When Does BP become a Worry?

[fwlady]

Okay. This came pretty unexpected. Well, sort of. For those unfamiliar with my history. I had hospital MW care up until 38 wks when they dropped the bomb that they were no VBAC, the old OB jumped ship, and the new one doesn't believe in VBACs. We had been planning a UC, then went to hospital birth plan because of some issues, and then back to UC when all was well and the OB situation came up. I wanted to transfer to the OB at the Centerpoint Hospital that does VBACs one hour from my home. Had I known, I would have started over there. Anyway, I had been concerned about my BP for a while, but it never got worse. My headaches and spots had lessened. The only thing that really concerned me was the PP time, whether it was PPH or PP Pre-e. But, I figured since I couldn't transfer my care, I would just wing it, I was due yesterday, so it won't be long anyway.

Most of today, I have had a dull headache. I went ahead and checked my BP, as I had stopped doing it, since it really didn't show any change. Even when I had headaches, my BP was never high. High for me, but it always goes up in the end. I was told baseline, but I can go by the MW's baseline at 105/65, or I can go by my prepregnancy baseline of 95/55. Technically, pre-e isn't usually diagnosed until BP goes to 140/90. I have never had readings that high, but I was also told that since I am usually so low, that it would be more concerning to be at 130/80s, and I stopped checking unless I had symptoms.

Today, even in the afternoon, I have been there all day, high 80s actually. I decided since I had the headaches too, that I would lay down and see what my BP was then. Actually, after a half hour, my BP was down to 121/72. That is MUCH better, although laying down and taking the BP isn't the right way to do it and can make it look like all is fine when it isn't. So, I got up again, gave it 10 min, and I was back up to the high 80s diastolic.

I talked to my IRL friend, and she said that if I really get concerned to just walk into the CP ER and have them evaluate me. Go home, or if they say it is necassary, they can induce me there. I really don't have the money to walk in unnecassarily, and DH has to go to work from Mon-Thurs overnights. Now, I really wasn't stressing about the 4 day week he has to do for the holidays (as he also has to do for New Years too) as he gets a 3 day weekend both times, and we can maybe try to jump start things then. Since I was just due yesterday, I figure I still have 10 days to go give or take a day.

So, my question is, when does the BP become a concern? I am not having any significant swelling (although I did after last PG because I am SURE I must have had PP pre-e after the last 3 pregnancies but never checked). I am not having any blurry vision for now. THe headache has come and gone, not constant, just dull and on and off.

This just figures. I fire my OB thinking that all was fine and stable, and now I am dealing with maybe needing to be on bedrest until the baby comes, in the middle of the holidays. Any ideas? I really have no choice but to UP at this point. I have already fired the OB, but I also thought everthing was fine and stable. I am sure the UC can go fine, but I am taking the BP machine with me to keep an eye on it. I just need to know what warrants going in. FWIW, I did have pre-e with my first, and I told the MW this. She was never concerned about my BP, but it never got higher than 128/78.

TIA. Please be gentle with me. I know that ppl can get alarmed when talking about possible pre-e. I feel fine, other than the dull headache. And, I never had the BP machine for any of my other UP pregnancies, so I could have done this same thing with the last 3 pregnancies and never known it. I never had any issues. The only difference is the number of headaches that I have had with this one. Kymberli

[Fruitful4Him]

Only you can decide this. No one can diagnose you over the internet...there are so many variables. It seems that you have had a lot of uneasiness during this pregnancy. I am very leary against convincing someone it is a good choice to UC...for many reasons. Maybe your body is trying to tell you this birth needs a bit more support or guidance? I caution anyone against choosing UC without carefully weighing the potential cost. It would be one thing if it seemed like UC really was the best thing...but one day you are considering ERCS and the next...UC in a hotel...or at home..with a hx. of serious hemmorrage in addition to possible bp issues, etc. and possibly little to no support. Please pray over whatever decision you procede with.

[rhiandmoi]

Since you've had pre-e before, I would monitor your bp hourly for 4 hours, and if it stays high or if the headaches don't get better go in. Since you haven't been monitored for pre-e in the past, you don't know if you have permanent liver damage - which other than the stroke and instant death problem, is the biggest problem.

I have heard that you can soak in an epsom salt bath to lower BP, but it has never worked for me.

