Blood pressure issues

[misscherryblue]

I'm due September 20th and have had high blood pressure readings at most of my midwife appointments since my second trimester. However, my blood pressure was always normal at home. Until now they were calling it "white coat" and didn't seem too concerned. However, the numbers crept up a little bit both at the midwife's and at home, so she called me in for a special check and then it was out of sight high- 170/110. Of course I felt stressed to be summoned in for a special blood pressure check, and I think that's why it was so high.  She had me stay and chill out a bit and after a couple of checks it went way down 130/96 but was still too high. At home it is now usually 125/75. I don't have any sympotms of preclampsia, and so far my labs have all been good. Still, my midwife is saying I should start preparing myself for a hospital birth, which crushes me, as it seems my blood pressure is fine at home. Have any of you had blood pressure issues like this and had home births?

[Katico]

I feel for you!  With my first pregnancy I had a midwife but under the system here at the time you also needed an OB.  I was assigned an OB who was REALLY a horrible woman (she kept telling me that if I had a home birth my baby would DIE) and surprise, surprise - everytime she took my BP it was high!  So, in my first trimester she immediately decided that I needed BP meds.  I turned that down and did what I could to keep it down by other methods but it still labelled me as high risk/high BP for that pregnancy.  Turns out, after I switched to a dr. I loved, my BP was FINE, absolutely fine when I trusted the person taking it.   I ended up not having a homebirth due to a change in legislation, but I totally understand your worry - I was so afraid to be mistakingly pidgeon-holed into high risk because of the difference in readings due to white coat etc. I still tend to get slightly elevated readings when someone new takes it. 

One thing my new doctor did right away (when she noticed they would get two or three different readings in a visit) was to put me in a quiet room with a book and an automated BP machine that checked it every 10 minutes or so, for an hour.  That gave a stress free environment and an average reading over time.  Maybe they could do that for you every week until your birth?

ETA - I also get higher readings anytime I WORRY about getting a high reading...ironic, eh?

[dot1]

Sorry you're having that stress.  I didn't have a homebirth (wasn't an option anyway as we had no midwives at the time) but I had high BP with dd1.  Statistically I have about a 20-25% chance of a repeat of GHT (gestational hypertension).  34 weeks along and so far so good here....

Anyway, just to share my story, my high BP develop at around 35-36 weeks.  It actually started the day after one of the docs at the family obstetrics clinic (OB's here are only used for higher risk pg) said I was measuring small fundal height and wanted an ultrasound to check baby's size, and then she told me baby was breech....and WELL guess what? in my ultrasound they discovered low amniotic fluid levels and "suspected" possible IUGR b/c baby was measuring around 10th percentile. Next thing you know I'm having to go in for regular monitoring and weekly ultrasounds. In the meantime, baby movement all felt normal and I was measuring my belly circumference which was steadily increasing.  My theory is that the baby dropped and so did my fundal height. Oh and I had also just started to get over a nasty flu and was still working.  Had to rapidly try to wrap up my caseload at work.  All recipes for stress induced high BP....so of course my BP shot up after all that!!!

By 36 weeks I was admitted to hospital overnight due to a very high reading in the clinic (160/95?) and a whole bunch of tests were done, including the 24 hour urine, non stress test monitoring, etc. Nothing showed up.  By the morning I was back to normal BP and went home, put on modified bedrest (but allowed to be up 4 hours/day).  At home my readings stayed pretty good until around 39 weeks when they started reading high, even at home (I would get as high as 170/100)...and I could "feel" the high BP.  At 40 weeks + 3 days I was induced with pitocen (other methods, e.g. prostaglandin gel, are contraindicated with high BP). BP was pretty high (140-150 ish over 90's).  It was the BP combined with low fluid that necessitated babe being born.   It went well (except for the hemorrhage after but that could have also been due to the high amount of pitocen needed to get labour going) , fast, no pain meds needed, and I was able to move around lots, get in shower, stay upright despite being hooked up to an IV and continuous monitoring. and my baby was perfect (around 40th percentile size...which would match genetics).  Did delayed cord clamping, kangaroo care, etc etc.  

You're so close to your due date, closer than I was when it all started.  Hopefully you can rest as much as possible, stay hydrated, meditate, drink calming herbal teas, lie on your left side etc. to keep it low at home.  Your inferior vena cava when compressed can increase BP (valsalva maneuvre) - it's located on the right (why they say to lie more on left side if possible).  

The manual cuff/stethoscope tends to be more accurate - I assume your midwife is using that to measure?  I always got higher reading with automatic cuffs.

