homebirth and high blood pressure

[learning_to_live]

I have a feeling I am going to be permanently risked out of home birth after my experience with my first (4 months old).

Background info: about halfway through my pregnancy, my OB said my BP had been repeatedly on the high side on and off over the course of the appointments. (120/80-150/95) I began taking my BP at home and it was usually below 120/80, sometimes in the 120s/80s. So I was monitored more closely, my BP seemed to settle down to 120s/80s at visits. Nearer the end it was creeping up again at appointments, and was more often above 120/80 at home, and eventually I was getting some readings at home of 130s/90s, but some normal as well. I was tested several times for protein in my urine and there was never an indication of pre-E, I was on home bed rest. At the end of my pregnancy I was alternating (at the dr. office) between readings of 120s/80s to as high as 160/90s. I was scheduled to be induced at 38w4d. I had an appointment that day, and my BP in the office was 160/130. Terrifyingly high. I was already in early labor (on my own) at the time of this appointment, and readings at home that day had been much lower, maybe 120s-130s/80s. I went to the hospital immediately, where thankfully my BP was at its highest 130s/80s, and during the vast majority of my labor, between 110/70 and 120/80.

I fear I have chronic high BP, since the problem was already present in early pregnancy. Then again, I am not sure if it is only "white coat" high BP since during the majority of my pregnancy it was normal at home. I also got much lower readings at other doctor's offices (I swear my OB's BP machine hated me). 

Anyway, I was disappointed that my natural birth plan didn't work out like I had hoped, and before I knew I was having an issue with BP, I had been considering home birth. Did anyone have hypertension in one pregnancy but not in a subsequent one? How high is too high for a home birth? Obviously I want to be safe and I'm expecting to require a hospital birth with future pregnancies but with my home readings and my readings at the hospital I just wonder how much of a problem there actually was...

[Plummeting]

I think you should monitor yourself before becoming pregnant again, to find out if you actually have high BP when you aren't pregnant. That would be useful information. Then keep track of yourself throughout your pregnancy. I got high readings during both pregnancies sometimes when I was stressed out at prenatals, but never at home. I didn't have pre-e either time. I don't know if you actually have high BP, and that would obviously make a difference, although I can't say what any particular midwife would say was too high for her to take you on as a client. I do know that my midwives were definitely not going to risk me out over anything in the 130s/80s range, and that was with two different practices in different states. I had readings higher than that sometimes at both of them. The first was a hospital OB/CNM team, and they said I was fine and not to worry about it. The second was a home birth CNM/CPM team, and they also said I was fine and not to worry about it. I do know, though, that my readings almost never reached the 120s/80s range at any other time but when I was at prenatals and was already stressed out, though, so that might be why no one was ever concerned.

[lisarenee25]

I think the pp had an excellent idea about monitoring your blood pressure while you are not pregnant.  Your blood pressure could be borderline when not pregnant and stay borderline throughout your pregnancy.  If this is the case, and your bp doesn't raise much beyond your base readings - then of course you won't be risked out.  I think if your bp was like 100/60 and quickly raised to 140/90 - there may be a problem.

I wouldn't worry about it too much, cause worry can cause stress.  From what you said, you won't risk out.  Your midwife might suggest that you start taking 1000 mg of liquid calcium a day to prevent HPB and it's complications.  She will also recommend other stuff (exercise, herbs, etc) that you can do/take to help the matter.

Personally, I think you are taking the most important step - which is being vigilant and asking questions before you have a problem.  I wish more woman would do that.  That will work wonders for you.

[aeiou]

I had high BP with my first pregnancy. I had a few spikes here and there, then the last week of my pregnancy (before I was induced) I had consistent 150-160/90-110. My BP stayed elevated a few months after the birth, then lowered on its own. I didn't have any other signs of problems or any other problems (urine and blood tests all negative). I had been planning a home birth, but my midwives were not comfortable with this elevation in BP so they transferred my care to the OB at the hospital where they work. The midwife at the hospital with me as she was transferring care was thinking the OB would need to give me magnesium sulfate or something to lower my BP during the induction, which is mostly why she transferred care. I was quite upset about having to birth in the hospital, since I had this vision of a calm, private birth at home (and thankfully the birth was only 8 hours). 

