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Discussion Starter · #1 ·
Does anyone have any resources or links to research about low blood pressure during pregnancy? From what I can find, there has been little research in this area.<br><br>
I am 26 weeks pregnant with my third son and I've been on nifedepine (along with a few other medicines) to treat preterm labor for about 5 weeks. Nifedepine (or procardia) is a calcium-channel blocker normally used to treat high blood pressure. It also is an effective tocolytic.<br><br>
I normally have blood pressure of about 90-100 over 60-70. With the nifedepine, however, my blood pressure would drop to as little as 65 over 45 and my resting pulse has been over 130. I obviously have not been feeling well and I've been concerned aobut the effect of the low bp and high hr on the baby.<br><br>
After a month of being on this medication, we discovered that my baby is not growing as well as he was (dropped from 50th percentile to 10th in 4 weeks).<br><br>
My gut feeling is that the low blood pressure is causing decreased blood flow to the placenta and baby, and that this could have contributed to the possible IUGR. But I don't have any studies to back this up...<br><br>
Any ideas? Resources? Experience in this area?<br><br>
As nifedepine is used so commonly to treat preterm labor, I feel like I should raise this concern with someone who could do something about it. How would someone do that?
 

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Are you being followed by a perinatologist? There are other tocolytics that can be tried, though to be honest, the literature doesn't generally show improved outcomes with tocolysis beyond 48-72 hours.<br><br>
Growth is an issue. Really, if the tocolysis is affecting growth, you should be followed by a perinate. The UWMC would be my first choice, but Swedish has some good perinates as well (Tanya Sorenson in particular).
 

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Discussion Starter · #3 ·
Yes, I see Dr. Gavrilla at Eastside Maternal Fetal Medicine and I'll deliver at Evergreen. We prefer Evergreen because they have basically the most family-friendly nicu in the area.<br><br>
We talked about this briefly today, but beyond deciding to stop taking nifedepine, we didn't have time to get into the details.<br><br>
I guess my question is whether the tocolysis is affecting growth - or if it is something else?<br><br>
It's sort of a connect the dots thing. I can find studies that say that low blood pressure could cause poor placental perfusion, and that studies that link poor placental perfusion to IUGR. Some studies seem to say that this link may have more to do with other factors than low blood pressure - but nothing has looked at hypotension caused by medication, from what I can find?<br><br>
I've also read that IUGR is linked to nifedepine - but the assumption is that this has to due with the hypertension that the nifedepine is treating rather than hypotension caused by the nifedepine?<br><br>
As far as raising my concerns, I'm not so worried about my own pregnancy (we've already decided to stop using nif.) but instead about this as a topic of research. Seems like a possible risk that is not being explored?
 

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Yes, tocolysis is problematic. What we don't know about it would fill more books than what we do, and teasing out the effects of any intervention is always tricky -- is it the intervention or the condition creating the issue?<br><br>
Evergreen's NICU is very pretty. I've heard from other women that the hospital is not as woman-friendly as it markets itself to be.
 

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I'm just glad you've decided to stop using the tocolytic--I agree with maxmama that tocolysis is not proven effective for the long haul, and there is no doubt in my mind that you have correctly connected the dots as regards your baby's slow/delayed growth.<br><br>
And you are probably right that the potential problems caused by tocolysis use are woefully under-examined. From my look at the med research on ptl and various other pregnancy problems as well, from discussions with med HCPs and also with many families over the years, it seems to me that when it comes to med maternity care there is too much tunnel vision and a blanket belief that a med treatment can't possibly be causing collateral harm (at least, not if it is working to reduce the original symptoms for which it was prescribed). Tunnel vision too often leads to their missing collateral issues altogether; irrationally firm belief in the efficacy of modern medicine further prevents any chance that dots will be connected in the manner that you--an outsider, someone who has not been indoctrinated/blinkered but is simply seeking answers with an open mind--have accomplished.<br><br>
I could tell a lot of stories to support the above statement, but not today! As I mentioned, those stories would cover many issues of pregnancy and birth apart from ptl, but which all have led to the conclusions I mention.<br><br>
And it is really no secret anymore, is it, that modern obstetrical care is both founded upon very little evidence, and extremely slow (compared to other med fields) to accept actual evidence as it arises and make changes to approach and protocols. I think you're right that research should be done as you suggest regarding tocolytics--no idea how to prompt that to happen.<br><br>
Back to your fundamental problem of pre term activity and your desire to carry to term or as close to it as possible--have you sought help from holistic care providers? I don't know what your situation is, what underlying issues may make you tend toward ptl--but I do know that for some women, lifestyle modifications and/or herb use is very effective in helping to establish a healthy pregnancy, calming an irritable uterus, etc. Perhaps you have pursued this line of thought and action already--but if not, and you are interested, then do ask about it. There are birth profs and mamas here who no doubt will have lots to say about it.
 

