Question about high blood pressure - Mothering Forums

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Old 11-16-2006, 02:47 AM - Thread Starter
 
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My sister just had a baby girl last week in the hospital. I was with her the entire time and knew her wish to go without an epi. Well, her water broke at home and she labored in the shower until she decided she had to go to the hospital. Once we got in a room I had her in the rocker with a pillow and she was rocking away through her contractions. The nurse came in and strapped her to the bed, started an IV and took two attempts to draw blood. Her BP was 160/110 at that point. The nurse ran to call the on call ob who ordered magnesium sulfate without even seeing my sister. The nurse started mag sulfate and put in a foley catheter (which ended up hurting worse than the contractions) all in the first hour we were there. I stood there in shock and didn't say anything. She tried sitting upright in bed and she was told she HAD to lay back so they could hear the baby's heart. She was starting to panic with the pain and the nurse said an epidural will probably lower your pressure. (She had already been informed NOT to bring up pain killers). My sister agreed and got the epi, then a few hours later got pitocin, and 17 hours after her water broke she pushed out her baby girl.

I am full of guilt that I didn't at least say we want to see a doctor, or I will hold a bed pan while she pees if you will not let her go to the bathroom, or at least say we want a minute alone to discuss her care. I feel like I let my sister get bullied and I could have been the voice of reason when she needed me, but I just stood there in shock thinking we should have stayed home longer! Do women have to have a foley when they are on mag sulfate? Are there other ways to treat high pressures in labor?
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Old 11-17-2006, 03:54 PM
 
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It's hard to say without knowing more about your sister's heath. What was her baseline blood pressure? What is her usual state of health? Any swelling or protein in her urine? Any history of blood pressure problems?

Depending on her usual not in labor blood pressure as well as her blood pressures during labor, that reading could or could not have been a big deal.

In my experience it is standard to put in a foley with mag sulfate, to monitor fluid intake and output; it also has to do with monitoring kidney function with the high blood pressure. And it is true, an epidural will lower blood pressure. And, in the case of extreme, sustained high blood pressure, sometimes this is a good thing. If blood pressure gets above 180, it is difficult for the kidneys to function. It is also difficult for the uterus to get a sufficient amount of blood flow. An occasional spike in blood pressure is not such a big deal, but a sustained high blood pressure, particularly if she normally is within normal limits can compromise her and the baby.

Without knowing alot more about your sister and frankly without having been there, it is impossible to say whether the doc and nurse overreacted. I don't work in a hospital for births--I work at a birth center. If a mama runs a little high, and then in labor is high, we have ways of dealing with it, especially if everything else seems okay. Laboring in the water or sidelying in a calm environment often helps. But I can imagine certain situations -- an extremely high reading, an increase in swelling, protein in her urine, baby not sounding as good as usual, or a typical low blood pressure to name a few -- where a blood pressure in the range of your sister's would be indication to transport to the hospital for much closer monitoring.

DO NOT feel guilty. First of all, it is over. You can't do anything about what has already happened. Look back over the situation. What would you have done differently? What did you feel good about? It sounds like you were incredibly supportive, and that is ALOT to feel good about. Your sister did not have a c-section (even more interventive and difficult to recover from), she had a healthy baby, and she herself is healthy. These, too, are aspects that you can look back on as positives. If you plan on attending more births, use this as a learning experience. Read, attend natural childbirth classes, and talk with those who have more experience (like you are doing now!).

Also accept that you were NOT "in charge" of the birth, and WERE NOT responsible for any less-than-desirable outcome. You have nothing to feel guilty about; you did nothing wrong, and *you did the best you could with the information and experience you had at the time*. Feeling guilty does nothing but make you feel badly about yourself and cause you to be less able to support your sister in her post-partum time period. Reviewing the birth and learning from it--both the good and the bad--will help you grow as a person, help you be able to celebrate your sister's birth experience and your new niece, and will help you be even a stronger support person next time you are at a birth.
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Old 11-17-2006, 06:36 PM - Thread Starter
 
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Wow, thank you so much for that information. This site is a wealth of knowledge. I am going to be attending my half-sister's birth in the next few weeks, so I feel like I want to learn as much as possible from this experience. My births were at home (except for one fetal demise which I chose to deliver in the hospital) so I have limited experience with how overbearing nurses can be. Fetal monitoring etc was not an issue in my case.

