Deliver Me doc vs my own OB

[soxthecatrules]

I got sucked into watching the DHC show "Deliver Me--Home Edition" a little bit ago. I tuned in simply b/c it said "Home Edition". I thought maybe, just maybe, the patients on this episode were considering HB or other alternative birthing arrangement. I will never know b/c I got so pissed off with in 5 minutes that I was forced to turn the channel.

The case involved a patient with a history similar to my own. She comes in for a 39 week appt, BP= 160/100, doc goes spastic, sends her over to the hospital for monitoring and blood work, 12 hours later the BP is now 150/90, and mom and baby are in danger and she needs to be delivered IMMEDIATELY! So emergency c-section it is!!

Here's my story with DD. Week 37, office visit BP= 160/105, +1 protein in urine, nurse asks if I'm feeling okay, I'm fine, she then asks me to lay down for 5 minutes, BP goes to 150/90, doc comes in shakes his head, says "Don't like this, don't like it at all. I want to see you on Monday (this is very late Thursday afternoon) and if the situation hasn't corrected itself then I will want to induce Tuesday morning. If the BP goes back up to the 160/100 range and stays there then call the after hours number. See you on Monday." That was it. The situation did correct itself and I had DD 2 1/2 weeks later.

Also, via my understanding of PE is that an induced vaginal birth is a WAY better option than c-section. Unless the BP is so high that mom is truly at risk for stroke then it is better for mom and baby to be induced. I personally don't think that BP of 150/90 is in the range of a stroke occuring. Perhaps I've been misinformed? This is the way my OB handled BOTH of my pregnancies.

Without knowing total medical histories....which OB was more correct? If my OB was in the wrong please feel free to tell me. I won't get mad or upset. I'm just curious.

[paintedbison]

I think the docs on that show are way over-interventive. You hardly see them do vag deliveries at all. I'd go with your doc.

[tndixiemom]

You are seeing 9 months of pregnancy in less than 20 minutes and even then you are only getting the final outcome. You don't know her history or anything else about her health. You can't compare your pregnancy to someone else's and judge the doctor's decisions or the patient's based on it.

[txgal]

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Another thing I have heard about high blood pressure in pregnancy is that the overall change is more important. In other words if her normal BP was 100/60 and it shot up to 160/100 that is more concerning than it normally being 140/80 and shooting up to 160/100. I do think perhaps the Csect was not necessary and they could have attempted in induction. But truth is we don't know all the facts. FWIW, I usually end up yelling at the TV when I watch that show too.

[AlexisT]

I had a similar CS. HOWEVER... I had consecutive dips of 4+, had been admitted to hospital for monitoring, a very high reading (can't remember exactly!) on my 24 hour sample, and my daughter was beginning to show signs of distress. There was simply no way they could have induced me quickly enough (cervix was totally unripe and they couldn't even strip my membranes; Cervidil would've taken all weekend).

Immediate CS rather than induction is considered the appropriate course of action for severe preeclampsia when one of several things happen, not just possibility of stroke. I can't remember the whole list, but things like non-reassuring EFM, reduced or nonexistent urine, a few others. Also, if it's really severe PE, and the cervix is unripe, they may feel they don't have time.

IN this case, either they're not telling you something, or the doc rushed to CS instead of induce. Is there any chance she had a previous CS or other uterine surgery? If that were the case, they would have to section her, especially since at 39 weeks an induction would be likely to require prostaglandins.

I don't like Monday morning quarterbacking, but this seems quite a jump. What your doc did is more in line with my understanding of how to manage (non-severe) preeclampsia.

[soxthecatrules]

Thanks for the responses. And, sorry. That was a really unfair question to put on the board. I was more venting about the show than anything and should have stated that. It seems that I always have a reason to yell at the screen when it comes on. All of your responses are so reasonable. My post probably was not. Should have waited a couple of hours and then posted. Probably would have come across differently!! Please forgive.