Tough decision - transfer to hospital now or later?

[misscherryblue]

I'm 37 weeks along in my first pregnancy. All along, I've had high blood pressure readings in the midwife's office, that usually come down when she takes it a second time. At home my levels are not perfect, but definitely fine (usually about 125/75) About a week ago, she decided she was concerned about my blood pressure (even though it was following the same pattern as always). She had me come in for a special check, and my first reading was sky high. It came down to below 140/90 after a couple of checks, but since then she's had me on bed rest, has done several non stress tests, is having me monitor my blood pressure every hour, and is strongly suggesting that I make the decision to transfer care to an Ob now. Her reasoning is that if office appointments stress me out enough to raise my blood pressure, labor certainly will. All my labs are fine and I have no symptoms of preclampsia.

I'm wondering if someone who has been there has advice for me. Part of me really wants to just see if I can stick with the birth I had planned, and then transfer to the hospital if my blood pressure stays up during labor. She seems to think that it would be less stressful for me to know ahead of time that I'm going to the hospital, and that alone might improve my blood pressure. However, I feel like if I go to the hospital and my blood pressure stays down, I'm going to feel cheated, and that I could've stuck with out original plan.

For those who have had emergency transfers, would you rather have planned it yourself ahead of time? Or are you glad you tried everything before transfering? If I plan to transfer now, I could go to a hospital a bit farther away that is more supportive of natural child birth than the one close by. But again, after talking to the nurse-midwife there, it sounds like if my blood pressure stays elavated, most of the things I would want (freedom of movement, using the tub, etc.) would be out the window anyway.

I could really use some advice. I'm trying to stay positive but this is feeling very lose-lose right now.

[tangledblue]

One thing to consider is that an emergency transfer due to preeclampsia is probably much more likely to result in  a c-section, especially if you are at the hospital that is not your first choice. Maybe go to the better hospital and then just try to be as low-stress as possible so that you can have movement etc. during labor if your bp stays down.  Your midwife sounds to me like she is being conscientious. Either way, I hope you have a stress-free final couple of weeks. 

[LiLStar]

Something about your midwife's attitude rubs me the wrong way.. your normal blood pressure readings sound fine, and just YOUR normal. The high one would be concerning, but by itself doesn't mean anything. But jumping to "if office visits stress you out enough to raise your blood pressure, then labor definitely will!" seems odd. "white coat hypertension" is soo common, and knowing you're going in *just* for a blood pressure check is bound to trigger it if you're prone to it. From your post it doesn't sound as if your midwife really has genuine medical concerns, simply "you're too stressed to home birth" I had to transfer to the hospital in labor with my first baby, and I'm definitely glad I tried everything to stay home before going in. My birth was SO FAR from what I wanted, but knowing that I tried everything helps me be at peace with it, it just is what it is.. I didn't have the cascade of interventions, I wasn't lied to or coerced, it was just the logical next step after everything else we tried failed. I wasn't treated rudely for attempting a home birth and though the birth I wanted was way out the window by the time we got there (I ended up with a c-section) postpartum was fine. Of course, how you're received as a transfer is going to vary SO much by where you live, the general attitude toward midwives/home birth in the area, what hospital, who is on staff. There's horror stories, and there's stories that go okay. Maybe post in the finding your tribe section and see if there's anyone there who has transferred to the hospital you would transfer to and you can see what their experience was. 

It can't hurt to try some natural ways to lower BP. a high quality calcium magnesium supplement is great. Prenatal massage, soaking in a warm tub.. anything that relaxes you. I've heard accupuncture works great too. From what I hear if you have long term high BP issues its not likely to fix it but it might help keep you down around 125/70 and prevent it going back up.

