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-   -   Hospital Interventions - High Blood Pressure Induction? (http://www.mothering.com/forum/213-birth-beyond/1400522-hospital-interventions-high-blood-pressure-induction.html)

stgertrude 04-15-2014 07:26 AM

I'm 36 weeks pregnant and encountering some issues with my blood pressure that may sabotage my desire for another natural birth (I had natural, intervention-free births with both my previous children.) 

I am working with midwives in a large urban hospital who seem anything but supportive of my natural birth plan, YET,  I obviously do not want to risk the health of my baby or myself by not going along with their idea of what is safest/best for my child and myself. 

I have a history of having borderline high blood pressure, though it does tend to be lower when I am not pregnant.  Throughout this whole pregnancy, my blood pressure (at the clinic) has usually been around 130/85, which I realize is creeping toward the high end, however, according to most things I've read is still not high enough to warrant induction.  I did have an isolated incident (when the nurses/midwives were upsetting me) where my blood pressure shot up to 145/95, which I realize is high, however it was down to 132/82 when it was taken again 15 minutes later.  I have been through several blood tests to check organ function and passed all of them.  At home, my blood pressure is usually around 122/80.   I have taken the 24 urine test, and there was no indication of protein in my urine. I am getting a bio-physical profile/ultrasound done tomorrow to check on the baby's well being.   My midwives say regardless of whether or not I have pre-clampsia, they would like to induce at 38-39 weeks, based on my higher than optimal blood pressure.  My question is, given my history, is induction necessary?  Oddly enough, when I was pregnant with my first daughter 6 years ago, I had similar end-of-pregnancy blood pressure and no one ever mentioned induction.  Now it is all they talk about when I go to my appointments.  Any thoughts, advice?


MeepyCat 04-15-2014 10:02 AM

One of the major differences between care you are receiving now and care you received when you had your first daughter is going to be that you're six years older now.  I have no idea how old, altogether, that makes you, but maternal age does introduce additional risks that, combined with high blood pressure, raise graver concerns.  So their suggestions for how to proceed may be much more cautious now then the suggestions they made back then.

 

If there are concerns about your blood pressure, an induction may be the best route to reduce your chances of developing pre-eclampsia, PIH, or other complications, and possibly needing an emergency c-section as a result. 

 

Good luck!  I hope you have a healthy baby in your arms soon.


neycie 04-15-2014 10:19 AM

Some midwives just feel more comfortable inducing at 38-39 weeks, period, than letting a pregnancy go past that point. In that case, they will usually find *some* reason to suggest it. (I have had different midwives have radically different takes on my pregnancy issues, even within the same practice and pregnancy. )
This may or may not be the case with yours, but if they are less than supportive of your natural birth plan, induction is a fairly good way to put you on a more managed path they are accustomed to.
My question is to why your readings are so much better at home? I would put more stock in the home readings since you may be stressed by your prenatal visits. Could you ask to have to have it taken lying down and deep breathing, etc? Also, eating well with lots a protein may help.

rnra 04-15-2014 10:41 AM

You may find this information helpful:

http://www.acog.org/Resources_And_Publications/Task_Force_and_Work_Group_Reports/Hypertension_in_Pregnancy

pillowy 04-17-2014 08:01 PM

I just saw this story today about high blood pressure and I thought of this thread: http://www.klrc.com/klrc-cares/prayer-center/friends-lost-their-baby/. High blood pressure is a very real indication for induction.


stgertrude 04-18-2014 06:02 AM

Thanks to all who responded with helpful info/advice.  I came here for some feedback/perspectives and will NOT be risking the health of my baby/myself if induction is deemed necessary by my very concerned midwives.  I also am a little confused as to why my blood pressure at home is consistently lower (last night around 115/76), but higher at the clinic.  I do tend to get anxious at the doctor's office.  Pillowy, thanks for the input, but I didn't come here looking for scare stories.  I can find those myself by Google searches and am fully aware.


suzywan 04-18-2014 12:32 PM

Quote:
Originally Posted by stgertrude View Post
 

Thanks to all who responded with helpful info/advice.  I came here for some feedback/perspectives and will NOT be risking the health of my baby/myself if induction is deemed necessary by my very concerned midwives.  I also am a little confused as to why my blood pressure at home is consistently lower (last night around 115/76), but higher at the clinic.  I do tend to get anxious at the doctor's office.  Pillowy, thanks for the input, but I didn't come here looking for scare stories.  I can find those myself by Google searches and am fully aware.


