PIH, terrified of induction, need wisdom please!

[Spiralshell]

Warning: Long!

I am 38 weeks + 4 days today. I am due October 29th. (I know exactly when I conceived, so my dates are sure.)

I have been swollen, hands and feet, bad, since July. But my blood pressure has held steady at 120/70 - 120/80, and I have never had any protein in my urine. I have gained a total of 50 lbs, pretty steadily since 20 weeks.

Starting in September, my BP has gone up. When it hit 130/80, my midwife had me start modified bedrest and I worked from home, only going in if I really HAD to. I started full maternity leave on October 1st. Since then my BP has fluctuated between 120/80 and 130/80. Last week, the other midwife in the practice saw me, took my BP and got a reading of 138/90, but then multiple successive readings were all down at 120/80 or below. They sent me in for a fetal Nonstress Test (NST) and Pregnancy Induced Hypertension (PIH) lab tests. Baby looked good on the NST strip. All the tests were fine except my Uric Acid levels were elevated to the top of the "normal" reference range. Still no protein in my urine at any time. The "official cutoff" for PIH is 140/90, so I was not at it, yet.

Today I had my weekly appointment again, and my BP at the midwife's office was 138/90. I went back into the hospital for another NST, and my very first reading was 148/95!! Highest it has ever been in my life. The next reading drops to 121/78, phew! But then it crept up over an hour, back to 138/95. All of my labs were normal, and Baby looked good. But that BP is really worrying me! I bought my own BP cuff to take measurements at home, resting on the couch. (This is my standard position these days!) But I'll be damned, my BP is higher here, not lower. I have taken 3 sets of 3 measurements:
137/95, 128/92, 125/92
155/103, 154/101, 141/103
147/101, 147/101, 137/99
If these readings are accurate, then I am official -- I have PIH.

So the worry then is that I will develop preeclampsia. Symptoms of pre-e:
Hypertension -- YES, starting at 38 weeks
Swelling or Edema -- YES, starting at approx. 24 weeks
Proteinuria -- NO, not even trace
Sudden Weight Gain -- I have gained 13lbs in the last 4 weeks
Headache -- none, other than just my general lack of sleep cranky headache
Nausea or Vomiting -- none
Changes in Vision -- none
Racing pulse, mental confusion, heightened anxiety, trouble catching your breath -- fast pulse and not catching breath when exerting myself, but I've had this my whole pregnancy
Stomach or Right Shoulder Pain -- none
Lower back pain -- have had some aching, like pre-period crampiness
Hyperreflexia -- none

So I don't think I have pre-e now, but it can develop quickly, they say.
My fear is that because I am past 38 weeks, and my BP is on the rise, they will want to induce me. From everything I've read, this is standard of care because the only way to drop my BP is to have the baby at this point. Currently my cervix is not favorable -- high, posterior, firm, no dilation, no effacement. Baby is not anywhere near engaged. I have had no mucous changes, no regular contractions, nothing. As a first-time mom, with a Bishop's Score really low like this, I face a 40+% chance of c-section if they induce me now without lots of ripening first. My midwife INSISTS that induction carries absolutely no increased risk of needing an epidural or c-section, but frankly I don't believe her.

I have spent the last 34 weeks (since I knew I was pregnant) telling myself that I CAN handle natural childbirth. I truly believe that I can. But I have absolutely no confidence that I can handle induced labor. I broke down in tears earlier at the very thought of it.
Then I start thinking that my lovely vision of a natural birth is unrealistic and I need to face the fact that I may be putting myself and my child at risk by fighting what may very well be a truly necessary induction. But I remain terrified of the cascade of interventions, and especially the chance of a c-sec if I "fail to progress" according to the hospital clock.

So my choices include:

• Find ways to get myself to go into labor on my own, and soon. And push back against induction as long as I can.
• Accept that I will need to be induced, get positive about it, and find ways to work with it.

Any wisdom from you Mamas out there?
Has anyone been induced with a closed cervix and made it through without a c-sec?
Other than drinking my RRL tea, taking lots of EPO, and using the breast pump for stimulation, what else can I do to get things going? (DTD is not an option -- DP is terrified to touch me, has been for months). I also cannot walk or bounce on the birth ball as I am ordered to be on the couch, feet elevated.
For those who have had to face giving birth in a way totally opposite from what you envisioned, how did you manage to make the mental turn to accept and go with the change?
I'm just feeling powerless and overwhelmed, and I'm not sure what to do next. If you're still reading, you deserve a cookie!

