Wwyd?

[octobermoon]

Here are the facts, we're planning a HB, first baby, i am 33 weeks. i am having labile blood pressure issues/ white coat hypertension when MW checks me and have gotten readings as high as 150/90. however my BP is fine at home with an average of 113/73, monitor has been checked and is working properly. i check my BP often. i have never gotten that high of a reading at home. my MW and another MW says this is not normal and that i do in fact have a risk factor. MW is willing to go on with the HB but seems very unsure IMO and tells me my BP is very likely to rise during labor and i will have to transfer. would you still try for a HB or would you transfer to a hospital now? i'm just wondering if i have such a risk factor if i am putting my baby in danger by trying for a HB. i really get the feeling from my MW that she is reluctant about this whole thing which has me unsettled. that and the fact that the HB climate in my state is really crappy. trust me. if i switch MWs (if anyone will take me) i am likely to have the same problems as i am having now. hope this makes sense. anyway, what would you do?

[sunanthem]

I'm not sure what the labile and white coat hypertension mean, but I had high bp at the end of my pregnancy and my midwife put me on a strict diet loaded with protein and super low on sugar. She also gave me a bunch of different herbal tinctures I had to drink everyday in some nasty tasting herbal tea. I cant remember them all, but I did what she told me for 3 weeks and everything turned out fine. Have you asked her about any natural methods for trying to lower the bp? To prevent you from having to go to hospital? I myself will do whatever I have to do to stay out of a hospital for birth, but thats just what I feel most comfortable with.

[notjustmamie]

I had white coat hypertension with DD. My in-office and at-home numbers were very similar to yours. I ended up changing practices before labor because my MW didn't do hospital births and I figured if I was going to have to transfer, I'd rather have the chance to get to know my new providers.

During labor, I had an automatic BP cuff, so I didn't always know when it was taking a reading. I asked my MW after birth how my BP had been. She told me it had always been normal, with the exception of a couple of times when the reading was taken in the middle of a Pitocin-induced contraction.

Knowing what I know now, I would try for a homebirth (and, in fact, I am, personally). I would be concerned about your hcps, however, as they do not seem very supportive. Is there any possibility that you could switch to another homebirth practice?

As far as keeping BP down, overall, regular exercise, a balanced diet heavy on whole grains** and protein with salt to taste, lots and lots of water (I was told a gallon a day), and learning some good relaxation techniques.

I hope you have a great next few weeks and an amazing birth in whatever location you choose!

**I mean as opposed to white bread/rice/pasta, not that it should be heavy on carbs overall.

[DoulaJulian]

(Sorry, but i am writing this while i am super tired...so if i sound curt, it is bc i have no writing skills this late at night! I totally get where you are right now)

Submersion in water can greatly reduce bp and also could help you to relax. Since it is summer, you can easily get ahold of a $20 kiddie pool, blow it up and stick it in your living room for the next few weeks! Get some hypnobirthing CD's and listen to them while you are submerged in water, getting your peaceful groove on...plus, when you do wind up being well enough to birth at home, you can use the pool to labor in!

I don't know a lot about herbs and natural remedies for bp other than nettles...and pp said some great stuff about hydration and protein. I would get some advice from an herbalist...or Susan Weeds book: Wise Woman Herbal for the Childbearing Year http://www.amazon.com/Wise-Woman-Her.../dp/0961462000

I know you are worried...and we all find something to worry about (that is what we do as Momma's!) but doing what you can and leaving the rest up to the universe is the best you can do right now! Write a detailed birth plan for the hospital in case you need to transfer, make sure your partner/birth team is willing and able to fight the good fight for you and your baby if need be, and then LET IT GO. I know that is hard...but i finally did it with our last birth at about 34 weeks and it brought me such peace to know that even if I were totally out of it, that my team was just as dedicated to my wishes as I was.

Certainly ask (beg) your midwives to help you find natural remedies to help keep you calm and keep you gestating in peace for the next several weeks! Keep asking around here for bp advice--plenty of homebirther momma's have been where you are. I think I remember reading on Tina Cassidy's (she wrote the book Birth) blog about her battle with high bp a few weeks before her successful homebirth. And here is the link! http://tinacassidy.blogspot.com/2008...llment-22.html

Blessings!
Justine

[lalemma]

I can relate in my own small way. At my recent MW appointment the first reading was HIGH, and I immediately started to fret about what that meant. Instead of freaking out, my MW said "We'll check again in a little while" and then changed the subject. About 15 minutes later she kind of slipped the cuff on while I wasn't paying attention, and hey presto, I was at the low end of normal (where I usually am). I honestly think her "No big deal" attitude about it was helpful. So I can absolutely see how it would be really troubling to get a different/more worried (and worrying!) response from your MW. That sucks.