[The4OfUs]

I had pre-e with BPs in the 155+/100+ range and was induced with my daughter, and was admitted for observation with high BP with my son at 39w6d (BP in the 140s/90s the last 2 appointments) and spilling protein, and then went into labor spontaneously that night while in the hospital. As far as I've heard, it's not so much 140/90, but 30 points up from *your* normal that becomes concerning. But pre-e is more than just high BP - to officially diagnose they run a blood panel and do a 24-hour urine collection. I did 4 separate 24-hour urines in late preggo with my daughter while doing all manner of things to keep BP down like high protein/low salt diet, resting a lot, and taking a 20-min warm (not hot) bath every evening. It worked to hold it at bay for about 4 weeks, but then despite all those, and using natural induction methods starting at 38 weeks, at 39 weeks my labs went up again and my BP was over 155/100 (I had a home machine, too) at my 40w appointment, so I consented to an induction at 40w 1d.

Oh jeepers, I just saw that this is the UC board. Well, I guess my experience still might be helpful in some way. Good luck!

[buckeye_bebe]

Aside from various cut-offs and criterias used to make decisions, something to consider is how much you are deviating from your baseline. You get (or might get) some mild cramps every month when menstruating, but if they are predictable, you know something might be seriously wrong if all of a sudden your period pain is crippling. Same with blood pressure. If you are normally non-pregnant and 95/55 (awesome and sexy, btw), and 105/65 when pregnant, you already have a good grasp on your baseline, assuming that was made over enough measurements to establish a trend. So then you can look at your baseline and and tack on some arbitrary number like 30mmHg and get concerned if you consistently clock in at 135/80.

Mind you, I am not commenting on your blood pressure, merely numbers because that's how I roll. And pre-e can be undiagnosed if asymptomatic. So really, it is up to you. My point is just that some professionals "go by the numbers" and you can draw your own conclusions based on your own criteria. Good luck, I'm rooting for ya and your numbers. I didn't get eclamptic until labor last time, and that was an almost disaster.

And good on you for investigating your own body, and abiding by your own unique circumstances!

[The4OfUs]

Originally Posted by buckeye_bebe

And pre-e can be undiagnosed if asymptomatic.

This was true for me - other than swelling, which is so totally normal in late pregnancy, I had no headaches, spots, or other symptoms at all.

[bicyclingbethany]

You can only decide what's best.

But please, please, please listen to your body and be conservative. I had a pre-pg BP of 105/65 and late in pg it was up at 130/90- that was enough to make me hemorrhage significantly.

[Kidzaplenty]

Yes, listen to your body. If your numbers are so much higher than your "normal" and you have the headaches, it may be good to have it checked out. I have been watching my own numbers lately, and am hoping to have this WO before things get out of control like they did last time.

[MsBlack]

Originally Posted by bicyclingbethany

I had a pre-pg BP of 105/65 and late in pg it was up at 130/90- that was enough to make me hemorrhage significantly.

I'm not sure where you heard that elevated b/p leads to hemorrhage, but this is just not necessarily true. I do not know as women w/high b/p have any more incidence of pph than anyone else--tho it's likely that if a mama had higher b/p, AND she also hemorrhaged, her care providers would probably tell her that the high b/p caused the hemorrhage. Anyone have any links to research on this topic?

The LEAST amount of blood I ever saw at a birth was a mama with a b/p throughout her last month of 130-140/80-90--the HIGHEST b/p I ever worked with. She let out maybe a teaspoon with the baby, a tablespoon total during the time between baby and placenta, and about 3tablespoons with the placenta. She also bled very little after that point and her flow stopped entirely by about 10dys pp.

The only pph I've seen, actually, was in women with normal b/p! Not that I see much of it in the first place.

Fwlady--this is a stressful time of year, and as someone else pointed out, your birth plans have been quite changeable this time around! I do understand why that is so--and when you came back to hotel UC I thought that might really be the best for you and baby under the circumstances. But still--it's a stressful time of year, and there has been stress around your birth plans, wouldn't surprise me if your b/p is just responding to stress. Which doesn't mean you should write it off as unconcerning! Only to say that if high b/p is being caused/worsened by stress, then the best thing you can do for yourself is stress reduction.

yeah, I know that a lot of people would say at this time of year: 'yeah right, reduce stress, not bloody likely til after New Year's Day--the kids expect a,b, c, the relatives want x,y,z, we *have* to do all this that and the other'
Now I'm not sure what your holidays are like, what your work load is in preparing for, and actually doing the holiday do--but I say, chuck it all. Or at least, a great deal of it!

