[CoconutCutie]

I went in today for my 28wk. Everything went great. Ive only gained 10lbs since the beginning. Baby is doing good...sitting sideways.

Dr wants me to go back to ultrasound to do a growth scan (because of breech presentation at my 24wk u/s) and at 32 wks wants me in there to do a NST due to "high blood pressure" my BP today was 130/86 and has been in the normal range every time. I didnt think it was so elevated that a NST was warranted but I guess hes being extra careful? He kind of has me a little freaked but Im keeping optimistic and positive hes just being cautious because he wants me to have a successful VBAC.

We went over a few VBAC facts. I was more testing his knowledge based on everything I have researched. Thankfully he was spot on and still seemed very on board. He did mention he might want to help my labor along (depending on how things go and how my dilation may be progressing) and even gave me accurate facts from my research as to what the risks were.

Does it seem my BP is to high? Or do you think he may want the NST just in case? Im confused a little. I go back in March. So I guess more answers will come then.

What are some questions you think I should ask when I go in next? Thanks

 

[kltroy]

Is there a reason that your doc is concerned about baby's growth? Are you measuring small? If so, doing a growth scan can't hurt. However, if the only reason was baby's position at 24 weeks that's silly, because MOST babies don't settle into a head-down position until around 28-30 weeks.

For BP, I have no experience on this matter, so maybe someone more knowledgeable can answer.

As for augmenting labor, did the doctor say in what situations he/she would want to do this? Or is it something that he routinely does? (If it's the latter, I would be concerned). Either way, why does he feel the need to do this? And if he uses any methods other than pitocin, I would not personally consent.

NST: all they do here is simply monitor baby's heartrate for an hour. I had one at 41 weeks. They're annoying because of the time commitment, but no big deal and if there is a concern with BP it can't hurt. I would make sure to eat something about 15 minutes before you start, and drink something sugary like juice so that baby is active. They will want to see "reactivity" - where baby's heartrate goes up with movement, so they want the baby to move. You can also help by scheduling this during a time of day that your baby is normally active.

 

[courtenay_e]

If that's been your baseline all along I wouldn't be as concerned as if it has started to creep up. HOWEVER, there are definately things you can do NOW to try to keep it low. Moderate exercise a couple of times a week, preferably in the form of a water activity, where you are fully submerged up to your chest and are moving would be a great place to start. As would yoga. Yoga has been proven to lower blood pressure. If you can get a great video for most days and hit a studio or other high quality class for one or two days a week, that would be perfect. I would definately shoot for practicing every day, though, or as close to that as you can.

A high quality liquid cal/mag would also possibly be beneficial if you're not already taking one. And nettles tea would be fabulous even with normal blood pressure. Do you consume sea salt? A little bit to taste on meals during the day of sea salt would be a good thing, as well.

Too, how much protein are you getting? I'd want to see you at a minimum of 60 g a day if you were my client and I was trying to keep BP in check.

It frustrates me that they want to do NSTs several weeks from now but do nothing before hand to make sure that your BP does NOT creep up anymore...but then I remember that as an OB this is how they are TRAINED to react.

So...it seems that he may be telling you most of what you want to hear, but also talking out of the other side of his mouth by suggesting testing that will make it much more likely that you will be induced or cut again. I would recommend getting an experienced doula and bringing her into your case, preferably one from toLabor (formerly ALACE), where informed consent is the keystone of their program. I would also then stay home for quite a while in active labor, to be sure that they don't have time to mess with you when you get there.

Are there other practitioners in your area who may be less interventive and more open to your body doing what it needs to do to have a baby? If you haven't already looked there I would try your local ICAN chapter. Also, please do consider an out of hospital birth (if your blood pressure was a fluke and it goes down and stays down--86 could be considered "creeping up" so if it's been normal before this it could have just been a stressful day, etc. but a sustained 130/90 may risk you out of some practices where they have to answer to OBs or a licensing board with older laws). Please go to your tribal area in the Finding Your Tribe forum and ask around there for friendly VBAC practitioners and midwives.

