What should I do?

[Usually Curious]

My MW want me to go to the hospital for PIH. She's a very close friend and is very concerned about me and the baby.

My BP has been around 136/93 this afternoon for about 2 hours. I had no other symptoms but now I have a headache. No swelling.

What does 'spots in front of your eyes' mean? I have had those for years, totally unrelated to BP. I think my eyes are very sensitive to light.

How high is too high? Is BP the main concern?

I am adamantly against delivering in a hospital. So much so that I would go UC in a heartbeat if I thought she was overreacting - but is she?!

[Romana]

Oops! Sorry.

[tlcdoula]

My opinion is that if your MW is concerned then you should go. If I was you I would hate to put her in a sticky situation by you not going.

[SublimeBirthGirl]

I wouldn't change my birth plans to avoid making my midwife unhappy, personally. I don't know a lot about BP issues specifically, but what's your normal BP during pregnancy? With no other symptoms I doubt I would go in immediately, but i'd watch myself closely for any other issues. That's just what I'd do. Be sure to listen to your gut.

[Usually Curious]

Originally Posted by tlcdoula

My opinion is that if your MW is concerned then you should go. If I was you I would hate to put her in a sticky situation by you not going.

Yes, but if she is overreacting I have a problem.

She is a very dear friend and our old pastor's wife. I love her and she loves us, my last birth w/her was amazing. I asked her if she was being cautious because of 'regulations' or because she was genuinely concerned about us. She is concerned about me 'stroking out'.

Another problem I have is that the advice she's given for lowering my bp is pretty outdated. Low protein, no salt, raw fruits and veggies. This is a personal bent for her, she is a big fan of the Hallelujah Diet.

I'm terribly conflicted.

[Jane]

Well, I know the absence of swelling doesn't mean there is no risk of pre-eclampsia - that's what she's worried about - a seizure or fetal distress from the sequalae of pre-e. A while ago, swelling was part of the diagnosis, but now the criteria is more like, protein in the urine and high blood pressure (higher than 140 on the top or 90 on the bottom, although some don't like +30 over your usual rate).
There are other things that are useful in diagnosis - blood work on hematocrit/platelet levels, and on the liver and kidneys, symptoms like headache, visual disturbances (changes in vision, spots, sparkles, flashes), abdominal pain from the liver area (often felt as heartburn-type pain).

Is the measurement accurate -by a trained person, not a Walmart machine? What's it like on your side?

Speaking purely hypothetically, depending on lots of factors, like gestational age, what the laying down BP was, the history, etc...I'd consider blood work on the mother, a 24 hour urine collection, an NST or BPP to assess fetal condition, a vaginal exam to assess cervical readiness for labor (ie, is induction an option). What would be appropriate really depends on lots of stuff - and what the mother wants.


That diet could lower blood pressure. I wouldn't consider it "outdated", just an option - there are others.

[MsBlack]

Hmmm....answer me some questions: How many weeks are you?
Have you been under stress for any reason lately--be that emotional/mental stress from money/home/family, or maybe just too busy, not getting enough food and rest kind of stress?
Have you ever spiked a b/p before in pregnancy?
How long has it been this way, besides today (if at all besides today).
How is your baby growing?


Spots in front of eyes refers to visual disturbances that can happen when b/p is 'pathologically high'--as opposed to 'normal for you'. It might be actual spots, or a general weirdness in your vision where you KNOW you are not seeing right but it isn't actual spots.

One thing you MUST MUST MUST do is get a break. Make it a priority in the next day or 2. You don't necessarily have to cure all forms of stress in your life, but you do have to set them aside, including this conflict with the mw (you don't have to do anything drastic...just get some space from her literally and figuratively). You do need some quiet calm relaxing time....luxurious baths, soothing music/scents/sounds, a massage and/or cozy snuggles...a good cry...a good laugh...whatever will help you to really really unwind for a time. If you can do this, and your b/p normalizes as a result (or at least reduces significantly), then it's probably safe to say that your b/p spike is 'situational', and not to be feared (as long as you can manage the situations that are causing the rise in b/p!).

Anyway, I might be able to say more if you answer my questions. In the meantime, while I understand your mw's concern, it may be that she is overreacting. Until there is greater evidence to support her strong concern, I hope you will work to keep your cool, give yourself lots of good nurturing (and ask for same from others), and otherwise think good thoughts of a healthy baby and birth.

and yes, the mw's ideas on b/p control are definitely not current or necessarily healthy for you. While it may be that she has a legitimate concern/hunch going on (this remains to be seen, in my opinion), you'll have to try other ways to bring down your b/p besides what she suggests.

sending you easy, gentle, warm, cozy trusting energy--

[Usually Curious]

Originally Posted by Apricot

Well, I know the absence of swelling doesn't mean there is no risk of pre-eclampsia - that's what she's worried about - a seizure or fetal distress from the sequalae of pre-e. A while ago, swelling was part of the diagnosis, but now the criteria is more like, protein in the urine and high blood pressure (higher than 140 on the top or 90 on the bottom, although some don't like +30 over your usual rate).
There are other things that are useful in diagnosis - blood work on hematocrit/platelet levels, and on the liver and kidneys, symptoms like headache, visual disturbances (changes in vision, spots, sparkles, flashes), abdominal pain from the liver area (often felt as heartburn-type pain).