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Discussion Starter · #6 ·
We began our journey into parenthood with a hombirth midwife years ago. I've had preterm labor with all of my pregnancies and ended up risked out of seeing midwives both in and out of the hospital.<br><br>
The main issue is lots (and lots and lots) of contractions that eventually do change my cervix. At 27 weeks, my cervix is slowly getting shorter and starting to dilate. I think we've done most everything we can from a "natural" approach to stop or limit contractions: hydration, nutrition, extra calcium/magnesium, extra folic acid, fish oil, probiotics, herbs (cramp bark), baths with epsom salts, even the occasional glass of white wine. We've also done lifestyle changes like avoiding sex and taking it very easy.<br><br>
My perinatologist is remarkably holistic. He is conservative in his use of medication and prefers to do everything naturally possible first. He has encouraged all of the above, and we only started using medication after these weren't stopping contractions. He encourages me to be intuitive and to listen to my body, and wholeheartedly belives that I know what is going on better than anyone else.<br><br>
As far as underlying issues that lead to PTL, I think it is a combination of genetics, being thin, and having a history of an eating disorder. Other than previous PTL and preterm birth, these are the only obvious risk factors. Genetics may be the most significant, as all of the women in my family had babies born between 32-38 weeks. I have been recovered from an eating disorder for 7 years, but I believe my body has never fully returned to normal as far as hormones and I think this contributed to my issues with infertility, miscarriage, and PTL.<br><br>
So I'm open to any other ideas? At this point, I can stay on motrin for another month and then we basically have no more options for medication to stop preterm labor. So I'm willing to try whatever holistic things may help.
 

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wow--it does sound as if you have done/are doing all the things that I might have suggested by way of 'natural measures to prevent/reduce ptl'. And you may well be right, that between genetics and personal history, pregnancy for you may never be as it is for the general population. I'm so glad to hear that you've found the kind of care provider you mention--sounds like the best possible for you.<br><br>
With all this in mind, then, there are only 2 other things I might suggest:<br><br>
1. can you keep the nef on hand, and use it on an 'as needed' basis? This comes from the thought that some days you will be more inclined than others to have contrax. Surely, taking it a day or 2 a week may not be as dangerous to your b/p and baby as taking it every day.<br><br>
2. Have you worked with beliefs/visualizations/affirmations at all? Given the power of one's family and personal history on a physical level, it may seem impossible to impact the course of things in any way--and well, *maybe* it is impossible. But maybe not. Surely some degree of the power of family/genetic history and personal health history lies in the mind....perhaps only a very small part...and yet.... Maybe some small part of this issue does live in beliefs and feelings, or at least is accessible to influence via the mind. If so, then maybe it is worth trying to access and reshape on that level. I do know a few people with different-but-similar issues as you (in the realm of fertility/birth) who have taken this approach with amazing success. I mention this since it is the one thing I can think of that was not on your list.<br><br>
best to you on working through this!
 

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Discussion Starter · #8 ·
Thanks for the suggestion. As far as the mind stuff, we are Christians and have been praying and I do believe this makes a difference.<br><br>
For now, we'll use terbutaline and nifedepine as a back up if contractions get too strong, but only in the hospital if someone is monitoring my hr and bp. I'd be fine with using these for a few days at a time to delay labor if it looks immanent.
 

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I like Gavrilla, he's experienced, and has a nice balance between cautious and too cautious. Evergreen's NICU is perfunctory, IMHO.<br><br>
You've named everything I'd try for PTL.<br><br>
I think that placental perfusion is pretty easy to measure with uterine artery dopplers. If low blood pressure is affecting the pregnancy, it should be easy to demonstrate and measure, go off the medication for a week and recheck would be an easy study for a medical center to employ.<br><br>
I know that one of the peri's touts folic acid suppliments, large ones for slow growth. I personally like to suggest 100-300 bedtime calories for moms that have eating disorder histories.
 

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Discussion Starter · #10 ·
Sounds like there are a few people out there who don't like Evergreen's NICU. Where else would you go?<br><br>
We've had our older boys at Evergreen, love the group of midwives there, and our younger son was in the NICU there. I really appreciate that they are supportive of breastfeeding and they have private rooms so moms can stay around the clock to breastfeed. We've met a lot of OBs and nurses - some excellent and others a little frustrating - but I imagine this would be true anywhere?
 
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