Induction due to sudden high blood pressure - do I really have to do it? - Mothering Forums
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#1 of 20 Old 03-03-2007, 07:10 AM - Thread Starter
 
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I've had a trouble-free pregnancy up until this week, when my blood pressure went from 120/80 to 150/95 or so and stuck. I'm 39 weeks, but my cervix is still completely closed and high, so I'm thinking the baby isn't quite ready. I have an OB who has a fairly medicalized and interventionist view of birthing, and he's done everything he can, even getting me on the phone with a "high risk specialist", to have her tell me that not inducing can end up in death for me and the baby. Drama!

I have a doula I love, and I had a natural birth all set to go, but the reality is I don't think I can non-stressfully fight this doctor off for two more weeks, assuming the baby is a little late (this is my first.) I'm in bed, I'm taking billberry extract and listening to my hypnobabies cds, but nothing is budging the BP. (My sister is a nurse and is taking it every few hours.) The only thing that's improved is that in two days I've lost five pounds of water that was really swelling me up.

So - has anyone induced and NOT gone down the epidural route? Has anyone else been diagnosed with gestational hypertension managed to make it to when the baby wants to come? Does anyone have more info? What else should I be thinking about? My doctor and I had a very pointed discussion abou the risks of inducing versus laying in bed, and I believe that laying in bed is a much more conservative route than intervention, but of course he's got the AMA and current medical convention on his side.
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#2 of 20 Old 03-03-2007, 07:58 AM
 
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how about some sub-lingual folate and B 12-- it can bring down hypertension that is from elevated homocystine levels a very common cause of hypertension- during pregnancy the levels of these vitamins drop steadily and are at their lowest near birth and according to some hemotologists the only way to accurately measure folate deficency is homocystine levels-- if you have a trader joes they have a grape flavored sublingual folate, B6, B12 supplement that could work-- I have recommended this to some clients with good success-
the thing with swelling near birth is that it acts just like swelling around your period- your body is protecting it's self from loosing too much blood by making the blood less "rich" by adding more fluid/ dilution
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#3 of 20 Old 03-03-2007, 10:25 AM
 
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It's possible to induce and have an otherwise natural birth, just harder. Stay up and active-if you get confined to the bed it's a lot harder. You'll be restricted by various wires and tubes, but you can still do it.

I would not personally induce for high BP alone, w/out other symptoms and issues. My main thought is, why do you think you'll get a natural birth at all with a highly interventive, medical minded OB? It's never too late to switch, if you can find an attendant who is more on the same page as you are. I can tell you that I've rarely met a woman using a really medical OB who had a natural birth. They just don't know how to attend normal births.

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#4 of 20 Old 03-03-2007, 10:34 AM
 
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I did not have high bp during pregnancy, so I don't have direct experience.

THat said, in your position, I'd also be looking at taking evening primrose oil in capsule form- from memory, it usually takes a week or two to work but it can be useful over a few days to loosen up the cervix. I would also try upright squatting as much as you can when you are out of bed, & as much as you are comfortable with, of course, to try & get baby to engage.

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#5 of 20 Old 03-03-2007, 10:45 AM
 
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Has he ordered a 24hr protein? A hepatic panel (this is looking at liver function? A CBC? Uric acid? These are all tests that help complete the picture for toxemia - which is what I suspect he'll be worried about. How's your BP when you're laying on your left side? What is he telling you are the risks of continuing with your pg? The benefits? The risks of induction? The risks of an epidural?

Anyway, yes it is completely probable to have a natural induced birth. Educate yourself fast! Personally, I wouldn't let anyone break my water. Induced births of first time moms (esp w a thick cervix) can take days! Ask him what his induction plan would be. Could you be brought in in the morning and started with low dose pitocin - for example only increasing the pitocin every hour instead of every 30 min (or even 15 min at some institutions). Will he let you home if you aren't in active labor by 5pm and come back the next day? Once you are in a good labor pattern, will he turn off the pitocin (even if he agrees to this, you can expect to have to advocate a lot for yourself)? If the pit is shut off, can your IV be saline locked. Could you then get up and shower, be active, etc. The worst thing about pitocin is you need to be continually monitored (this doesn't necessarily mean in bed though). Once the pit is turned off, would you be treated like any other laboring mother?