What does the MW say when you explain that your home readings are normal?

[nashvillemidwife]

"White coat syndrome" is not something to be dismissive of. Even though it "only happens at the midwife/doctor's office", it means that your blood pressure does routinely go that high. Is it going that high when you're stuck in traffic, waiting impatiently behind someone in line at the supermarket, when talking to unsupportive family members, etc? What will happen during labor? I would not change to another midwife, unless like the previous poster, you can choose one with hospital privileges. Otherwise it will not make a positive difference. I think the midwife you have now is right to be cautious, and changing to another one just because she's willing to overlook your risk factor would be foolish.

[littlebb]

I'm in the same boat. I had a major surgery last year and I have a lot of tension where doctors and hospitals are concerned, even my midwife's office. My blood pressure in her office is routinely 160/90 or somewhere around there, but I monitor my BP all day long at home and it's always in the normal range (I am indeed on blood pressure medication, too).

My midwife has me bring in my BP readings each visit and has been okay with continuing with a HB as long as she sees my BP is stable outside of our visits.

Now, I will say that I also see a hypertension specialist, so it's not as though my MW is just being lax about it. I have had so much blood work, urine and other tests done throughout my PG to make sure my BP isn't affecting me or the baby in a really bad way (because high BP is never good). All of my organ function is being monitored by him and he has done routine u/s of my kidneys and other organs to make sure there's no swelling. More importantly, he routinely checks for protein in the urine to rule out Pre-eclampsia. I realize I'm probably a rare case because my BP is likely a result of the surgery I had last year and my body didn't have time to regulate before I became PG (long, long story).

I've been lucky with my MW and doctor - most doctors here aren't open to HB because it's gray area where the law is concerned. But he fully supports my HB decision at this point because he can clearly see I have white coat issues - he strongly feels if I planned a hospital birth, my BP would be less controllable the second I walked into a hospital, and that will just open the door for interventions. We've worked out a plan together for laboring at home (to include the dosage of my medication, ways I can lower my blood pressure during labor and a few other things), and if it does get too high, obviously we will transfer or do what we need to do.

We are convinced (as is my MW and doctor) that if I'd been seeing an OB or MW at an OB's office, they would've induced me WAY too early because of the white coat issue and I would've been visiting my little one in NICU.

I'm not sure if it helps with white coat hypertension, but there is a good MW remedy for some BP issues (and every little bit helps). Make a mixture of 1/2 cup water, 2 teaspoons of Cream of Tartar and juice of half a fresh lemon. Mix them together in a glass - the Cream of Tartar won't dissolve, so it'll taste like lemon water, it'll just be a little gritty. Take the mixture once a day for three days, then skip a day. Monitor your blood pressure and see if it helps. If you do a search on this, you can see how Cream of Tartar affects BP. But if you have normal BP at home, this may not apply to you.

It sounds like you need to do a little more mental work like myself. As a PP mentioned, try reading the HypnoBirthing book with relaxation and visualization exercises. Then work on using these techniques when you go to your MW's office.

If nothing else, perhaps you could make a deal with your MW to have your blood pressure checked out by a regular doctor or hypertension specialist like I am? I am pretty sure if I weren't taking active steps, my MW may have risked me out already.

Sorry this is so lengthy. But I really know how you feel. I'm ready to deliver so I can put all this behind me! (I'm 41w today)

[littlebb]

Originally Posted by DoulaJulian

[I] I think I remember reading on Tina Cassidy's (she wrote the book Birth) blog about her battle with high bp a few weeks before her successful homebirth. And here is the link! http://tinacassidy.blogspot.com/2008...llment-22.html

Blessings!
Justine

Thank you so much for this! You are popping up all over with such good little gems! I have been battling elevated blood pressure here toward the end of my PG (see my comment above) but have been lucky to have a great team between my MW and my doctor. I am happy to see the suggestions in the blog you linked to - I think I'll try those myself.

