Homebirth and high blood pressure

[Salem Lily]

I was discussing homebirth with someone and they mentioned that someone they knew was transferred due to high blood pressure. They couldn't remember if it was before or during labor. So.....I'm not sure if she means transfer of care or transfer to hospital. (sorry for the limited details). This got me thinking......

Just so I'm clear and have a better understanding: If I was in labor and developed high blood pressure, is this reason enough for a hospital transfer? If I have high blood pressure during my pregnancy, is this a "risk out" for a homebirth and/or midwife care?

I'm sure it probably depends on the severity and if other signs/symptoms are present, but in general, how is this typically managed?

Thanks mamas!

[HeatherB]

A HB midwife worth her salt will help you to monitor and moderate your blood pressure, if necessary. It is absolutely true that high blood pressure can cause and/or be a sign of problems that require medical care, so it is a concern for risking out. However, there are many things that can be done at home to help keep your BP down.

I wouldn't expect to be risked out IN labor, unless there were other problems in the labor. If I was clearly eclamptic, then I'd expect to be transferred for additional care (anti-seizure meds and such), but if it was a moderate or pain/stress-appropriate level of increase, I'd expect to stay home and be monitored. FWIW, my MW doesn't check my BP a ton in labor, anyway. A few times, yes, but not constantly.

[Salem Lily]

Thank you for taking the time to respond to my post! Your reply helped set my mind at ease.

[autumntwilight1981]

High BP in pregnancy or labor can result in transfer of care. There can be a normal increase in BP during labor as a pain response, but typically the bottum number doesn't have much of a rise. As a midwife, I do not check BP very often in labor. It should always be checked between contactions, and if it is high it should be rechecked on the opposite arm with you lying on your side and using relaxation techniques. Some herbs can cause a rise in BP, so your midwife should be knowledgable about those effects. Submersion in water is a good way to lower a pain-response high bp

Crystal Musselman CPM, LM

[ishyfishie]

At my 38 week visit with my CNM, after perfect BP all through pregnancy and 5 days of on and off labor, my BP had spiked (something like 155/105). We agreed to a NST, some bloodwork (to see if it was metabolic vs stress-related) and some extra BP monitoring. I'm fairly certain if I'd refused it all and insisted on continuing with our homebirth plans, our CNM would have still attended, but we knew she'd be uncomfortable with it (because of the increased stress of labor, risking a stroke, PPH--which was my main concern, after some heavy bleeding during my first birth). We didn't want to put her in a position where she wasn't completely comfortable with the situation and where it was her career at risk, since we knew she (very reluctantly, knowing our feelings) felt that the hospital was the safest choice.

I don't know what would have happened if I'd been in active labor before we caught the high BP, though...I'm guessing she would still have recommended transferring, but by then it might have been too late to make it there before the birth.

[Pyrodjm]

I had pre-e. I had crazy swelling and boderline/high BP from 33 weeks on. My midwife did bloodwork and a NST at about 34 weeks and all was well. If if my bloodwork had not been fine she would have transfered care at that point. But she kept me even though my BP was still too high. At my 37wk5day appt I was finally spilling protein. She said that we needed to get DD out. I was already 4-5cm dialated and she sent me for accupunture with plans for castor oil and AROM if it didn't work. But at that point she was comfortable with me delivering at home.