I am worried you seem to have such a distrust in your dr. The dr/pt relationship should be built on trust and respect. Do you have any other choices open to you?

Janel ~ wife and mother of 4, L&D RN, midwifery student
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#6 of 20 Old 03-03-2007, 10:50 AM
 
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Also, have you taken your BP at home? Or at least at the drugstore, in nice calm conditions?

Homeschooling mama to 6 year old DD.

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#7 of 20 Old 03-03-2007, 10:56 AM
 
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laohaire, from the OP, I think her sister is a nurse & is keeping a close eye on the blood pressure situation.

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#8 of 20 Old 03-03-2007, 11:01 AM - Thread Starter
 
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I don't trust doctors as a general rule, this guy is nice and competent and all that, my distrust is not about him. I did try to switch to two different midwife practices about six weeks ago, but because of my age and the fact that my glucose tests were a little high (142) neither would take me. I'm in Houston, capital of the most medicalized births in the country.

We are doing a 24 hour urine protein test starting tomorrow. We will turn it in on Monday and decide what to do from there. We have taken my bp at home and at our local walgreens, and unfortunately it's still highish (like 138/93 or so) at home.

I will try the sublingual folate and B's!
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#9 of 20 Old 03-03-2007, 11:13 AM
 
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I had to do both.... bed rest and then induction at 38 weeks. I was on bed rest from week 30 or so on. Not fun. My bp was 160/100.

I hate to be the voice of dissent, but the high bp thing is really quite dangerous, and I would go along with the induction if I were you. But that's just me. This was my first pregnancy, and I did not know anything about preeclampsia or anything.

See what the 24 hour urine says. I had to do one of those, too, and it came back fine, but we still induced 3 days later because even with bed rest, my bp was too high.

I just don't want you to get complacent about this, it can be really serious. Even without other symptoms. You want the best thing for you and your baby, and even though I HATED being induced, and yes, I did end up with an epidural AND a c-section. Not my favorite thing... but I got a wonderful healthy baby out of it and that is all that matters. Just try and remember that "natural" sometimes meant death for mom and baby... but we have interventions now that can help.

I totally sympathize with you not wanting to be induced or have other interventions, and I think you should try as hard as you can to stick to that. Just remember that the important outcome is having healthy mom and baby, and high bp can turn into other problems REALLY fast.

Best wishes to you and your baby.

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#10 of 20 Old 03-03-2007, 11:14 AM
 
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I thought I remember some rule about bp's increasing 20pts that red flagged them. Couple things to remember before you take your bp... dont cross your legs for some reason it makes it higher before they take your bp next time close your eyes and take a couple deep breaths think calming thoughts like your baby sleeping peacefully in your tummy. It can really can make a 5-10 pt difference.
the other pp suggestions are great also.


Its crazy but rushing to the ob/mw appt, parking, some guy cutting you off on the road etc can make a huge difference in your bp.

Jeana Christian momma to 4 sons Logan 18, Connor 15, Nathan 6, and bonus baby Jack 1
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#11 of 20 Old 03-03-2007, 01:10 PM
 
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High blood pressure alone can result in all kinds of very serious problems for you and the baby. Period.

The risk of placental abruption is very real when your pressure is too high.

The risk of insufficient oxygen to the baby is very real when your pressure is too high.

I could go on and on, as I've had pre-e with two of my three pg. It is absolutely *not* something to mess around with.

My last baby was delivered at 37w1d due to this very issue. It is NOT worth putting your baby's life at risk to stay pg another week or two. Period.

