trying to decide how long to wait it out with gestational hypertension « Back to Group Discussions

[leafylady]

I'm at 37 weeks with a due date of Nov 27th. I'm 44 yrs old, 3rd child, and didn't have this problem with the previous 2. My blood pressure is hovering in the 140s while resting in a recliner. Whenever I go into the OB office, it goes up into the 150s (upper number). Blood pressure really didn't go up like that until 35-1/2 weeks, so it hasn't been long term and probably hasn't affected baby's growth.

There are no signs of toxemia in bloodwork or urine.

The OB leans toward taking it easy at home, trying to keep bp in the 140s, and waiting as long as possible, but he is also open to induction at any time that I feel uncomfortable with this approach.

I'm not dilated or effaced at all, so an induction would probably have to start with cytotec.

I'm torn on what to do. The main risks are stroke or seizure, both of which I'm low risk for right now. Seizure would be more associated with toxemia. Stroke risks, when I look them up, seem very low in my case.

Any advice? Should I keep waiting it out and keeping the bp at the mild hypertension levels? I'm a worrier, so then I wonder if I should go ahead with an induction, for peace of mind.

Both of my previous births were vaginal. First was completely unmedicated. Second involved some pitocin, but no epi. My first choice is all natural childbirth, but I want the healthiest choice for myself and baby.


any advice?

[leafylady]

My OB did say that if my bp went into the 160s over 100s, that he'd recommend hospital and inducing for sure. That is his personal threshold.

[guen]

I'm in a similar position.  I'm 40 and pregnant with baby #5, but I am chronically hypertensive, meaning, I have hypertension outside of pregnancy as well.  We play this waiting game towards the end of every pregnancy and it really makes me crazy.  Until about 35 weeks, my meds tend to keep things in a comfortable range (for me, that is around 130/80).  But inevitably, pressures will spike and I end up with pressures ranging up to 180/100 (in previous pregnancies, as high as 190/115).  We've doubled my meds this past week and my pressures now seem to be hovering around 145/85 or so, give or take 5 points.  I've been consistently been told over the years that the lower number is the one you really need to be careful with.  My own OB said if we can keep my pressures in this range, we can sit tight for now (so long as baby continues to do well and I develop no symptoms of pre-e) but once the lower number hits 100, then we need to talk induction.  I only had pre-e with my first child, 15 years ago, and it developed a week *after* my DD was born, which is rather rare.  I'm comfortable to sit this one out and monitor, but I do worry a little about my age and whether that puts me at a higher risk when my pressure goes up than it did when I was younger.  Anyway, I have no help or advice to offer only a great deal of understanding and empathy!  I really hate this point in pregnancy where, instead of sitting back and just waiting and anticipating the birth, I have to constantly worry and monitor and try to keep b.p. in check.  It sucks any fun out of these last few days/weeks.  :-( 

You mention the possibility of starting an induction with cytotec.  I assume you are aware of the controversy around cytotec being used in birth induction?  If not, I really urge you to read up on it before you allow it.  I wouldn't touch that stuff for anything in the world.  Unfortunately, my sister didn't know before she was given it and she'll never go near it again either.

I hope you can get your b.p. to behave until labour kicks in on its own. How far along are you?  If it helps any, my first birth was induced at 37 weeks due to high b.p. in an attempt to avoid pre-e but I developed it anyway a week later, as I mentioned.  However, with my second and third babies, I was able to wait it out and they came spontaneously at around 38+ weeks.  I've heard that babies of hypertensive mums tend to come a bit earlier, as if they sense when it's time to get out!  My last came at 35 weeks, but that was due to a premature rupture of membrames which may or may not have been due to my hypertension.  Depending on how far along you are now, baby might just decide it's time before you feel pushed to an induction.  BTW, what is your normal b.p.?  That also makes a big difference when deciding whether or not it has gotten too high.
 

[leafylady]

Thanks so much for your input. It's a big relief to hear from someone who has been through this repeatedly and makes me feel more open to idea of waiting it out. I think my anxiety about it makes it worse.