Good luck...it sounds as if you will have to be VERY knowledgable, very inquisitive, and very proactive to stay in this practice and get a vaginal birth...it just sounds as if he is stacking up the tests to look for something wrong so that he can say, "Well, I am really sorry that you can't do this vaginally/naturally but this test is showing that we need to intervene..."

Just my thoughts (after catching two babies in eleven hours...so take it with a grain of salt).

 

[CoconutCutie]

Ok Im going to try and anwser your questions to the best of my ability

To:kltroy-
Is there a reason that your doc is concerned about baby's growth? Are you measuring small? I believe its just because she was presenting breech. He may just want to check her postition and frankly Im not saying no to seeing my little girl

He didnt mention measuring small--I feel huge lol.She has a tendency to lay side to side. On the last scan she was measuring right on +3 days.

As for augmenting labor, did the doctor say in what situations he/she would want to do this? Or is it something that he routinely does? He didnt go into much detail. I think he just wanted to let me know. We were talking about my BP so from that Im going to gather if he feels my BP is becoming a prob he may want to. Im not sure if this is something he routinely does. We have talked about "agmenting" labor (ds was 41 wks and i had to be induced) in the event I "go over" the OK "time line" to have her. We have talked about the fully bulb to start? the dilation process. Im assuming we will talk more about this later.

To:courtenay_e
Thats pretty much the base line for my BP this pregnancy. I could do better on my end for sure and I will be wathching what Im consuming for sure. I have noticed myself adding regular table salt more to my food than I usually do. It was an eye opener for sure.

My friend who is a doula suggested usuing the cal/mag for the cramps I have in my hips. I havent gotten any yet but I will this week!! I dont eat sea salt on a regular basis maybe i should get it on the table if I need the taste of the salt.

As for thr protine Im not sure how much Im getting but I do know Ive been eating way more Red Meat than I usually do. I know this is a no no. Hubbys schedual has been crazy so drive throughs are the easiest thing right now. Time to be mindful of what Im eating. You know I used to be so good about that before I got preggo because my BP was High before hand and I knew I didnt want to go into this with it being high. Ive let myself go-time ot get back on track. Expecally if I want this to go my way w/o tons of medical inerventions.

I got the feeling he was trying to push the knife-but i flat out told him it wasnt an option and wasnt going to happen unless Ive weighed the odds myself and decide. I have plans of going in when i feel its time. I know they cant admit me w/o me saying so. So if I go in and they check me and Im just to early for my taste Ill be walking out. Thankfully my mom raised me to be a hard @$$ when ot comes to my medical care so I dont think Ill have problems there.

There isnt another option for me to VBAC here. Id have to leave my "level" of insurance and go from prime to standard for 1yr from they day I change. My husband is in the military so Im in the miltitary system. The hospital Im at is pro VBAC and they encourage their provider to give the option if thats what we (the patiant) want. The chances the OB that is seeing me will deliver my daughter are slim-lol. Its you get who is on rotation that day kinda deal. Yep sucky but thats how the military system works.

And unfortunatly there isnt an ICAN chapter here. Ive looked!!

I do know several doulas so I will be talking with them and se if they have time for me and what not.

Ok this has turned into a book. More later

 

[GOPLawyer]

nak

A measuring u/s for breech alone is crazy (that's the nicest word I could think of)...especially at only 24 weeks. A measuring u/s is a common tactic used by doctors to push a RC. Personally, I wouldn't do it on those facts alone. Yes, the choice for a RC is yours but a HCP can still make your life miserable. BTDT

 

[CoconutCutie]

Thankfully I dont have to pay for any tests or ultrasounds or anything else the doc wants.

 

[GOPLawyer]

Yeah....but do you actually want to have those done?

 

[CoconutCutie]

Its just an ultrasound. And just a test where I sit with a strap thingy around my belly. As long as its non evasive Im not to worried about it. The doc can say all sorts of things but really it all comes down to me--ya know?

Ill update when everything is done.

 

[GOPLawyer]

Quote:

Originally Posted by CoconutCutie Its just an ultrasound. And just a test where I sit with a strap thingy around my belly. As long as its non evasive Im not to worried about it. The doc can say all sorts of things but really it all comes down to me--ya know? Ill update when everything is done.

