Water, CFM, and High BP

[DocsNemesis]

I've been trying to write my birth plan since I'm going to be in the hospital for this baby now and I realized that I really don't know what to push for.

I have BP that fluctuates a lot-its been normal a good chunk of the time and then occasionally gets boarder line high-but I'm on full bedrest. So I'm going to assume that during labor, it'll be getting a bit higher, especially if I'm up and about. I know they'll be wanting to watch my BP and I know that hospital policy there is CFM. I do NOT want CFM, it drives me nuts, especially if I'm up and trying to deal with labor. Obviously I'm not getting an epidural (though I may reconsider if I'm stuck in bed the entire time-then all of this would go out the window anyway though), so I don't see the CFM as being helpful in seeing a rupture-I'll be able to feel everything-and in that case, it'd just be like a regular labor having CFM right?

So, if thats the case, would it be a good idea to insist on getting in the water? I'm thinking that with my BP's being high, being in the water would probably be a good thing-its relaxing and would, in theory, help lower it. I've always found water to be very relaxing and healing...I'm one of those people who will head for a nice warm bath whenever I have any aches and pains or tummy problems over anything else.

So I'm thinking-refuse monitoring, allow occasional BP checks, and get in the water as soon as it seems like the right thing to do, getting out when its time to start pushing? Does my reasoning here seem sound? I just want to do whatever is most likely to prevent complications and it seems like this is the best route to take-even if my BP is high. On the other hand, I've also read that epidurals can lower blood pressure....so maybe at some point if my blood pressure is too insane, that'd be the best route? I don't know!!!!! Stupid BP!!!

[Monkey Keeper]

UGH...I'm sorry you're dealing with BP issues. I think one additional argument you're going to get for CFM is related to high BP--they're going to cite abruption as a strong reason for CFM since it's a significant complication of high BPs.

I hope your BP stays stable enough for you to get the birth you want!

Oh, and there was a thread somewhere recently regarding water and high BP. It seemed there was some disagreement as to whether it would be advisable with BP issues, but IIRC, that depended upon the temp? It wouldn't hurt if you searched; I remember it was interesting reading.

[DocsNemesis]

Hmm...well, my only previous experience was with my 2nd. I had very mild pre-e with her as well, dx the day before I was induced with her at 39w4d. However, my bp was higher and I did have protein in my urine (not that I'm sure that matters-the 24 hour urine measures other types of protein as well so at this point, all that negative dipsticks are saying is that I don't have one particular protein). Anyway, in her case, I had a CNM and while it was against policy, I still got up and moved around and even got in the water for awhile (with her blessing) with my water broken. I was on the monitors the whole time beyond that though and like I said, it drove me NUTS.

I don't to do anything to hurt my baby obviously but I also don't take policy at face value. At what point does the risk of an abruption actually go up? Are there no other signs of it?

I was going to stay home until I was sure I was in labor anyway, maybe I can at least get some water time then I usually have fast births so I don't know...maybe I can deal with it, but it still just seems like laying in bed is just going to make my BP skyrocket (I labored like that with my first and it was absolute hell for me!!!).

[Dana_305]

I think a bath would be GREAT for your BP during labor. The water has its own calming effects, and you could do one better by adding epsom salt which has a positive effect on high BP because it is magnesium sulfate. At the end of my labor with DS, my BP spiked and my MW immediately put me in the tub with epsom salts to help bring it back down. I don't know that greater medical community would recognize the positive effects of a bath or an epsom salt bath, but it would probably be beneficial regardless.

[Monkey Keeper]

Originally Posted by DocsNemesis

I don't to do anything to hurt my baby obviously but I also don't take policy at face value. At what point does the risk of an abruption actually go up? Are there no other signs of it?

I was going to stay home until I was sure I was in labor anyway, maybe I can at least get some water time then I usually have fast births so I don't know...maybe I can deal with it, but it still just seems like laying in bed is just going to make my BP skyrocket (I labored like that with my first and it was absolute hell for me!!!).

I have to add the disclaimer that I was with an OB rather than m/w so the standards are a bit different, but I feel you on how the lying in bed is hell. Even though I was numb for the entire thing... Long story.

I'm sorry I don't have any specifics/stats on the abruption risk, but in my research on pre-e, that is one of the fetal complications cited. Just like stroke and seizure, the pressures at which abruptions occur vary from case to case. I just wanted to throw that out there so you could be prepared to handle that objection should the OB throw it at you as well.

[DocsNemesis]

No problem, I'll look it up and see what I can find out about it. I do know that even with my BP being 180/120 when I had my last baby, I never had a seizure and he looked great the whole time. He was quite oblivious to what was going on Having said that, I know each pregnancy is different...

Part of the problem I'm having right now is most of the things I ask are answered with "well, that depends on the situation..." So that tells me either that if I'm doing ok, I have more options or that they really won't let me regardless and they are just saying that to placate me. Like I said, I do know for sure that CFM is hospital policy for ALL VBAC's and I don't see the VBAC part as being a good reason for it since I'm not having drugs. But with the BP thing complicating things, I'm not sure at what point I should give in and just deal with the annoying things. I still have to check out the abruption thing, but I'm leaning towards refusing if my BP is only slightly high or below the limits.