Have you brought your own BP cuff in to ensure it reads the same as the ones used by OB/midwife?  That can be reassuring for you.  I think most doctors/midwives understand white coat syndrome....and if they don't take into account your readings at home, then I don't think they're really doing their job to get a complete clinical picture.  

I know my story might not be the one you wanted to hear, but just wanted to share my story (in case you have any anxieties about hospital transfers) that the outcomes can still be great.  Although I was disappointed to not start labour naturally at home and be able to say, "honey it's time...", I had a very good birth experience overall. It can't hurt to mentally prepare yourself for the possibility of a "home birth in the hospital" and tour the facility just to know what resources they have, e.g. bathtubs, showers, birthing stools, etc. ...with the goal of it being to reassure yourself that it's okay for that to happen and things will still go well.  I'm going to send vibes to the universe to hope yours can stay at home :)  And hopefully you'll be able to keep BP/stress low by knowing it can go well either way.  Best wishes :)

[misscherryblue]

Thanks so much to both of you for your responses! I will definitely bring up the idea of the automatic monitoring in a quiet room. I also really appreciate hearing about a good hospital birth experience. After your message and a long meeting with my doula I'm feeling a lot better about the possibility of having the type of birth I want in the hospital. So far my blood pressure is really good at home, and getting even better with some of the self-care things I'm doing. I have brought my automatic cuff in to check it against the midwife's and she said the reading on the cuff was slightly lower but close enough to assume it was accurate. Unfortunately I'm having trouble spending too much time on my left side. I ruptured a disc and had severe sciatic pain on that side several years ago. It hasn't acted up at all during pregnancy until I was put on bed rest and started spending extra time on that side. Even with all the pillows in the world it's still become too painful to lie that way for more than a few minutes. I'm going to try and reduce that with some massage and chiropractic, and I'm trying my best to let go.....

[Katico]

Originally Posted by dot1 

I know my story might not be the one you wanted to hear, but just wanted to share my story (in case you have any anxieties about hospital transfers) that the outcomes can still be great.  Although I was disappointed to not start labour naturally at home and be able to say, "honey it's time...", I had a very good birth experience overall. It can't hurt to mentally prepare yourself for the possibility of a "home birth in the hospital" and tour the facility just to know what resources they have, e.g. bathtubs, showers, birthing stools, etc. ...with the goal of it being to reassure yourself that it's okay for that to happen and things will still go well.  I'm going to send vibes to the universe to hope yours can stay at home :)  And hopefully you'll be able to keep BP/stress low by knowing it can go well either way.  Best wishes :)

This too ^^ - I was disappointed not to get my home birth but in the end, we were very happy with our experience in the hospital and don't regret it at all.  Home birth is currently "illegal" here (that legislation keeps changing things) but I'm not feeling sad at all about having another hospital birth.  I'm very glad I had taken the time the first time, to find out everything about the hospital in case we ended up there - when we did have to go I was much more relaxed about it (and I'm sure my BP reflected that! ;)

[biophdmom]

This is similar to what happened to me during my first pregnancy (although I wasn't trying for a home birth, just a natural birth with my hospital based midwife). They started to get antsy and call it pre-E towards the end of my pregnancy even though all my bloodwork was totally normal and fine and, for the record, had no ill effects of high blood pressure. My midwife put me on a modified bedrest at 38 weeks (basically told me to stay home from work and rest) and then at 41 weeks decided it was time to induce. I ended up in a hospital bed being induced and as my bp went gradually higher throughout the day, they decided that I need to get an epidural to bring my bp down, which, incidentally, didn't work. I did deliver my daughter vaginally but instead of the low-key relaxed natural birth, I was stuck in a hospital bed for 12 hours. I was subsequently diagnosed with chronic hypertension and have been medicated for a while. Because of that diagnosis, I risked out of all of the midwife practices in my area and am with an OB this time around (he supports midwifery, has CNMs as part of his practice and was very supportive when I described the type of birth I'd like, so hopefully will be okay). When we talked about the hypertension (my somewhat steady bp unmedicated is about 145/95 so borderline high), he told me its very common for women with hypertension to see steady increases throughout pregnancy and that its totally unrelated to pre-E.

I know this doesn't completely relate to your situation but I think the point is, they probably are going to react strongly about your bp and if you end up with a hospital birth, they will most likely try to medicate you for the bp. My current OB has said that although the epidural can be a vaso-dilator (will bring down bp) it tends not to work on women in labor, so perhaps read up on that and be prepared for them so suggest it.  I also think taking regular bp readings and recording them can be useful and if your midwife suggests things that are stressing you out, maybe remind her that stress will only raise your bp :) Good luck!!!!!