Hmmm is the blood pressure instrument you use at home accurate?  I've had funky readings from machines that I don't get with a manual cuff.  Or, alternatively, the cuff at the clinic might be too small. 

 

I can't speak for anyone but myself, however, if my midwives were ever very concerned about something, I trust them enough to be concerned, too. Do you have reason to suspect that your midwives are not looking out for your, or your baby's, best interest?  If they work in a large, urban hospital they probably have been witness to a wide spectrum of outcomes with elevated BP and are acting conservatively, which isn't necessarily a bad thing all told.

 

I hope things work out!


katelove 04-18-2014 02:20 PM

Sounds like it could be white coat syndrome. Do you take your BP regularly at home and record it? I would suggest you start doing that and show your midwives. Hypertension and PIH are certainly not to be trifled with but, based on the information you provided in your OP, you have neither. I saw nothing in your OP which was an indication for early induction. I would be asking the midwives some questions about the precise criteria and evidence they are basing this advice on.

I would suggest that you continue to monitor your BP after you give birth though. Long-term, low grade hypertension can cause microvascular damage which increases your risk of cardiovascular diseases. As you get older, you will want to know if your BP starts to creep up and stay up.

sierramtngirl 04-20-2014 10:12 AM

I have terrible white coat hypertension-I always have my entire life . I have tremendous anxiety at OB appts and now have even more concern related to a possible IUGR dx at 35 weeks. The day I got the dx, at the perinatologists (whom I can't stand, btw) my BP was 146/80- everyone freaked out and I had to go do stat labs, urinalysis, etc (all checked out fine). The good thing is that I've explained this to my OB and he has the tech check my BP at the end of the appt rather than the beginning, and it is never above 120/78. He also has me monitoring at home (DH is a PA-C) and it is never above 115/75 @ home. They are really watching me due to concerns about the baby's growth, but I seem to have escaped concern about my BP at least for now. I know I may end up with an induction due to concerns about baby's condition (so far so good) but I certainly wouldn't agree to such on the basis of BP readings that I have in the OB office. Remember, you can ask for additional testing for pre-e and that is a better indicator than one or two isolated high BP readings when you are anxious.

rainbownurse 04-22-2014 02:49 PM

It could be the added stress of going to the midwives. I had to get mine to check me at the end of the appt, because I was usually more relaxed by then. 
I agree with Suzy, your BP cuff could be off or the cuff at the midwives office could be too small. If the one you use at home is an electric, there's a good chance it needs to be re-calibrated. 
If your BW and urine tests are coming back okay, personally I don't see a reason to induce early. To be honest, your BP isn't that high, it's perhaps at the high end of normal. The systolic (top number) is pretty good, but the diastolic (bottom number) would be a bit concerning to me. 


sierramtngirl 04-22-2014 03:25 PM

Quote:
Originally Posted by rainbownurse View Post

It could be the added stress of going to the midwives. I had to get mine to check me at the end of the appt, because I was usually more relaxed by then.

If your BW and urine tests are coming back okay, personally I don't see a reason to induce early. To be honest, your BP isn't that high, it's perhaps at the high end of normal. The systolic (top number) is pretty good, but the diastolic (bottom number) would be a bit concerning to me. 
^^^ yes this. My OB said that " interventions" don't really become necessary until > 140/90. Even then, if all pre- e tests are negative, he just encourages rest. >160/90 warrants possible medication or induction. I know all docs/midwives have their cut off, (& believe me, I had another similar scare at the perinatology office with a high reading and again, they freaked out). Won me an hour in L&D on the BP monitor, more stat labs, 24 hour urine---all ok (BP was at an average of 124/75 while there). I totally understand your situation and hope the best for you!! ((Hugs))

stgertrude 04-22-2014 06:23 PM

Thanks for all the recent replies.  I know I have anxiety and white coat syndrome as well, which is playing a big part in my high clinic readings.  I too get very worked up when going to the clinic and feel so much more at ease at home when my husband takes my blood pressure.  I'm quite confident my home readings are accurate because my husband is an RN and uses a manual cuff.  I've been logging my home readings and will take them to my next appointment.  I am not going against medical advice and am completing all of the recommended weekly urine tests, biophysical profiles, bloodwork, etc.  All has come back normal so far.  Good luck to you, Sierramtngrl!  Our stories sound quite similar and I wish you all the best as well. 



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