[fyrebloom]

OK, FIRST breath! No more stressing out about it, it won't do you a lick of good and is only going to make things worse. Believe me I've been there. Get a bp cuff and take it at home resting laying on your left side and see how it is. If it's lower it's nothing to be alarmed about. If it's not try drinking 1/2 a hop full beer (guiness or the like) and take it again. IF it's lower it's nothing to be overly alarmed about. You need to rest and take it easy. The more strain you put on your kidneys the more likely you'll start spilling protein. Eat a high protein diet if you aren't already. I mean like 100g of protein a day. This will often reverse pre-e if it's already in progress. Salt to taste. Artichoke extract can help too.

As for your question about induction, I was induced at 41.5 weeks with ds, 36 hour induction but it worked. I was not dilated at all and had a vaginal birth. Not ideal at all, but better then a c-section. You need to get yourself rested and calm so you don't have to go that way because most moms don't get as lucky as I did with my induction.

I had pre-e with my twins and they were a section. They tried to keep me from breastfeeding because they had be on mag sulfate. Don't let them use that as an excuse. Demand your baby immediately after birth not matter how baby makes his entrance. The earlier you bond and breastfeed the more likely things will go easier and if you do have to have a section, as I did it's esp important to make sure you get time right away with your lil one.

Sorry you are going through this! You're in my thoughts! Hang in there and just stay as calm as you can. Pre-E is scary stuff but you're not there and you might not ever even get there. Let me know if you need anything sweetie!

ETA: Oh and your MW is just trying to smooth things over and make you feel nice. Induction carries a high high risk epidural need and for C-section, but if you get to that point it's the lesser evil. You just need to avoid getting to that point at all costs.

[Bokonon]

I have to respectfully disagree with the PP. Taking your blood pressure while laying down is almost always going to give you lower readings. It's when your BP spikes that the seizure and stroke risk is highest, especially when it is prolonged (even sitting up).

There is no way to reverse preeclampsia. Eating excessive amounts of protein can damage already-taxed kidneys in preeclampsia.

You don't need all of the symptoms to be very sick. And even without proteinuria, you could still develop HELLP Syndrome or eclampsia, or have compromised blood flow to the placenta. At 29 weeks, with pressures similar to yours, I already had the calcification of a 37-week placenta.

The only reliable way to determine if you have protein in your urine is with a 24-hour catch, as the dipstick tests are not very accurate, especially if you are very well hydrated.

I don't mean to scare you, but it's important to understand that PIH/preeclampsia are very serious conditions. I've read more tragic stories in the Preeclampsia Foundation forums than I care to think about.

Please try to take care of yourself. I wish you the most satisfying birth and happy babymoon!

[sam1980]

Have they done a 24 hour urine? My urine dips were neg for protein, but I was very high on the 24 hour.

Anyway, I had PIH starting at 26 weeks or so (along with GD). Then the protein showed up at 32 weeks. They still did not call me pre-e until my liver and kidney function showed major changes (37 weeks).

I did end up with induction, but only because my BP got dangerously high for me (my normal is 110/70 and was 160/110 the day they induced).

You are so close, I would try not worry just yet. Close monitoring is the best bet. You don't have to decide anything yet, just prepare yourself that you could be induced if medically necessary. Since it is just now rearing it's head, you may be able to hold out and go into labor on your own anyway.

While I wish I would have went into labor on my own, I don't have horrible feelings about my induction. I knew my BP was crazy high and my liver was shutting down. I felt like crap. I still had a vaginal delivery to a healthy baby, which was my ultimate goal.

Oh, and I never had to get the mag. while in labor either.

[jenak]

Originally Posted by Spiralshell

My midwife INSISTS that induction carries absolutely no increased risk of needing an epidural or c-section, but frankly I don't believe her.

Hahahahaha... ::slapping myself to stop the hysteria::
At least now you know you can no longer trust your midwife. :

Originally Posted by Spiralshell

...I need to face the fact that I may be putting myself and my child at risk by fighting what may very well be a truly necessary induction. But I remain terrified of the cascade of interventions, and especially the chance of a c-sec if I "fail to progress" according to the hospital clock.