If you cannot get your numbers below 140/90 (ESPECIALLY the bottom number under 90), it's time to do something. And I'm not talking about taking some herbs, resting, and/or hoping for the best. I'm talking get that baby out.
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#12 of 20 Old 03-03-2007, 01:13 PM
 
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the new rule is 140/90 suspect and do labs

the up 15 pts has been dropped but to be cautious many providers still follow that old rule-- I guess what the study group found was that elevations in pressure that were not 140/90 and above were not as ominous or common-
yes we pay attention to pressures going up and I know someone who had a stroke at 140/90- so it does happen- the thing that I also pay attention to is what happens to the clients who transfer -- well even mild-pre eclampsia if the hospital is on diversion will net a send home until things settle down at the hosptial.
The B vitamins may help even if there are some poor labs-- at this point my clients may already be taking some magnesium oxide- about 1000 mg per day this helps with blood sugar regulation , is a smooth muscle relaxant- which helps the vessels to relax too, will help to clear the intestines--- reduces the possibility of the liver labs creeping up- ( it is also used for migraines and prevents seizures) ---
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#13 of 20 Old 03-03-2007, 02:01 PM
 
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Originally Posted by aussiemum View Post
laohaire, from the OP, I think her sister is a nurse & is keeping a close eye on the blood pressure situation.
Oops, LOL, I read the OP three times before that one sentence jumped out at me! :

Homeschooling mama to 6 year old DD.

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#14 of 20 Old 03-03-2007, 07:24 PM
 
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It is a very hard thing to stare in the face. My BP did about the same thing as yours (except I was being medicated for high BP from about 12 weeks on.) Some upswing is normal at the end of pregnancy but yours does seem to be going up there pretty rapidly. Mine went from 130/75 or so to 155/114 in just a week and a half at the end of pregnancy.

I think it might be prudent for you to consider the induction. I am 100% against inductions except for true medical reasons, but I believe BP can be a real reason to consider induction. I am glad you're getting your BP monitored regularly.

If you agree to an induction, what method will they use? I assume they will do cervical ripening first. This can take a LONG time, longer than they "allow" in a hospital. You may want to ask about going to the clinic or hospital, getting the cervical ripener placed or applied, being monitored for a couple hours, then coming home to wait. It could take a while but the less time spent in a hospital, the better IMO.
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#15 of 20 Old 03-03-2007, 09:37 PM
 
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What about trying more natural induction techniques before going into the hospital for an induction. Castor oil, herbs, a breast pump - those things generally I would stay far away from, but they're better than pitocin! Also, evening primrose oil vaginally can help soften things up and get your cervix ready.

Just an idea - I am NOT a medical professional in any way!
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#16 of 20 Old 03-03-2007, 10:13 PM
 
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My BP spiked on my due date and was dx'd with pre-e. I went for the induction. I was having migraine headaches along with the high blood pressure which was scary. My cervix wasn't dialated at all. They admitted me and ripened it with cervadil overnight. When they started the pitocin the next morning, my cervix had softened but was only .5 cm dialated. My baby was very high too which meant I would have alot of pushing to do to get the baby down. Because of this my doc told me I had a 90% chance of having a c-section. That motivated me so I didn't give up on the pushing when it came time to push and had a vaginal delivery. I caved and got the epidural at 3 cm though. I tried to hold out as long as I could but the pitocin contractions were so close together and intense. My cousin had a pit induction too after she had been prepared for a natural birth her whole pregnancy. She caved after 4 hrs of labor and got the epidural too. She now says that the first 4 hours were the stupidest 4 hrs of her life, , and is just happy to have her beautiful, healthy baby. While I wouldn't want to have another induction if I could possible help it, I am grateful that it was an option for me when I was sick. I'm looking forward to my next pregnancy and hope that I'll get the natural birth I so want.

Kim
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#17 of 20 Old 03-03-2007, 11:20 PM
 
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Originally Posted by mommyminer View Post
Has he ordered a 24hr protein? A hepatic panel (this is looking at liver function? A CBC? Uric acid? These are all tests that help complete the picture for toxemia - which is what I suspect he'll be worried about. How's your BP when you're laying on your left side? What is he telling you are the risks of continuing with your pg? The benefits? The risks of induction? The risks of an epidural?

