC is more or less in remission (I occasionally have some softer stools than normal, but am only going once or twice a day and no blood or mucous). The baby is measuring right where he should be, ultrasounds look great, etc. But.. Because I have UC, my midwives had to send me for a consult with an OB. The OB now wants to be involved in my care throughout the entire pregnancy and she has also referred me to an obstetric internal medicine specialist.

I know I should feel grateful to have free access to good healthcare, but I am just frustrated with so many interventions. Every time I see another specialist, they keep adding in things that I should be concerned about that just don't seem relevant to UC, or at least not to my particular situation.

Some of the things that I've now been told I should worry about:
1. I have a new husband this time around and he is taller than the last, so the doctor thinks the baby might be "too big" to deliver vaginally (complete opposite concern from the UC risk of having a small baby or delivering early).
2. I finished a course of prednisone in Nov 2019. This baby is due in Feb 2021. The internal medicine specialist says that you can have adrenal insufficiency for up to TWO years after stopping prednisone and that I should have IV steroids while I'm giving birth to avoid this. I have never heard of the two year time period, and have always been told that you need to be careful for 6 to 12 months after stopping pred (and even this seems to be conservative - I was in a major car accident this summer, and the paramedics were not at all worried about me having recently been on pred).
3. The internal medicine doctor said I should be worried about tearing causing fistulas and I might want to consider a c-section. Everything I read says that this is only indicated for crohns patients who have active peri-anal disease.

I just feel like all these doctors are looking for anything they can to classify me into a high risk group. I feel quite strongly about delivering the baby at home, with the care of qualified midwives and with a back-up plan to transfer to a nearby hospital in case of emergency. However, if I truly am at higher risk of complications during delivery, then I would plan to deliver in hospital. But nothing has yet convinced me that I am at higher risk.

I don't want this discussion to turn into a debate about home vs hospital birth, but rather am looking for thoughts on whether the above doctors concerns are valid, and also any info on whether well-controlled UC actually increases risks for having a healthy delivery. So far the only consistent research that I've found has said that there is a risk of having a low birth weight baby and of delivering early.

As far as the concern I mentioned above about possibly having a large baby - it seems that the doctor should be happy for this, since it should offset my risk of me having a small baby ;)

Generally, having UC puts you at higher risk anyways. We have higher risks of needing a c-section especially when the rectum is badly inflamed.

You have strong opinions and preferences on this. It depends on your risk tolerance. I would continue to follow up with the obstetrician as your delivery gets closer to quantify your risks going forward. If your UC remains well controlled and there's no major concerns then continue with a natural birth. However, if things don't look good absolutely go with what your obstetrician says.

If you have adrenal fatigue/withdrawal from Pred then it's obvious: fatigue and body aches. You can get a blood test from an endocrinologist to check if you have normal or abnormal cortisol levels and adrenal fatigue. It's most common with very long courses of prednisone, 1 year or more continous. Less common with a course lasting months.

There is a propensity in the medical community to endorse c-sections at this time in history. The rates are extremely high especially in the USA. A lot of women get categorized as high risk when they aren't and it's because of hospital scheduling policies. In other words, it's convenient for doctors. You have a right to request vaginal birth even if it's inconvenient for them. You also have a right to deny medication that speeds contractions (like pitocin), a technique they use that can actually force the need for a c-section. I understand your desire to have an at home birth. You may want to consider doing so, but have a backup plan to go to the hospital in order to appease these interventionist doctors.

Giving IV prednisone in the presence of confirmed adrenal insufficiency is normal. For example, UC patients who are on prednisone or recently stopped it will get IV pred before going into surgery, and sometimes after. It's because the body has not recovered from prednisone usage and surgery is trauma injury that shocks the body. If the body can't release enough cortisol to cope, then it could spell disaster. However, this approach is for UC patients who have confirmed adrenal fatigue... i.e. their AM cortisol has been measured, along with ACTH and other endocrine functions. You may want to ask the internal medicine specialist to refer you to an endocrinologist for hormone testing. If your adrenals test normal, then IV pred is unnecessary and you should protest such treatment. It is true that the adrenals can take a long time to fully recover after prednisone use. Some say 2 months for every 1 month on the drug. However, this needs to be confirmed with medical evidence. They can't just assume you have adrenal insufficiency.

I question the internal medicine specialist's approach, especially all the assumptions being made without any scientific evidence. Also, the comment about fistulas is perplexing. That's Crohn's, not UC. If your UC is in remission and you have no history of perianal disease, then his comment seems... unskilled.

It makes me wonder how much real world experience he actually has doing delivery with IBD patients.