She is in great health, 27 years old, and had swelling in her ankles and hands the last 4 weeks or so. Her BP before and during pregnancy were normal and she never had protein in her urine. She did complain the evening before her water broke (38wk3days) that she was seeing spots, and in the hospital she didn't have that symptom but did have brisk reflexes. Never protein or bad blood work though. Her diastolic was over 100 a couple of times but then back in the high 80's low 90's until she got pain relief. Could she have used a bedpan with mag? I know she needed a cath for the epi but before that??

My sis is doing well and says she wants to learn more about birthcenter birth for next time (Yeah!) She is nursing like a pro and I have been here cooking all organic I try to shake the feeling that I let her down but I guess we both got bullied by the nurses.
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Old 11-17-2006, 07:42 PM
 
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It could be that she was having some issues; though I'm not sure that the first line of action should have been mag sulfate. Like I said, though, Idon't work in a hospital, and maybe someof the hospital based nurses will chime in.

Based on seeing spots, swelling, brisk reflexes and her blood pressure being that elevated when the rest of the time it had been normal--well, she might have been going into preeclampsia.

I tell you what, I do work in the hospital as well, but on the medical floor. I deal with alot of cardiac patients. About once a week I have a patient who develops chest pain, and I follow our protocol in dealing with it - starting oxygen, checking what the heart monitor is reading, getting an EKG and vital signs, giving nitro if ordered, giving mylanta, etc. I had a patient last week who had chest pain and really scared me. Everything was normal--EKG was just a little changed, but otherwise everything was great. But her skin color, her breathing, her posture in bed, the change in her affect, I just knew something was wrong. I had no real numbers, just instinct and intuition, and I have learned to trust it. I could have been wrong (I've been wrong before!), but I just had a really bad feeling about her, and I pestered the doc and was hyper-watchful of her all night.

The night before last I had a patient who was having chest pain. Almost exact same situation-no change in vitals or EKG, tele normal. I treated her the exact same way as far as the protocol went, but I was sure it was heartburn. The patient was sure she was having a heart attack, but her symptoms subsided once I gave her mylanta. Even if I didn't have the order for mylanta, I just really felt strongly that this wasn't heart related. Her color, her posture, and her affect just told me it wasn't. Just to be sure, I treated her as if it was.

So maybe the nurse just had a really bad feeling about what was going on with your sister. Or maybe not--maybe she overreacted, maybe she was new, maybe she was stretched thin as far as staffing goes and decided that it was better to overtreat than undertreat since she couldn't give everything the attention the situation deserved--I don't know. It's a tough call as a nurse.

I will tell you that I would be shocked if the doc would come in and evaluate. I've only worked in this hospital, but many of our docs rely on the nurses to make an evaluation; short of the patient coding, a physician doesn't necessarily evaluate a patient unless it is time for rounds. So if the doc wasn't in the hospital, I can almost guarantee that he/she would nto have come in to evaluate your sister.

I really hope that you can come to terms with this. It really sounds to me like you did a great job in a tough situation. If that was your first birth you attended (except for you own), that was a tough one. Depending upon how your sister's relationship is with her doctor, maybe you can go to the postpartum check. Ask her to ask the doc why they chose to do mag sulfate at that time, what his thought process was. Try not to make the doc nervous about it, but rather in a "help us understand what happened" sort of way. You might get more information that way, and it can help you process how you might react the next time you attend a birth where blood pressure becomes an issue.

Good luck! Hang in there!

I also really hope that someone else chimes in here. My info on OB floors is limited...it'd be cool to hear some current OB floor nurses weigh in here, give more current (and possibly correct) information.
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Old 11-18-2006, 05:00 AM - Thread Starter
 
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That does make sense. Though when we arrived I asked the nurse how she was doing and her reply was "exhausted." I hope that everything happened for a reason, and from what I recall my sis had some high readings after the mag and epi. She is feeling down about getting the epidural, but this is her first and there is always next time I think I will mention to her about bringing up her L&D when she sees her doc.

I have been to friend's births before but that was years ago, and I wasn't the only support person in those instances like I was for my sister and like I will be for my half sister.
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