Anyway, yes it is completely probable to have a natural induced birth. Educate yourself fast! Personally, I wouldn't let anyone break my water. Induced births of first time moms (esp w a thick cervix) can take days! Ask him what his induction plan would be. Could you be brought in in the morning and started with low dose pitocin - for example only increasing the pitocin every hour instead of every 30 min (or even 15 min at some institutions). Will he let you home if you aren't in active labor by 5pm and come back the next day? Once you are in a good labor pattern, will he turn off the pitocin (even if he agrees to this, you can expect to have to advocate a lot for yourself)? If the pit is shut off, can your IV be saline locked. Could you then get up and shower, be active, etc. The worst thing about pitocin is you need to be continually monitored (this doesn't necessarily mean in bed though). Once the pit is turned off, would you be treated like any other laboring mother?

I am worried you seem to have such a distrust in your dr. The dr/pt relationship should be built on trust and respect. Do you have any other choices open to you?
I liked all these questions. I know a lot of hospitals have a stay-in-bed-policy for High BP issues. If laboring in the tub is a possibility for any other laboring mother's I'd ask about laboring in there--it's like bed and being water can lower BP.
Have you had your BP taken while in the bath? Just cuious what would happen.


I agree that PIH can turn very serious quickly and Pre-E can develop without much notice. I am glad you are getting monitored frequently and if you start to *feel* sick or if any other symtoms pop up it's, IMO, worth re-considering immediate induction. An emergency C-section for severe Pre-E would be worse than a laid back induction for PIH, even if that leads to a cesarean for a failed-induction.
I say all this though and I still don't think *I'D* personally do an induction based solely on a high BP. A lot of my gut instinct would have to go into that decion as well as a lot of research. I'm guessing that's where you are right now. Good luck with whatever you decide.

~laura
and planning to eat it again
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#18 of 20 Old 03-03-2007, 11:42 PM
 
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Here's a link to the Cochrane Library, scroll down to Pregnancy and Childbirth and you can select "Medical Problems in Pregnancy" to get to PIH and Pre E stuff and you can select induction for all things induction. They are really strict about what they consider high-quality science so you get a lot of "blah blah blah it's in conclusive", but it's nice when you're trying to filter out crap because that's their goal.
http://www.mrw.interscience.wiley.co...bjects_fs.html

~laura
and planning to eat it again
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#19 of 20 Old 03-04-2007, 10:20 AM
 
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And I just remembered this thread from recently. . .I don't know, maybe there's something in there you'd want to read

http://www.mothering.com/discussions...hlight=selfish

~laura
and planning to eat it again
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#20 of 20 Old 03-04-2007, 12:14 PM
 
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i had a similar experience in my first pg. i had been getting readings of 145/95 in the first trimester that resolved in the second trimester, and my normal was more like 125/80 then. then at 37 weeks it jumped up again to 150/95 and there were small amounts of protein in my urine and blood tests. since the elevations were not huge, my OBs were ok with close monitoring... i started doing twice weekly appointments, alternating NSTs and BPPs. also did a weekly blood test. as far as self care, they recommended that i stop all activities like exercise, cooking, shopping, cleaning... and rest on my left side for 4 hours a day. at this time i also stepped up the amount of protein i was eating, since i realized i'd gotten complacent about that in the last month or so with my BP doing so well... my doula recommended baths with epsom salts to help lower my BP as well. taking all that advice, my BP did come down and i stopped showing protein in my blood and urine. BPPs and NSTs were all fine and i scheduled and postponed several induction dates as long as things continued to look fine. i think it helped that i was due right around thanksgiving so the OBs didn't want to induce then anyway i ended up going into labor naturally 7 days past my due date, with an induction scheduled for 10 days past. oh, and my BP was totally normal throughout labor & delivery and post-partum - which i found surprising considering how intense and painful labor was - but hormones are a magical thing i guess!

that's a good sign that your doctor is willing to investigate more thoroughly before rushing to an induction, but is also taking it seriously and monitoring closely. hopefully your results will look good on monday and you can keep waiting! if things do look ok, definitely have a good talk with your doctor about what signs would trigger an immediate induction. and ask what kind of self-care he thinks would help - like the partial bedrest idea...

oh, and i did have two acupuncture treatments after my due date to help me either prepare for an induction or be more ready for natural labor to start!

good luck and take care

Rosemary & Gary :
James 12/04 & Cecelia 4/07
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