Choosing a midwife - need advice please :)

[macha10]

I am currently deciding between two midwives for my homebirth.

I would probably prefer the first one, but she says you risk out if you have pre-clampsia. The second one would still work with you, and risk you out if it becomes uncontrolled. I am scared of picking the first midwife, getting preclampsia, and not getting my homebirth. This may be an irrational fear, but it's still there.

I didn't have preclampsia with my first birth, just high BP which I feel was partly a function of "white coat syndrome". But the (CNM) midwives I saw kept threatening me saying I should be on partial bedrest, I would get preclampsia, etc.

What would you do? Should I go with my gut and pick the first midwife I like better, and hope I just don't get pre-clampsia?

[AlexisT]

If you develop preeclampsia, you SHOULD be risked out, IMO. It's a serious complication of pregnancy that can pose risks to mother and baby. What's her definition of "uncontrolled"? PE can progress rapidly.

If you didn't develop it in your first pregnancy, the odds are favorable that you will not do so again.

[macha10]

Good question. She may be talking about controlling it before it happens. I am just so scared of not getting my homebirth. I guess I need to be positive.

[dogmom327]

I think you need each of their specific definition of pre-e. If you risk out because your blood pressure goes over a certain number (say 140/90) once, I'd be concerned. If she's risking you out for full blown pre-e, then that's a different matter.

[AlexisT]

Preeclampsia means blood pressure over 140/90 and proteinuria. Hypertension on its own is not PE. Honestly, it wouldn't impress me if an HCP didn't have their definitions straight, either.

[Youngfrankenstein]

You may want to pick the first one and research diet-controlled pre-e prevention. I DO NOT know much about this and I've never been through it but Ina May Gaskin talks a lot in her childbirth book about diet being a huge factor in Pre-E. It may steer you in a direction that you feel comfortable with.

Like I said, I do not know much about the topic but reading up on it and depending about how far along you are might help.

[macha10]

Thanks for the help.
I think it's more that I didn't ask the right questions, or don't remember what they said. I know that neither of them would risk me out just for high BP on it's own.

[autumntwilight1981]

As a midwife, I believe preeclampsia is a serious condition that is not compatible with hb. High blood pressure is also a concern without progressing into preeclampsia IF it is consistant and uncontrollable. High BP can affect baby growth and can increase your risk for major complications like placental abruption.

The key is prevention! Call the midwives and do a follow-up on your interview. They will appreciate it. Ask what their cut-off point is and what they recommend to prevent that situation from arising. BP issues are commonly treated easily with diet and herbs. Ask what early warning signs they look for, and each step they take prior to transferring care. Proper cuff size is extremely important; a larger arm in a normal cuff will have an inaccurately high reading. Also, if the BP is normal when you are laying down it's not nearly as concerning. Consistant BP's with the bottum number over 90 or climbing BP's that are consistantly rising are very concerning. Slow baby growth, low amlniotic fluid, extreme swelling, protein in the urine, and rising hemoglobin (restricted blood volume expansion) are some signs that a borderline high BP could cause a problem.

Hope this helps!

Crystal Musselman CPM, LM