I could have written your post 2 years ago. While I do not deny that I had PIH, it was very late onset and not severe... and TWO different OBs have said that they would NOT have induced me after reading my records (and I don't think doctors usually like to say another doctor is wrong). I was never on any medications or Mag while being induced and that seems to make everyone pause and think that it really wasn't as severe as my OB made me think.

I don't know what the answer is. I wish I had asked more questions. I wished I had pushed back against the induction - not necessarily refusing it in the end, but asking about what other options I had, what risks I was looking at for me and for baby.

And no, my induction did not go well. I was not effaced. I was not dilated. My cervix was "high and tight" the OB said. I had 2 days of cervical ripening (cervadil) and one day of pitocin. Got the epidural at 5cm because they said I could no longer sit upright in bed (no getting out of bed was allowed except to pee)... and laying down hurt a lot more. After the epi, my progress promptly stopped... made it to 7cm and stayed there for 4 hours and then agreed to the c/s at 9:30 that night. I also wonder what would have happened if I had refused it at this point- again, I wish I had asked more questions.


I don't know if pushing back and asking more questions would have changed the outcome for me. But I think that it would have made me more accepting of what happened. No, a natural birth isn't the end-all-be-all... but I still want it.

Good luck to you mama.

[fyrebloom]

www.blueribbonbaby.com It seems counter intuitive but it really does help.

Yes dipsticks are not very useful and frequently give false positive results as well as false negatives, however consistant high protein results warrent further testing.

Please keep in mind I'm not saying don't continue monitoring it, but since you DON'T have pre-e at this point you def need to do what you can to keep it from getting worse. A high protein diet can help prevent the changes in the placenta that lead to pre-e, eclampsia and Hellp. IF you start having protein then a 24 hour urine is good as is liver tests to make sure you're handling it well. IF you have pre-e (and I know this from personal experience) your bp will not go down if you lay down. This is why i'm suggesting checking your bp laying down. Also if you do better laying down, REST! The less chance your bp has to spike the better off you both will be. Your BP isn't obsenely high yet, def high but you have time kwim?

The three leading causes of maternal death are pre-e, induction and c-section. Pick your poison. So yeah, now that we've got you stressed, try to relax and take VERY VERY good care of yourself until the baby comes. You don't want to go down ANY of these roads.

[jaylily]

Easier said than done but try not to stress too much. Natural childbirth scares me but not as much as induction and c-sections and such. But many women have gone through each, and they and their babies are fine.

My baby isn't here yet and I'm trying not to be nervous about going all the way to 42 weeks and needing to be induced. I don't think I could do it w/o an epidural (which I'm also nervous about.) but for now I'm trying to remind myself not to worry about it until and unless it actually becomes an issue - trying to be optimistic and thinking my baby will come before then (even if it doesn't seem like it right now!)

I remember having an appointment with my midwife just days before my son was born. I had swelling, protein in my urine, and I think my blood pressure was a tiny bit higher than normal - she seemed a little worried and told me to call if I had signs of anything else going on. A part of me wonders if that has something to do with when I went into labour with my son much earlier than expected, (and my cervix was closed right up to the point that when i went in after having contractions all day and my water likely having been leaking or broken, they thought I was in false labour- my son was born the next morning!) but, I really have no idea - hopefully your baby will be born soon and your fears put to rest!

[boobs4milk]

hugs! both of my inductions were with favorable cervical conditions. sorry i can't help but wanted to send s

[sam1980]

I wanted to add more to my post, since it was late last night.

When I was induced, my cervix was 1 cm dilated. However, I was showing signs that labor would be within the week (my GD was suddenly improving, which often means labor is near). They gave me cytotec to ripen the cervix, and I actually starting having regular contactions on my own and dilated to 3. They then put me on Pitocin and everything stopped. They quit the pitocin and I went into active labor on my own.

I planned a natural (hypnobabies) birth and had full confidence that I would be able to handle the pain. But, I also swore to myself that I would beat myself up if I asked for drugs. To be honest, as much as I wanted a drug free birth, it was mostly for selfish reasons. I hated the idea of an epi and the possible complications for myself. I would have chosen a narcotic (Stadol) before an epi. That was my plan, if it was unbearable I would ask for Stadol, but try my best to not get an epi.