[Autumnshades]

I suffer from the 'white coat syndrome'.  Just the thought of having my bloodpressure checked makes it go high.  Normal readings for me are 78 or 79/120 but most times when I go to my midwife appointment my heart races, and my bloodpressure goes up.   I know there is nothing to be nervous about but I still am.  I have told my midwives this - and they understand - I can't believe that your midwife would say to transfer you to an OB just because office tests stress you!!! Yikes!  I did have one high one like yours at 90/140 (but it was the day after we found out my hubby lost his job ) I started taking a really strong odourless garlic supplement and my bloodpressure went down and has been down every since - except when I 'have' to have the check at the midwife office.  I am going the route too of trying to have our baby at home, and if need be, we will transfer to the hospital.  I want to know that we tried everything ... I know it will help me have peace. 

[Mummoth]

A few questions... what is your blood pressure like during the NST's? Does it go down as you've been in the hospital for a while?

Would your midwife be willing to come to your home for a prenatal visit? Maybe she'll get the more normal readings when she's on your territory. If she's willing to try, that could be a strong indicator that you might be better off birthing at home.

[HawaiianBlesing]

At the point, I wouldn't transfer either.  Like PP, I don't like the perception that your MW has.  If your readings are low at home, she should allow you to continue care with her.  If you have no other signs of PE I would opt for the home birth.  My BP would go up every now and then when I went for a pre natal visit but because my diastolic (bottom number) was always in the same range she didn't make a big deal about it.  She told me that she has a client that has "white coat syndrome."  Her BP is completely normal at home but off the charts when she comes for visits, like 160/110.  She allows her to monitor herself at home.

During my home birth, my pressure went up a few times.  It was initially 150/96.  She was very understanding.  I had just vomitted and it could have been from the contraction.  We filled the birth pool and I got in and just relaxed and had some massage work done. BP came down and we continued with the home birth.  This happened 3x that I can remember but my pressure always returned to normal.

I was able to relax so much more because I was at home.  The last place I would want to give birth would have been the hospital unless it was absolutely medically necessary. 

One reading shouldn't disqualify you from your home birth IMO.  I'd talk with her again and make sure you are on the same page.  Will she make you transfer if one reading is high?  I would hope not. 

Good luck!

PS  if you laugh while your BP is being taken, it automatically lowers it....just a little helpful hint.

[misscherryblue]

My midwife did the NST and didn't check my blood pressure during. It was lower afterwards, but still "skating the line" as she calls it. I've had readings all over the place with her. I think last time after the NST it was something like 135/88. I'm actually planning on a birth center birth, so I'm not sure if having her come to my home would help. It has made me regret not planning to give birth at home in the first place though.

 

Originally Posted by Mummoth 

A few questions... what is your blood pressure like during the NST's? Does it go down as you've been in the hospital for a while?

Would your midwife be willing to come to your home for a prenatal visit? Maybe she'll get the more normal readings when she's on your territory. If she's willing to try, that could be a strong indicator that you might be better off birthing at home.

[onlyboys]

What do you mean "sky high"?  Is there something else happening that could be worrying her clinically?  Like proteinuria, headaches, swelling?  

I think you should have this talk with your midwife.  Preeclampsia is nothing to mess around with.  

[misscherryblue]

The highest reading was 170/110. I cam down to 150/90 then 135/85, after spending quite awhile in her office. I don't have any other symptoms of preclampsia. I've had labs twice and a 24 hour urine collection and it's all been fine. She doesn't think I have preclampsia, just pregnancy induced hypertension. She thinks that although I may very well be able to forgo any interventions in the hospital, she doesn't think her birth center is the right place for me if my blood pressure is so sensitive to stress.

[LunaLady]

Originally Posted by misscherryblue 

The highest reading was 170/110. I cam down to 150/90 then 135/85, after spending quite awhile in her office. I don't have any other symptoms of preclampsia. I've had labs twice and a 24 hour urine collection and it's all been fine. She doesn't think I have preclampsia, just pregnancy induced hypertension. She thinks that although I may very well be able to forgo any interventions in the hospital, she doesn't think her birth center is the right place for me if my blood pressure is so sensitive to stress.

I came across this thread in searching for PIH and my situation is EXACTLY the same as yours!