I've been reading about cytotec, the good and the bad. I'm going to talk to my doula about it today. I've had pitocin once, when already dilated, but never cytotec. I don't like the idea that I'd probably be confined to bed because of the high bp and a fetal monitor.

My normal bp is usually in the 120s over 80s. Thanks for explaining about the lower number being more important. My fiance has had high bp his whole life and keeps saying the same thing. The lower number has stayed in the 80s to 90s so far. I haven't used any bp meds and the OB wants to avoid them at this point, maybe because the bp didn't kick in until recently?

How does the high bp affect labor during your spontaneous labor and deliveries? Do you usually have to stay in bed and not walking around?

[guen]

If your normal b.p. is around 120/80, I personally would not feel too worried at this point (that is, go for an induction) until the bottom number rises to 100 and won't come back down.  I am very comfortable, personally, with my top number being in the 140s/150s and my lower number 80/90 for now.  I say personally, because I am not a dr., I'm just saying this is what has worked for me.  If your normal b.p. was more like 110/60 or so, pressures of 150/90 would be much more serious.

My high b.p. did not affect my spontaneous deliveries at all. They were completely natural--one, the baby was born naturally just moments after we arrived at hospital, the other born at home peacefully in the water.  Both were great births.

Pitocin-induced births do not necessarily require you to stay bound to bed.  I think women find them more painful than spontaneous birth (I do!) and more frequently need an epidural, which can leave you stuck in bed, unable to move around.  Cytotec-induced births cannot be controlled like pitocin and I've heard many stories (my sister included) where the labour was very violent and painful. There are also safety concerns with Cytotec. Cytotec was not developed to induce labour and the company does not sanction this off-label use.  They even issued a letter to that effect several years ago.  Many practioners and hospitals won't use it and, to the best of my knowledge, it is not used at all here in Germany. 

BTW, I am taking methyldopa (during pregnancy, I take another drug normally) and it is felt to be fairly safe in pregnancy.  Also, if you were to consider meds, it would only be for a few weeks, further decreasing the chances they would do any harm to baby.  However, your dr. might feel it's a bit too late in the game to try meds, I don't know. 

How much longer have you got to go until your due date?

[leafylady]

My due date is officially Nov 27th, so really not that far off.

[guen]

Hey, we're in the same boat, LOL!  My due date is Nov 26th!  We haven't got long to hold on.  Hang in there, monitor your b.p. (have you got a cuff at home?) and just try to relax (as much as that's possible with kids in the house!).  I'll be sending you "blood pressure behave!!" vibes. :-)

[OceansEve]

I have no experience with the bp issues, but I want to through my hat into the "just say no" to cytotec ring. They tried to use it w/ my first, did not go well at all!

I'm a big advocate of follow your instincts! If t makes you more nervous to stay pregnant then get her out.

[leafylady]

I'm getting all negative responses to cytotec here and in the local crunchy mama group, so I will definitely be looking for alternatives if I do end up inducing.

Yes, I have a battery operated blood pressure cuff at home. It's about 10 years old but still seems to work. It does drive me nuts, because it shows about a 20 point difference on the left and right arms, mainly on the upper number. I'm going with the left arm reading, since that's the one we always do at the OB's office. The nurse said sometimes the cuffs don't do the best job.

The children and the dogs are trying my patience today. They are probably lucky that I have to stay calm.

[Thyme Mama]

I also wanted to add that all those horror stories of uterine rupture, fetal death and maternal death when women would attempt a VBAC were nearly *all* Cytotec induced labors. Like guen mentioned, Cytotec cannot be controlled and can cause unceasing, violent contractions that can severely compromise the baby's blood/oxygen supply and the mother's uterus.

Simply put, Cytotec is what gave VBAC a bad name and led to many of the unsafe (unscientific) rules and restrictions surrounding VBACS, including outright bans.

Definitely avoid it!

That said, I don't have experience with high bp, but I do agree with OceansEve to follow YOUR instincts. You are really the only and best person to choose what's best for you both. Please keep us updated!