Well, about 11 hours into labor DS's heart rate starting being whacky. He would decel and not rebound very quickly at all. I allowed them to break my water and put a monitor on his head, because I was concerned and the doc thought maybe it was monitor error. It wasn't, and his heart really was decelling. After 16 hours I agreed to an epidural because the doc thought I may need an emergency section if his heart didn't come back up. I consented, because as much as I wanted natural, I definitely did not want to be knocked out for a section!

If it hadn't been for the goofiness with his heart decels, I think the induction wouldn't have been too bad. I was handling the pain well and had not requested any meds (even with my water broke). I have full confidence I could have done it without drugs, but felt that my situation warranted me getting the epi anyway.

I did have a crappy OB after shift change who wanted to do a section, and I refused and delivered my son vaginally (the epi wore off before that as well, so I did do that part naturally).

[gumby74]

I am clueless in this area, but wanted to say that in the end you have to do what is best for the baby as well as you. Induction may not be the ideal way to bring the baby into this world, but in the end you will have a baby to love and hold. To me....it's not worth it to take a chance of something happening to you or that baby. Ideally, I don't want to have another c-section, but because of my bladder issues, there is a lot of risk for me delivering any other way and the thought of losing the baby or my other son going without a mom makes me cry thinking about it.

[Tenk]

DDC Crashing.........PreE is nothing to sneeze at, first off. I had it with my oldest and signs of it with DD2 and I was so unaware but so sick.

2nd, just because your cervix is not favorable right now doesn't mean that it won't get that way easily. Mine was long closed, felt like they were touching my tonsil when they tried to reach it, and although it took several days, I did deliver vaginally. At the time (11 years ago) I had cytotec (a major NO NO now that I would refuse no matter what) but there are other ways to bring on a favorable cervix, and I know other moms that had Pit inductions and still had a drug free delivery.

I'm by no means suggesting you make a rush decision but my BP was 175/115 before my stupid Dr even admitted me (they didn't pay attention to the fact it was creeping up the whole time) and where I was is borderline coma. Anything over xxx/110 is severe enough that you could seize mama, and not something you want to risk if your home alone. Too many bad things can happen when you are that high and alone. I personally wouldn't take that risk.

I'm sure you'll make the right decision for you and your baby, just consider all the options before you make it. Good Luck!!!

[Tenk]

Originally Posted by fyrebloom

ETA: Oh and your MW is just trying to smooth things over and make you feel nice. Induction carries a high high risk epidural need and for C-section, but if you get to that point it's the lesser evil. You just need to avoid getting to that point at all costs.

Not necessarily, and it's still not something to mess with. Personally the risk for epi or C/S is worth it to save what could be 2 lives. Her BP is creeping up even resting on her own couch, and it's really so sudden in most cases that being alone could be detrimental to everyone involved.

Mama, if you feel the right thing to do is wait, then wait, but again really consider your safety and that of your baby.

[StephM76]

I'm so sorry you are faced with this decision Spiralshell

If you are not dilated now, do EVERYTHING you can to ripen your cervix. Have you been doing the EPO vaginally? You may want to start. Unfortunately if do not have a ripe cervix the chances of you having a c-section are around 50% So I'd definitely try everything I could to get things going!

If you really want to avoid a medical induction I highly recommend castor oil. Put 4 tbs. into a glass of oj and drink it down. Repeat in an hour, and hopefully it will start labor. If not, all of the contractions it brings on might help to dilate you.

[SolaSola]

I am 40 wks + 4 days and afraid of induction. Midwive and doula both stress the importance of being relaxed and not being in the fear zone. My doula said that fear will stop the release of oxytocin ,the harmone which begins labor. I am 1 cm dilated, cervix is hard, no regular contractions. I wish I could be more helpful but that is all the advice I have, as I am a first time mama.

[Mommy2Liz]

I haven't read all of the previous posts, but wanted to offer some words of encouragement.