I have a question and maybe you can give an opinion (since I know you're a doula and have assisted as a midwife). I saw the suggestion to soak in the birthing pool to get used to being in it and to help lower BP. I know that in labor, being in the birthing pool can sometimes slow or stop labor altogether. I'm 41w and haven't seen any real signs of impending labor (other than the baby having dropped, bloody show about a week and a half ago, and some random cramping/PMS feelings that are sporadic and days apart). Could being in the birthing pool slow or stop any progress toward labor? I just want to make sure, but it sounds like it would be good for my BP. Thank you!

[Mamatoabunch]

Cal/mag, dandelion, watermelon and more protein. Also water submersion. These all helped me and I had UC's.

[violet]

I had high BP with my first pregnancy. Always high in the office, sometimes high at home, often not. I watched my diet - there's lots of advice out there on lowering BP through diet -- you and your midwife would know best on that. But my biggest thing was to walk a LOt and I would walk immediately before my appointments. I was working as a substitute teacher and one day I subbed as a PE teacher, literally walking with the kids around the track and school for 5 periods out of the day, then zipped over to my appointment and low and behold, low BP. Other days I would get to the office early and walk for at least 30-45 minutes in the neighborhood before my appointment. Low BP every time. I also visualized a relaxing scene while she took my BP -- diving into a pool of clear cool water for me, just the thought of it relaxes me and helps with white-coat syndrome.

My BP was sometimes high, sometimes low throughout until the end of the preg. and in labor it Was Never High. And since that first pregnancy I have never had high blood pressure. IMO high blood pressure is a red flag because it can mean something is wrong, but then sometimes it is just high blood pressure with nothing else underlying it. If nothing else is coming up as wrong, listen to your body and your intuition and good luck!

[littlebb]

Originally Posted by violet

But my biggest thing was to walk a LOt and I would walk immediately before my appointments. Low BP every time. I also visualized a relaxing scene while she took my BP -- diving into a pool of clear cool water for me, just the thought of it relaxes me and helps with white-coat syndrome.

Thank you so much for your post! As I mentioned above, I've been having similar issues, though I have a hypertension specialist treating me. What struck me is odd, and you mentioned something that's made me curious, is that last night DH and I went for a long walk around the neighborhood. I'll be the first to admit that I haven't been the best about walking lately since the weather has been so hot and humid. My BP has been fairly stable on BP meds, but as I progress to the end, I am seeing elevation, especially in my Diastolic numbers. Anyway, after our walk, I took my BP just for fun within 10 minutes and it was amazingly lower! I for some reason figured that your BP tends to elevate after exercise? But you mentioned here that walking can and will immediately lower BP, correct? Such good information to know! I'm 41w and kind of late in the game, but I suppose it's never too late to do some walking, even just a little. Perhaps I should try to do some when I go into early labor, too, in an effort to help control the BP?

Thanks again!!

[msmiranda]

I was in your same boat as well, except my numbers were not quite so high at the MW's office, and sometimes at the high end of normal there. At home they were consistently 110s-120s/70s. She did not freak out about the higher readings at her office, and I had a perfectly lovely home birth three weeks ago. During labor my numbers were 130s-140s/80s. A little high, but nothing that would warrant real concern. Personally, I don't think there is any reason not to go ahead with a home birth (assuming that your MW is vigilant ab. checking for preeclampsia and that is not a factor). If your numbers got too high during labor, you could transport to the hospital at that point, but they likely will be fine, and at the hospital you will be subject to unnecessary interventions. However, I would be concerned that your MW does not seem supportive of you and would be looking for someone who is a little more understanding of white coat hypertension. My first birth was in a hospital because my BP was 130s/80s at my MW's office and that risked me out of the birth center. In labor it was 120s/80s. I didn't need to be in the hospital then, and I didn't need to this time either. The difference was that I was with a CPM this time, who had the independence to be able to evaluate my individual situation rather than basing a decision on one reading taken in her office. If I was in your shoes, I would probably be looking for another midwife. I totally understand what you're going through, and I hope you end up with the birth that is best for you and your baby.

[Kidzaplenty]

[smeep]

I would (nicely) grill her on how she normally attends birth. I would say your best bet would be a mw who is willing to stay out of the room until you are ready to actually birth your baby, better yet stand nearby out of your view while you and you partner birth/catch the baby, and intervene only when necessary. Is she willing to be extremely hands-off except when her help is absolutely necessary? My concern would be if her being around causes a blood pressure rise in labour, surely birthing in a hospital will almost certainly bring on a cesarean. Perhaps if she doesn't even arrive until well into active labour you will be too far in labourland to notice/care?