Homebirth Safe with Chronic Hypertension?

[blestmomma]

Hello Ladies

I'm 6.5 months pregnant with baby #7.  The first 4 were with a midwife and the last 2 my husband and I caught.  I developed chronic hypertension about 2 years ago.  I have a CNM who I'm getting my medication from and who thinks I'm coming into the hospital for the birth.  BUT......  I just read this article about Chronic and Gestational Hypertension at http://www.gynob.com/htiup.htm 

Now I'm thinking...."IF" I do not develop eclampsia (which I never have had any symptoms with any other children and do not now) WHY NOT HAVE MY BABY at home?

My midwife who caught the first 4 said she will catch baby #7 as long as I do not develop symptoms and my BP stays low (it is a constant 135/60 am and pm for the last 4 months.)

Do any ladies here have some thoughts you'd like to share? :) 

Shannon

[Bokonon]

Preeclampsia can be as dangerous as eclampsia, to the mother and fetus.

You could develop eclampsia with no notice.  You could develop it during labor.  Yes, if your BP stays stable consistently and you don't develop any other symptoms (having chronic hypertension gives you a 25% chance of developing superimposed preeclampsia), then I don't see any reason why you couldn't deliver at home with proper monitoring.  However, as someone who has experienced severe preeclampsia twice, I would highly encourage you to educate yourself on preeclampsia symptoms and risks, and be aware that pre-e can occur in any pregnancy with no notice. 

FWIW, the Duggar's 19th(!) child was born at 25 weeks due to preeclampsia/HELLP Syndrome.  Just because it hasn't happened in a previous pregnancy doesn't mean it won't.

I don't mean to be a wet blanket, but I had to deliver my children at 32 and 34 weeks due to severe preeclampsia despite no risk factors.  It is serious, and it isn't rare.

[blestmomma]

I'm not sure I understand the "developing eclampsia or even pre-eclampsia without symptoms".  Are not the symptoms high BP, swelling, seizures, etc...?  Did you have gestational or chronic hypertension?  Thank you for your response :)  and I will do further research.

[briannas auntie]

I have never had children yet, but from what I have read, people with high blood pressure before they became pregnant are at higher risk of developing preeclampsia.  That doesn't mean they will develop it 100%. 

I would research online at some homebirth websites and see if there is any information regarding this.  I have a couple medical problems, including gastroparesis, an ileostomy, and a neurogenic bladder.  My gynecologist told me that since all these conditions are under control, she doesn't see why I can't have a homebirth or birth center birth.  She'd rather have me at a hospital, but understands how much I hate hospitals since I was in and out of them for years because of medical issues. 

Have the midwife keep checking your blood pressure frequently, as well as you checking it at home on a blood pressure machine.  This way, you both will have a regular record of any changes.

Jessie

[Bokonon]

Originally Posted by blestmomma 

I'm not sure I understand the "developing eclampsia or even pre-eclampsia without symptoms".  Are not the symptoms high BP, swelling, seizures, etc...?  Did you have gestational or chronic hypertension?  Thank you for your response :)  and I will do further research.

Once you've had a seizure as a result of elevated BP, it's eclampsia.  There may or may not be other symptoms leading to that.

I had gestational hypertension - with a normal blood pressure of 100/60 that rose to 200/110 at 32 weeks gestation with my first.  The only other symptoms were proteinuria and mild swelling.  Preeclampsia is often called a silent killer because an expecting mother often doesn't have symptoms indicating impending pre-e.  With my first, I only knew that I was sick because of frequent OB visits and seeing a rising trend in my blood pressure and proteinuria.  At the end, I had swelling, but it wasn't severe.  I never had headaches, visual disturbances, clonus, or any of the other symptoms associated with pre-e.  But I was spilling a ton of protein in my urine, despite having normal blood labs, and when my son was delivered at 32 weeks, he and I were both very, very sick.  The placenta was very calcified, and my son's Apgars were 1 and 8.  He spent 6 weeks in the NICU.

I've spent a lot of time on the forums at www.preeclampsia.org and have read many stories similar to mine and many that are very different, but all have a common bond - we've all been affected by gestational hypertension in some way.  

[AlexisT]

Chronic hypertension on its own is dangerous to mother and baby. It can cause placental abruption, stillbirth, and IUGR. It can result in a hypertensive crisis during labor. Antihypertensive medication in pregnancy has its own risks (outweighed by the benefits, however).

I developed superimposed preeclampsia with my first. If I had not gone to the antenatal clinic I would never have known. I developed no symptoms (that could be detected without a lab) until I was so far gone I had to have an emergency C. This time, because of my chronic HTN and history of severe PE, I am facing a 37 week delivery--at best. Chronic hypertension is no joke.

BTW, I believe Michelle had had PE in a previous pregnancy, though it is unusual to have it, have multiple PE-free pregnancies, and then have an affected one.

[BirthTender]

Taking antihypertensive meds & planning a homebirth is not a good idea. some of the meds can cause circulatory  problems for the newborn. Planning a homebirth w/ chronic Hypertension is also not a good/safest for homebirth,a s placental abruption can occur, problems with the baby's heart, etc. Mom can have a stroke. Best is to reduce hypertension before getting pregnant, there are ways to control/reducs one's BP w/out meds, it takes dedication, study, lots of exercies, diet changes, weight reduction, etc. before getting pregnant. Much harder to control once pregnant, esp. in/beyond 2nd trimester.

Karen Benfield, CNM & owner of BirthTender Midwifery, a homebirth, well woman, family planning midwifery practice near Hickory, NC & covering western/central NC