I was induced with my first for PreE. I was 36ish weeks and had BP of 160/110 with protein, swelling, headaches and 3 beat clonis. They used Cytotec (scares the crap out of me now that I really understand the risk of that stuff, but our hospital doesn't use Cervadil) I was then given pitocin. My labor was 9 hours from first contraction to the birth and with the help of a doula and my husband, I was able to work through it and still have an unmedicated birth. I really tried hard to do what I could as far as getting in the shower and walking around. Thankfully, I had some good nurses who would let me take the fetal monitors off to get up. I know that made a difference. I know induction is not what we want if we can avoid it, but I am SO grateful that I made peace with what was happening. My daughter was born very healthy and I didn't realize how sick I was until after she was born. I was in BAD shape. For me, induction was necessary and important. I am 100% okay with how her birth went. It was very empowering despite how it started.

Whatever you decide and however it ends up for you, I wish you peace and comfort and healing. Good luck with meeting your LO.

[Pandme]

Just wanted to add that my best friend was induced with a rock solid cervix and she got preeclampsia during delivery. It was tough and scary and she got an epidural but she DID deliver vaginally. If any labor should have ended in a C-section it was that one, but it did not.

[stephanie95]

Both of my inductions were with unfavorable cervix even though my water was leaking (with my 1st) /had broken (with my 2nd). I did ask for an epidural with my 1st but I was 22 alone with no support and completely unprepared for childbirth. My 2nd was a natural unmedicated birth. It is possible to birth naturally with an induction. Hang in there.

[BlueEyedLady]

Both my kids were induced labors due to PIH.

My son was induced at 37+3, and my cervix was not ripe at all. High, tight, closed, super unfavorable. They gave me cervadil 24 hours before starting pitocin. The cervadil ripened my cervix fairly well. I did fairly well with the pain until about 6 cm, then requested an epidural. I'd been in the hospital for 2 days already on no sleep, monitoring for the hypertension, and the cervadil had made me cramp badly all night long before the pitocin was started. By 6 cm, late in the afternoon I was induced, I was just done and requested an epidural. They had trouble getting that in, and during the half hour it took them to place it, I went from 7 cm to 10. So I really only had the epi for the pushing stage, which took 1 1/2 hours, but I did deliver my son vaginally after a total of 14 1/2 hours of labor. The only complication I had was that my blood pressure tanked really low (ironically) as soon as DS was born. It had been up around 155/95 and it went to 100/60 almost immediately.

With my daughter, I was induced at 39 weeks exactly. No cervadil this time, my cervix was very high, but soft and 2-3 cm, so my OB thought I'd be okay without it. I progressed fairly quickly to 5 cm, then stuck there for 4 hours until my OB broke my water. The pain was pretty minimal at that point, nothing compared to DS, and if I hadn't remembered his labor so vividly I would not have requested an epidural. But, I remembered how it felt to have pitocin induced contractions while going through transition, trying to hold still for an epi to be placed, and that terrified me, so I requested the epi when my OB broke my water. This time they had no trouble getting it in, but I think the placement was off since it only worked on my right side - which is a super weird feeling, by the way, to feel everything on only one side of your body. Still, I went from 6 to 10 in 2 1/2 hours, and 5 minutes after that DD was born vaginally. Her birth was much easier than my DS', and I think had I not remembered his so vividly I wouldn't have requested an epi at all. My BP had been elevated this time since 33 weeks and I'd been on modified bedrest with NST's, 24 hour urine tests, and u/s to check fluid levels twice per week. Immediately after birth with DD I hemorrhaged, which of course also tanked my BP, but otherwise I had no complications.

Neither time did I end up with pre-e, though it can progress very quickly from PIH. With DS I also had swelling the whole pregnancy, but with DD my only symptom was the elevated BP. You need to watch it closely because pre-e is nothing to mess with, but it is possible to have a natural vaginal birth with PIH.

[APToddlerMama]

I don't know that much about preeclampsia, but I will say that one of my friends was not dilated, was induced and had a successful, natural, childbirth. So, it can happen. Don't get yourself worked up too much...that only makes your blood pressure rise higher. Try to think positive thoughts.

[hartfelt]

i hang in the november DDC, but i am due 10/30. i am going through pretty much the same thing you are. i went to the hosp. for the NST and labs yesterday, they came back good. i am today doing the 24 hour catch. trying to stay calm and not stress is the hardest part. i just want to say that i feel you mama and we'll get through it. big hugs!