I also have had slightly elevated readings at my MW appointments in the last few weeks (I'm at almost 32 weeks right now) at about 125 or so / 85-90 or so. She was worried about it, so had me buy a home monitor and I've been monitoring it this week. My readings have been even higher - about 128-135 / 90-100. I'm SO LOW STRESS, too! I'm not sure what the problem is! I don't work, I have no stress in my life. My DH and are so happy and in love and he has a great job that he enjoys - he just got a huge raise and everything is great.

I'm also tracking protein in the urine with the urine sticks my MW uses and I don't have any issues with that. My MW has done a Pre-E blood panel and everything came back normal.

My MW called me last night and told me something similar to what yours told you - that I should look into finding an OB at the local hospital because if my BP doesn't go down that I'll be 'risked out' of doing a home birth with her. I'm so bummed about that!

I am taking hawthorn berry caps, magnesium liquid and drinking coconut water to help... I hope it does.

How is everything going for you? I'm curious!

[AbbieB]

I'm gonna call BS on the whole, "you will be too stressed in labor" thing.

As a person with a history of white coat hypertension (do you have to take it right after you tell me you want to collect blood, of course it's high!) I would not be worried, just alert and observant. Make sure you are eating well, especially protein. Do as many things as you can to stay relaxed and stress free.

It sounds to me like you are in a state with some very strict guidelines for midwifery care and your midwife is just concerned about needing to do a transfer and how it may reflect on her. Or maybe her hands are tied in what she can legally do to help you, not all states allow midwives to do very much. Or maybe she is just not comfortable with dealing with borderline hypertension. Sorry to be so pessimistic but I was shocked at how over the top quick midwives in my area were to dump clients for pretty common issues like what you are having. Nobody wanted to mess with their license so at the first sign of needing to actually deal with something, you are referred out to an OB.

I understand the midwife side of the issue, why take any risk at all? It's not worth loosing your livelihood and everyone wants women to have good care.

[Monkey Keeper]

Originally Posted by misscherryblue 
She doesn't think I have preclampsia, just pregnancy induced hypertension. 

Just a PSA that pregnancy induced hypertension (PIH) still is a serious complication. Even moderately high BPs or high spikes in BP can damage the placenta, compromise blood flow to the baby, and endanger mom's health as well. Also, it is very common in both PIH and pre-e to have pressures bounce up and down until the disease progresses enough to have sustained high pressures. Things can go from borderline to deadly on a dime. If I were the midwife, I too would want ready access to facilities in an emergency situation with a mom who has experienced seriously high BP spikes in my office (160/100 is the threshold for severe PIH, if memory serves).

To share my experience, my BP bounced around from 120s/70s to as high as 160s/90s for 5 weeks of bedrest until I was induced. By then I was spilling protein, and my BP shot up to well over 180s/120s during labor. I had *just* PIH until I didn't--and then I had severe pre-eclampsia and severe post-partum PIH.

So based on my personal bias, your midwife is being cautious--probably because she has seen situations like yours go downhill quickly.

[maryeliz]

Originally Posted by PinkBunch 

Just a PSA that pregnancy induced hypertension (PIH) still is a serious complication. Even moderately high BPs or high spikes in BP can damage the placenta, compromise blood flow to the baby, and endanger mom's health as well. Also, it is very common in both PIH and pre-e to have pressures bounce up and down until the disease progresses enough to have sustained high pressures. Things can go from borderline to deadly on a dime. 

Unfortunately, this was my experience.  I went into my pregnancy with White Coat Hypertension, so my midwives weren't too upset with my occasional high reading, when I got a small but steady BP rise they diagnosed PIH, within a month PIH became mild pre-eclampsia, ten days later I was diagnosed with severe pre-e and delivered my baby.  You are pretty far along, so maybe you will stay stable until you have your baby (maybe baby has already come by now!?!), but it is possible that things will get more serious.  Think positive, but be vigilant, I hope you have a completely uneventful birth!