Even if your b/p is not *caused* by stress, stress can certainly make things worse in that department. Being extra busy can act to mask other signs you may be having that you need to read well, in order to make the best choices for yourself and baby--being too busy/exhausted also makes it far harder to hear one's intuition. I say, reduce your stress, reduce it now, make safe, peaceful healthy gestating your #1 priority for these next couple weeks. The kids and other relatives will just have to understand. Get help around the house, don't go to family parties or do anything that gives you more work, makes the kids overexcited/cranky, or keeps you up later than usual at night. Take naps, lay around a bit, have fun and relax. You could even put off some of the celebrating traditions for another month or so--why not? Include a babe-in-arms in those celebrations.

Ok, well there is my 2cents!

[Fruitful4Him]

Originally Posted by MsBlack

I'm not sure where you heard that elevated b/p leads to hemorrhage, but this is just not necessarily true. I do not know as women w/high b/p have any more incidence of pph than anyone else--tho it's likely that if a mama had higher b/p, AND she also hemorrhaged, her care providers would probably tell her that the high b/p caused the hemorrhage. Anyone have any links to research on this topic?

The LEAST amount of blood I ever saw at a birth was a mama with a b/p throughout her last month of 130-140/80-90--the HIGHEST b/p I ever worked with. She let out maybe a teaspoon with the baby, a tablespoon total during the time between baby and placenta, and about 3tablespoons with the placenta. She also bled very little after that point and her flow stopped entirely by about 10dys pp.

The only pph I've seen, actually, was in women with normal b/p! Not that I see much of it in the first place.


Ok, well there is my 2cents!

I had a client with high blood pressure who also had HELLP syndrome. She did hemorrage extensively, but it wasn't the high blood pressure, it was her blood loosing its ability to clot as her platelets dropped...she bled from her gums, nose, birth canal...everywhere... So while the blood pressure was a symptom, it wasnt the cause. That is the only thing I can think of.

[fwlady]

TY ladies so much. As far as holiday stress, it isn't that. I would have eliminated that already if I thought it was. I have been very laid back about that whole thing. THe kids made some cookies. I have a couple things that I am doing for the kids for Xmas that need finishing. But, they know that Xmas isn't a big deal around here. We are having company, but it is just my FIL and SIL. No big. So, that isnt' an issue at all. Thanks for pointing it out though.

I don't feel quite ready to have the baby though. There are still so many things I want to get done for her. I have been knitting and having so much fun with that since I learned. My BP actually had been staying quite low after I started doing that. I have not been running marathons, running around doing this and that (except a few trips to the city to Joanns LOL).

Today, I have had 2 readings of 135/90. I used to say that I would monitor it a little closer if I got to 75 diastolic. After getting there, it never changed, so I just stopped. Then, when the headaches started again, I figured that if it got into the 80s, then I would be concerned, if in the afternoon, not at night when it is naturally higher. Yesterday was high 80s all afternoon. So, I laid down a bunch. Today, now, I am hitting 90 even. So, I decided to lay on my left side again, and see where we go from here.

The other thing that I considered is that if I go into that ER, and even though I think my numbers are high (protein has never really been an issue, but neither was it when I had the PIH/pre-e the first time), they will look at me being a stranger with no OB back up there, and send me home because it won't be a concern for them unless I meet diagnostic criteria. I know finances shouldn't be an issue, but I cannot afford to have the copay and not be treated. KWIM?

They did have me on baby aspirin to prevent clots, and I know it can also head of pre-e for those that are susceptible, but it is too late for me to be on that now. I don't think that has anything to do with my BP though.

Thanks so much. I may go in today if my afternoon BPs aren't improved. Kymberli

[rhiandmoi]

If you go in, walk into L&D not ER. If you can try to call the L&D Nursing Desk and tell them your situation so they are ready for you. If you have any documentation of your MW's baseline, bring that with you.

[gossamerwindweb]

O.K. well... I have always had low blood pressure... around 110/70 or less. During the last few weeks of my pregnancy my b/p jumped up to around 140/90 but not over. I didn't have any swelling, no weight gain, no headaches, just high blood pressure. And every time I went to take my blood pressure, my heart would start racing and adrenaline pumping because I was SCARED IT WOULD BE TOO HIGH. And so then... it was too high. I was on the Brewer diet, and I decided that taking my blood pressure was what was causing it to be too high.

So I stopped taking my b/p all the time. I kept eyes out for other signs of possible pre-e but mainly I started drinking green smoothies with cucumber in them (raw fresh spinach, cucumber, and strawberries with some water) and we moved a mattress to the living room floor so I could lay on my side to watch TV and rest and wait out my pregnancy without feeling stuck in my bed alone. My blood pressure dropped some by the end of pregnancy but not a ton.