Is the measurement accurate -by a trained person, not a Walmart machine? What's it like on your side?

Speaking purely hypothetically, depending on lots of factors, like gestational age, what the laying down BP was, the history, etc...I'd consider blood work on the mother, a 24 hour urine collection, an NST or BPP to assess fetal condition, a vaginal exam to assess cervical readiness for labor (ie, is induction an option). What would be appropriate really depends on lots of stuff - and what the mother wants.


That diet could lower blood pressure. I wouldn't consider it "outdated", just an option - there are others.

I was not spilling protein today. I am 38.5 weeks and SUPER ready. I'm dialated to 4 and 'very squishy'. Inducing should not be a problem, I imagine. In fact, she said if my BP went down and stayed down tonight that I could try castor oil in the morning and it might work.

Oh, with all four of my other children I went to almost 41 weeks. We consider me a 41 weeker so I would be shocked if he came early, on his own.

I'm glad you are saying the diet is not 'outdated' but that there are differing opinions. That is what you're saying, right?

[Usually Curious]

Originally Posted by MsBlack

Hmmm....answer me some questions: How many weeks are you?
Have you been under stress for any reason lately--be that emotional/mental stress from money/home/family, or maybe just too busy, not getting enough food and rest kind of stress?
Have you ever spiked a b/p before in pregnancy?
How long has it been this way, besides today (if at all besides today).
How is your baby growing?


Spots in front of eyes refers to visual disturbances that can happen when b/p is 'pathologically high'--as opposed to 'normal for you'. It might be actual spots, or a general weirdness in your vision where you KNOW you are not seeing right but it isn't actual spots.

One thing you MUST MUST MUST do is get a break. Make it a priority in the next day or 2. You don't necessarily have to cure all forms of stress in your life, but you do have to set them aside, including this conflict with the mw (you don't have to do anything drastic...just get some space from her literally and figuratively). You do need some quiet calm relaxing time....luxurious baths, soothing music/scents/sounds, a massage and/or cozy snuggles...a good cry...a good laugh...whatever will help you to really really unwind for a time. If you can do this, and your b/p normalizes as a result (or at least reduces significantly), then it's probably safe to say that your b/p spike is 'situational', and not to be feared (as long as you can manage the situations that are causing the rise in b/p!).

Anyway, I might be able to say more if you answer my questions. In the meantime, while I understand your mw's concern, it may be that she is overreacting. Until there is greater evidence to support her strong concern, I hope you will work to keep your cool, give yourself lots of good nurturing (and ask for same from others), and otherwise think good thoughts of a healthy baby and birth.

and yes, the mw's ideas on b/p control are definitely not current or necessarily healthy for you. While it may be that she has a legitimate concern/hunch going on (this remains to be seen, in my opinion), you'll have to try other ways to bring down your b/p besides what she suggests.

sending you easy, gentle, warm, cozy trusting energy--

Stress? Bwahahaha.

Yes, I am under a load of stress but just talking about it makes my BP go up. Suffice it to say that I care for my adult, disabled cousin, have two teenagers (one who just yesterday went to public high school for the first time), am transitioning from high corporate pay to low ministry pay(for dh) and I have been in a lot of pain this pregnancy.

My BP has been creeping up over the past few weeks but definitely spikes in situational stress.

She gave the same advice...relax - at all costs - and think about this precious baby being in my arms. My dh is trying but frankly I've coddled him our whole married lives so he's rather clueless when it comes to the kitchen and he just doesn't notice until the kids are at 'fever pitch', ykwim? Not to mention that we have a VERY attached 20mos who has not enjoyed the evening separated from me. He's doing okay w/my 17yod now, though.

General weirdness in my eyes? I'm gonna have to think about that one, that may be going on but I'm not ready to admit it yet. I also have a dull headache, I've had one since my appt.

Grrrrrr. Oh, I mean, Ohhhhhmmmmmm. Ohhhhhhmmmmm.

[Usually Curious]

Oh, and my BP spiked during labor last time (at 8cm) and she made me lie down. It was still under 140/90, though. It was always normal last time.