I'm almost done my second pregnancy (due at the end of June), and haven't had any spikes in my BP so far (fingers and toes crossed it stays that way). At the beginning of my pregnancy, my midwife and I talked about how we would try to make sure we didn't have any issues this time, and that I would be able to have my home birth. One of the things she suggested, should my BP start to spike or creep up, was beet juice. There are studies that drinking a cup of beet juice can lower BP for up to 24 hours. 

Other things I'm doing differently this pregnancy are I'm not working at my frustrating job anymore (I'm at home with my now 2 year old daughter) and so I'm not on my feet for almost 8 hours a day 5 days a week. Also, I'm trying to go on more walks and be more active this pregnancy than I was during my first. I have no idea if these are actually doing anything BP-wise, but I feel healthy and they can't hurt. 

I definitely agree with PP about checking your BP pre-pregnancy. Also, if you think it's white coat high BP, maybe think of finding an OB or a midwife you feel more comfortable with so you aren't as stressed during your visits? 

[Derag082181]

I had high bp with my first pregnancy. I had somewhat high bp before (considering I was a non-smoker and VERY active)  I puffed up like a balloon the last week of my first pregnancy and was definitely having issues when I went into labor on my own at 39 weeks-probably b/c my bp was climbing and my body wanted the baby OUT! lol. Luckily I had a relatively fast first-natural labor and an OB that understood what I wanted and gave me a chance to birth on my own. I shoulda been on Mag though. And I did consent/tolerate to a straight cath for a urine sample. I did not have protein in my urine, but I did have other major symptoms of pre-eclampsia.

A year and a half later I became pregnant with my second, in a different area of the country and I knew HB was the way to go. My doc and midwife were supportive. I had already significantly changed my eating habits for the better, and followed the brewer diet very well for almost all of my pregnancy. (I had some stress related hiccups from 22-28 weeks, but kept it together). My bp was low-great at the beginning, and did climb a bit at the end. But no swelling or other issues like first time. Had a wonderful homebirth at 39 weeks.

I think you can plan to try a homebirth regardless of high blood pressure history, but regardless, you need to have a transfer plan if complications arise. Ie: go ahead and plan a HB, but then if things start getting hairy, go for more a more watchful eye.

It's a tricky thing, high blood pressure vs. Pre-eclampsia. I used to work as an L&D nurse, and one of my patients had a devastating stroke at home a few days after birth, from pre-eclampsia. I still had my homebirth after that. you just have to be aware of risks, signs and symptoms.

[learning_to_live]

Thanks for the stories and advice! It's good to know that I can still have a chance. I'll definitely monitor and do what I can to keep my BP in check between pregnancies.

[Krcl]

I had two home births and had the same exact fears with each of them. Every time that cuff was brought out I thought...oh no...here we go. I had high BP throughout my entire pregnancies and was monitored closely for it. I consider myself lucky that I had an amazing midwife, because I'm absolutely certain that if I had gone with an OB that they would have had me go in for a c section or induced me WAY early. I know now that I have gone through two pregnancies that I have pregnancy induced high BP. The further along in my pregnancies, the higher it would go. Starting around 6 months it would be 110/75. 7 months 115/80...8 months 130/90....9 months 140/100 ish. I think I had a little white coat syndrome too. I had some swelling but we all kept a good eye on things. No proteins in urine...with my first I did the 24 hr pee test, still no protein. Anyway, It was quite amazing...with both of my labors my BP was excellent. My midwife was really good about doing it quickly and with no warning, and she would just nod and say you're doing great. She wouldn't tell me the numbers. I think that helped...but anyway, all was well and no transfer needed. I was pretty amazed and SO grateful. Also, when my BP was checked after labor it was right back down to normal. So, midwife says it must be the way my body reacts to pregnancy. Good luck mama, I'm sure you'll be fine! 

[MarleneCPM]

Much of  the pre-e sx are diet related. Improving diet should improve BP. The  Brewer diet really does work, if one follows it!  Stress is also a factor. White coat syndrome is very real too. I agree with taking BP at home, frequently. Chart what was eaten & what emotional factors were going on just prior to BP. See what works for you & what doesn't. Visualizations can work wonders too, as can theraputic massage. Sad that more docs aren't more nutritionally aware! Pain, hard work & worry all can raise BP. So it's not surprising that if you wee contracting already Plus being threatened with induction that your BP would climb under those circumstances! Sounds like you really need a midwife who can help you make better food choices, and do visualizations to help you relax and keep that BP down. So, instead of r/o a homebirth, I'd say, that's just what you need! Please engage care early & be very selective. Not all midwives are equal.