The point is... I did what I felt I needed to do since there was an absence of other symptoms besides just high b/p. I read up in Dr. Brewer's book about women with high b/p but no other symptoms being called pre-eclampsic when they really aren't. I educated myself and then we decided what we felt was best to do. That is what I recommend. Really educate yourself and take steps to do what you feel will help and is right for you and your body and your family.

[gossamerwindweb]

I should also add that besides the green smoothies, I also started taking more calcium and magnesium. I have already forgotten what else I did besides rest and lay on my side. And again... I really do believe that my high blood pressure was caused mostly by the stress of taking my blood pressure, and my worry that it would be too high. I have had issues with white coat blood pressure in the past (one time when I had wax in my ear and was upset about not being able to hear right, my b/p was 170/100, ENTIRELY from being upset, the next day my b/p was back to 110/70)

[gossamerwindweb]

Originally Posted by crukai

If it was just blood pressure that would be one thing... But when you throw in other things like the OP's headache and I thought on the other thread about the hotel she said something about visual spots. That is a potential problem...

That is true. HOWEVER she needs to figure out what is up with HER body. Sometimes even pregnant women have a headache for no reason. Has she been reading more than normal? Spending more time online? I don't know. Neither do you. The whole point of UC is taking all kinds of factors into account and then deciding what is right for you.

[Bokonon]

Originally Posted by gossamerwindweb

That is true. HOWEVER she needs to figure out what is up with HER body. Sometimes even pregnant women have a headache for no reason. Has she been reading more than normal? Spending more time online? I don't know. Neither do you. The whole point of UC is taking all kinds of factors into account and then deciding what is right for you.

With a history of preeclampsia, I don't think trying to self-diagnose is prudent. Headache and visual disturbances when accompanied by elevated blood pressure can be a sign of cerebral edema, which is absolutely nothing to mess around with because of the huge risk of seizures.

[gossamerwindweb]

Originally Posted by crukai

nevermind.

I was not trying to be rude, just showing another point of view. I understand most people freak at the thought of high blood pressure during pregnancy, and I am not trying to negate that. I personally decided my high BP wasn't something to worry about. I don't know what OP will do, but I assume if she feels this is a dangerous situation, she will seek help. I'm sorry I upset you somehow.

[fwlady]

TY ladies so much. I REALLY appreciate it. I wasn't concerned about the headaches and spots, until my first REALLY high readings. I always reasoned it away. They seemed to calm down after that, when my 3rd tri hit, they lessened. Now, I am having them more again, and then the rising numbers. Not all the time, and many times, when I would have a headache, my BP was fine. That is why I stopped testing to start with. But, when I started having the dull headache for hours again, I started checking again. My other PGs weren't plagued by headaches.

Of course, now I have the stress of the OB situation. I am not sweating that too much though, I am used to UP. Now, my DD has been having a major health crisis that no one can decide what is wrong exactly. We've been from acute asthma, anaphalaxis, and now pneumonia. But, this doesn't act like any asthma I know of and I have 4 in the house, nor is it acting like the pneumonia that my son has had 3 times this past year. We've been into the dr, now the ER for 3 hrs, and she is acting up again, and there really isn't anyting else I can do for her, unless I use her brother's emergency 02 (which I am not likely to do unless it gets to be a 911 situation), or take her back to the ER. She can't have her meds until tomorrow, and the breathing treatment she just had has made her worse than when she started. She is acting like she is fine though, this time, because they had to poke her 3 times to get in an IV, and she doesn't want to go back. This stinks.

Well, I have a one track mind, and it is hard for me to worry about me, while worrying about her. And, now our medically fragile son is acting like he is coming down with something, and he could potentially spend Xmas in the hospital. While I am due to have a baby any day now.

Okay, so NOW the numbers could be stress. It wasn't before, really, THIS is real stress that isn't going to help. I know that. The baby is moving fine though, and that is really what counts, right? At least if she goes back, I can always be checked out too, as we have done that once before. Kymberli

[Kidzaplenty]

I hope your stress goes down and all the children get well soon (without hospital stays). It is so hard expecting right near Christmas and then topping it off with other "things" that need our attention. I hope you have a wonderful birth as well.

[gossamerwindweb]

... I hope your family illnesses get much better very fast and your stress goes DOWN... along with your blood pressure