[Jane]

I think it's an alright diet to try. Some people thrive on high protein, some on low. You can't really go wrong with fruits and veggies. Not very many people are salt sensitive, but those that are should stay away from excess salt. I've seen too little salt cause swelling, too. I think it's a good thing to try out. However, if you have a "healthy" diet that you occasionally try out and really feel healthy on...that would be my first choice.
I'm not a huge fan of Brewer...but some are - and it works great for a few!!!

So, do you have a bathtub? I'd like to "prescribe" a warm bath, in a locked bathroom, a little music, a book (something not baby related), and a half gallon of water. Take a towel into the bathtub with you. If you get it wet, it will help you keep warm, even if some parts of you don't fit under the water. Maybe a little tylenol if you do that - to see if it's a tension headache.

[Paige, CPM]

I would ask you to do the 24hr urine if you had high bp that isn't going down. That will tell you the answer you need to know...pe or not...good luck resting!!!

[pamamidwife]

I feel like its not only common to have a rise in bp @ the end of preg, but it also can be viewed as being positive.

As our babies age, the placenta asks our bodies sometimes for more for the baby. This more is likely a rise in bp to increase volume to the placenta.

I wouldn't worry about things unless labs came back weird or if the diastolic - bottom number - gets over 100.

Laboring and birthing in water will bring your bp back to normal levels.

The issue is this: you have a mw that has some serious fears and a misunderstanding about the physiology of preg hypertension. Its not that she is not a good mw, but you need to evaluate what type of energy and mgt she will bring to your birth space.

[MsBlack]

Usually Curious--

While I do agree with Pam about your mw to some extent, I also want to say this:

As a midwife, the thing that worries me most in any woman is stress. Thanks for reminding me of your situation--I remember you now . Stress is a great ruiner of pregnancy and birth. Yes, it is a bad thing for the mw to allow her stress over your stress to get to her--and yet, I have seen how situational stress does impact birth negatively in one way and another--sometimes in small ways, sometimes larger, but it can always be seen in labors, deliveries and babies one way and another...just had a birth that I would say manifested mom's excess stress. I was very glad that this was fairly minimal as these things can go, and mostly it was a wonderful birthing with a healthy babe. But I have no doubt that mom's situational stress--really, far less than yours seems to be right now--impacted events in a way that a more relaxed mom would not have suffered.

It really doesn't matter 'what' or 'how many' the stressors are; what matters is the level of stress FELT by the mother. And I think I am hearing you say that you have reached an intolerable level of stress that is starting to drain your resources and create dysfunction (of some degree) with your pregnancy. Your bodymind is speaking loudly of this! I understand your mw's concern, especially as she is a friend who is no doubt a bit closer to your situation and emotional state than a stranger would be. I still don't think that she ought to get too wrought up over this herself--but in her shoes I believe I would be hearing alarm bells too on your (and baby's) behalf.

While Paige's suggestions are sound scientifically and I do not argue the benefits of the labs she suggests, in my opinion the key here is stress reduction. Time to hand off some of the load! So what if dh is clueless, treat him like a grownup and an equal partner and he will muddle through--IF you really step back and let go of things happening the way you would do them. You are doing too much, and the world will go on just fine without as much of you, while you get more rest and nurture yourself and baby for awhile. I can't say strongly enough how much I think stress is effecting you...and who knows? Maybe your life can improve in all kinds of unexpected ways over time, if you seek balance and calm now.

that's my 2cents. All the best to you and baby!

[Usually Curious]

Thanks all.

I had to go out this morning to meet w/a few of my son's new teachers(after I checked my BP and it was okay) so I went to the store on my way home and bought a bunch of junky freezer food that the kids can fix themselves and some 'labor' foods and castor oil for me(castor oil doesn't affect me as negatively as it does others).

I am set for a day of lying in bed and eating nutritious foods. When my dh gets home from his press check in a few minutes I'm going to take castor oil. I have super short labors so IF the castor oil works I don't want him in town rather than here.

Oh, Ms. Black, he is perfectly willing to muddle through it just makes my BP go up to know how inefficient he is, haha. You nailed me to the wall on that one.

[MsBlack]

Er...as long as you know I only nailed you with best of loving intentions!

:P
Happy laying about and castor oil--

[Usually Curious]

My BP went up really high on Friday afternoon and we went in to L&D that evening. They ran all the applicable labs and monitored me for about five hours and the labs all came back negative and my BP stayed low. They released me about 11:00pm.

They were VERY nice to me and very respectful of my choice to homebirth. It was quite suprising.

Anyway, we KNOW there is no damage to my liver and kidneys and my BP is doing fine. We are working on stress management now.

[MsBlack]

Yay!

Somehow I knew you see normal labs....

[Usually Curious]

Yeah, I thought so too but now my dh, my mom, my mil, and my midwife are all comfy w/homebirth again. I know that doesn't matter to some women but I respect all of them and like them to know/feel good about what we are doing. yk? No one needs the stress of conflict w/in the family this close to labor!