Can you give the kids and dogs some Nyquil or something???? Just kidding!

[guen]

Originally Posted by leafylady 

I'm getting all negative responses to cytotec here and in the local crunchy mama group, so I will definitely be looking for alternatives if I do end up inducing.
Yes, I have a battery operated blood pressure cuff at home. It's about 10 years old but still seems to work. It does drive me nuts, because it shows about a 20 point difference on the left and right arms, mainly on the upper number. I'm going with the left arm reading, since that's the one we always do at the OB's office. The nurse said sometimes the cuffs don't do the best job.
The children and the dogs are trying my patience today. They are probably lucky that I have to stay calm.

I'm guessing you already know you should always use the same arm to measure, right?  Yes, you can get wildly different measurements from one arm to the other and it's very annoying!  If your cuff is that old, I strongly suggest you take it with to your next appt. and compare its measurements to the cuff there.  With time, they can start to lose accuracy and need to be recalibrated (which is really expensive--you may as well just buy a new one).  The nurse is right, that some cuffs are better than others.  I have made sure to get the good, medical ones (my insurance has covered it, so that was helpful) rather than the cheap ones off the shelf that they sell Joe Public.  It really does make a difference.  Also make sure your arm is supported (resting) and you are not holding it up, and make sure that your arm is roughly level with your heart (don't take your pressure with your arm hanging straight down, for example).  

I noticed last night that my hands, legs and feet are starting to swell just a little. I'm trying to remind myself that this is perfectly normal in late pregnancy and not to make more of it than it really is.  I hate stressing about every little symptom and wondering if I should take it more seriously or if I'm overreacting.  Sometimes, for that reason alone, just allowing them to induce me seems tempting.  Just have this done with!  But my goal is to let this baby bake as long as s/he needs to and I just need to hang in there.  It's making me crazy though! 

[leafylady]

making me crazy too.  baby-daddy is ready to have me induce just to get past the 9th month craziness.  tough tooties for him.

[MrsKoehn]

Lol hang in there Mama! Do all you can to relax, it will likely help your bp too.

[guen]

Originally Posted by leafylady 

making me crazy too.  baby-daddy is ready to have me induce just to get past the 9th month craziness.  tough tooties for him.

LOL!!  I started musing today about giving in and just inducing, I'm so fed up.  DH reminded me why I did NOT want to do that.  He's been through this as many times as I, so he's used to the drill and knows me too well to let me throw the towel in now. ;-)  What we need to remember is, just because we are now considered "term", the baby is still early if s/he doesn't get to choose her/his birthday.  So, if our babies choose to come this week, YAY!  But if we go ahead and induce, they could be early.  So, we get to walk that tight rope of pros vs. cons and weigh the risks on both sides.  Isn't it fun?  <<heavy sarcasm>>

[leafylady]

ugh yes!

I'm having severe hip pain today, hoping it's labor starting, but realizing that it's probably just baby having a trampoline party.

[Thyme Mama]

Originally Posted by leafylady 

ugh yes!
I'm having severe hip pain today, hoping it's labor starting, but realizing that it's probably just baby having a trampoline party.

Yes, my baby is grinding on my hip bone too! I nearly fall down in pain if I'm standing. It's so sudden and sharp!

[leafylady]

My bp jumped up to 160s over 100s at the OB visit, so now I'm at the hospital on observation. Of course my bp is staying at 130s and 140s here in the hospital and still no signs of toxemia. It's actually quite comfortable and I don't have any stress to get anything done, like the stress I put on myself at home. I just hope labor starts naturally and soon.

[OceansEve]

Well I'm glad you are feeling less stress, sending labor vibes your way, hope it happens soon!

[leafylady]

I'm home again waiting it out on continued bedrest. The lab tests at the hospital showed no toxemia and my bp stays reasonable if I stay in bed or reclined. He says my bp will just go up during office visits and there isn't anything to be done about that . So I'm home and hoping for a speedy cervical ripening and move into labor. la la la