If I'm without the monitor, I don't see a reason not to get in the bath. If I keep my arm out of the water I could even have BP checks while in there, though they might need to do them manually (Oh no!! Not that!!). Not sure how safe an electric monitor next to the bathtub is. lol

[Monkey Keeper]

I think that if my BP was within limits, I'd decline CFM as well. With my pre-e delivery, my BP was well over 180/120 as well, and neither baby nor I showed any distress until pushing. For some reason, like you, my body tolerated the high pressures frighteningly well.

As long as they are checking BP however often they need to, then you should know how "safe" you feel to decline CFM. And it's not like they can't check FHT while you're in the water.

[DocsNemesis]

Thats true too. Hopefully I'll get a nice nurse too...even with my midwifes blessing on doing everything I did with my 2nd, the nurse was totally nasty about it. I really didn't like her. (And niether did my midwife, lol) At least I don't have to worry about getting this particular on call OB at the hospital anymore-I HATE THAT WOMAN SO MUCH! Yay for having my own OB, lol.

[em2077]

My BP is a bit high as well. Planning to have a VBAC though if we can keep it under control - just started a low dose of Aldocet this week. Only 6 weeks left to go! My hospital is supposed to have wireless monitoring that can be water-proofed for the tub. Wonder if that is an option? I know, I hate the stupid things - they are always sliding out of place!

[kltroy]

Just wanted to add that I had CFM for my VBAC (un-medicated, hospital, but I ended up in L&D far earlier in labor than I planned due to a non-reassuring NST at 41+1 weeks). What's more, the telemetered system was broken/lost, so I was "plugged in".

I know everyone is different, but it actually ended up being really fine for me. I sat on a ball next to the bed the whole time. I got up, unplugged, and peed whenever I wanted to (and for however long I wanted to sit on the toilet). My mom rubbed my back and put pressure on my pelvis, which was great. My L&D nurse even gave me her sweet tarts (my end-of-pregnancy craving), which I love her for to this day.

Anyway, my only point is that CFM does not necessarily mean you are in bed. You will still have some flexibility. Just make sure they turn down/off the sound so you don't have to listen to the fetal heartbeat, since that's a distraction.

Best of luck! I think the best approach to any birth is to make your best plan and then go with the flow and be flexible about the details. The first item on my birth plan said that I was planning an intervention-free and natural birth, and that I had confidence in my body. Please be respectful of my privacy during labor by knocking or coming in quietly, not flipping on the lights, etc.

I think this in general set the tone for a great birth.

[MNHall]

Do you know if your hospital has a monitor that is water proof and wireless? Our hospital had 2. And apparently all of the nurses didn't even know about it...but my doula did. She said that she often had to even tell the nurses WHERE it was located, because a lot of patients just didn't have the need since I think something like 97% of the deliveries (at our hospital at least) had an epi...so, no wireless needed and obviously they weren't around water!

Anyway, that was my plan, to request that....although my plan went out the window since I showed up and was pushing within 30 minutes!

Hopefully you'll just have great BP and will have lots more options and lots less pressure to do x, y, and z, just because!

[DocsNemesis]

Just wanted to update, I had another cesarean.

I had PROM at 36w6d, labor never started. We even tried pit and went up above the max dose (which was 6 there, we went to 8). Nothing was happening unless the pit was going and even then my contractions were mild and far apart. She was just too high. I tried for 24 hours and decided on my own that I'd had enough. I'd had NO cervical change the entire time (I was at a 3) and I was exhausted by then because I had spent most of the time trying to get contractions going by walking, squating, doing anything we could think of-and hadn't slept in so long.

Anyway, I have to say that the fetal monitoring annoyed the heck out of me and really did hamper our attempts to get her to move down-but it also depended on the nurse. The one we had at first was VERY adamant that she be seen at all times on the monitor but the 2nd nurse was a lot more lax, which made movement a lot easier. Its hard to walk around or squat when the monitor loses the heartbeat and they have to try to find it again every 2 minutes. I had made it my plan to allow the fetal monitoring at first but then switch to intermittent monitoring if it was annoying me too much in active labor, but that never happened since labor refused to start.

In the end, I don't know if or when labor would've kicked in and while I'm sad, I don't really feel like I failed or something. I mean, I could've held out longer, but with all that we did to try and get her to move down with zero results, I don't know that it would've mattered. We did find out during the cesarean that her head was cocked to one side, she was posterior, and her hands were by her face/head-which she does ALL the time now too. With all of that against us, I'm not surprised she didn't move down!

The good news is, my BP stayed good and although I had protein show up in my urine a few days before, we really kept the pre-e under control and she was born before it could progress, on her own terms.

[ShwarmaQueen]

Congrats on your new baby! I'm glad everything worked out for the best.

[MNHall]

Congratulations! I'm glad to hear that you were the one in control and I think that's a super important part about being okay with a c/s! You did so much to try and that's a lot to be proud of!

Congrats on your sweet new bundle!