True. However, that's assuming you are given true and accurate results/information. Case in point...when I was at the hospital for preterm labor @ 28 weeks, I had the external monitor on. The OB was flipping out because I was planning a vaginal birth after having 2 c/s (one with a vertical incision). It was clear that the only acceptable birth to her was another c/s. She started looking at the printout from the monitor and shaking her head. I kept asking her "What does it say?" over and over. She wouldn't answer me. She was clearly on her way to saying a c/s was needed stat. The nurse took one look at the strip and asked me to roll over on my side. Everything was fine after that. The look the doctor shot the nurse was one I will never forget. She was PISSED. She wanted to declare a c/s was necessary but the nurse completely busted her. Think about that...this doctor was willing to lie and withhold information *just* to get that RC....even though it meant DD would be born at just 28 weeks.

Yes...they are just tests but doctors also use them as tools to get the result they want. No, they don't all do that but some do and not everyone is going to be lucky enough to have a nurse come to their rescue.

I could also talk about how doctors lied about my u/s to try to force a c/s but I think you get the picture.

 

[CoconutCutie]

Im sorry youve had bad experances with that. Thank you for your concern. However my doc wont even be presant durring these times. And Im sure my doctor is not the type. I always have the option of a 2nd 3rd or 4th opinion. Ill get the opinion of the entire OB section at my hospital if I feel the need.

I will keep in mind what you have said. Thank you for sharing your experances with me.

 

[MNHall]

My main piece of advice is, don't be afraid to get a second opinion and/or change providers if you feel like your provider is not working towards YOUR goals. If you feel like you're starting to get pressure to be cut, look elsewhere...no sense in fighting if you can get what you want from someone else!

My sister had "high blood pressure" and was treated high risk the entire time. Her BP was about 130's/80's. However, her good friend, with a different OB had very similar BP...she was just monitored and they kept an eye on things. Both women's BP never really fluctuated much...stayed in this range. Both delivered healthy babies...my sister was convinced to do a scheduled c/s, her friend successfully vaginally delivered. Just two different OB's and the way they handled things! My sister of course now wants to switch to her friend's OB...she was always very upset by the fact that she was treated high risk, while her friend with the same BP was not...but she just didn't want to go through the trouble of switching OB's...now she wishes she did!

 

[liberal_chick]

I always decline u/s at the doctor's office (my aunt is a registered u/s tech, so I just go see her for the 20 week and then I'm done). I've heard way too many stories of "oh, your fluid is too high," "your fluid is too low," "your baby is too big," "your baby is too small," when that isn't always the case and is just a scare tactic. Any doctor worth his degree should be able to tell baby's position (and if they are really good, give an approx weight) by external palpitation.

 

[kltroy]

I think there is truly no malice on the part of your doctor. BUT I would also decline any test that didn't have a medical indication, and here is why: most of these types of tests are what we refer to as "screening" tests. This means that they have a high sensitivity, but low specificity. That is, they are excellent at catching all of the people who truly have a problem, but cast a wide net and often catch people who do not have a problem too. For example the triple screen test, which you may have been offered around 16 weeks or so. With this test 99.95% (or thereabouts) of all babies with Down's syndrome will show up positive. But only about 2% of all the babies that have a positive triple screen test actually have Down's syndrome. Does this make sense?

So when posters here talk about wanting to avoid tests because they often do more harm than good, this is partly true. If you have other risk factors or reasons that the test might be a good idea, then IF something shows up it has a better positive predictive value than for the average healthy person, and if it comes out clean you can be reassured. BUT if there is no real indication for the test and something shows up, it is more likely than not a false positive and can lead to all sorts of worry and potentially interventions that are unnecessary. OBs are trained to spot and react to potential problems because they are trained to care for a high risk population.

At the end of the day my advice would be to ask your doctor about what the test results mean. Ask what the liklihood is that there is an actual problem (if one is uncovered) versus being a false positive. Ask about the risks, benefits, and alternatives of each test and each intervention that is suggested so that you can make an informed decision.