Dodgy blood pressure in late pregnancy

[owlbooty]

I'll try to condense this as it's a bit of a waffley long story. I am 39 weeks.

Basically I want a home birth and due to two dodgy BP readings where the lower figure was over 100 (taken within half an hour of each other during a period of high stress), despite lots and lots of subsequent readings where it is nowhere near 100, I am now finding myself up against a consultant who has decided I am high risk. Yay.

This is contrary to all the available evidence - baby is fine and healthy, I have no symptoms of anything, no protein or pre-eclampsia, no subsequent dodgy BP readings and have consented to taking a low dose of beta-blockers in order to placate the consultant.

Consultant said that according to NICE guidelines she wanted to medicate me and induce at 39 weeks (i.e. today).

I asked her what the evidence base was behind this and she couldn't answer me, just said that was what the NICE guidelines said. I've read them. They don't say that at all. They say induction should be offered and discussed with the woman if the BP is 160/110. Mine is consistantly hovering around the 140/80 mark and I am measuring it myself several times a day to make a point.

I told her that I am still planning a homebirth as I feel induction if the baby and my body are not ready is likely to lead to extremely high BP and major interventions, and whilst I recognise that if my BP goes up in labour I will have to transfer in, I have always known that is possible and am completely prepared for that. I just want to at least start off at home instead of being medicalised from square one. The consultant's plan would mean no homebirth, no MLU, no pool. All my coping strategies gone in one fell swoop.

I believe that by trying to take the route of least stress I am giving the baby and myself the best chance of a good delivery without intervention that could be damaging to both of us. I do not believe that I am putting either of us at additional risk. I am not two numbers on a sheet of paper; I am a human being who reacts badly to medical people stressing me out!

I'm seeing my lovely CMW today to discuss and I hope she will be supportive, but I feel really guilty and depressed about all of this. I should be excited about meeting my baby. Instead I feel like crying all day.

Has anyone else ended up in this sort of situation? Any advice? If you're just going to tell me 'OMG you're stupid home births are dangerous' then please don't bother, I have done a lot of research and they're really not.

I booked a home birth, so definitely not anti. However I got pe at 41 weeks and I nearly died. Your medical staff aren't trying to stop you having a home.birth, they are trying to do their best for you and your baby. High blood pressure could be lethal for you and your baby and shouldn't be fuck about with.

Sorry pressed send too quick, please follow your medical professionals advice. They wouldnt want to induce you unless it was necessary. The birth is a tiny part of the rest of your life with your baby, and a home birth is a nice to have, not an essential.

High blood pressure as far as I am aware is bp that stays up - not that rises on a one-off and goes back down again. If you have PE it remains high and continues to climb. I don't have PE or any symptoms that suggest I am about to get it.

I'm going for regular (every other day) check ups with MW so anything dodgy would be spotted and at that point obviously hb would not be on the cards, I'd never refuse medical intervention if I knew there was a real risk there. But from where I am standing the risk actually looks higher if I allow them to start poking me around than if I don't. I've seen what happens when babies are induced and aren't ready to come out.

Yes, but high blood pressure can escalate in to pe suddenly and without warning. I notice this thread hasn't been overwhelmed with posters saying that your hcps are being stupid and of course you should go ahead with your home birth.

90 is considered high blood pressure so 100 is well in the range. Looks like your normal bp tends low as well so 100 is high for you.

Maybe you will get you homebirth in the end, but giving birth puts a massive strain on your body any way so if you have already had some high readings there's a higher risk your bp will rise during the birth.

A ambulance transfer from home is no fun either ( had it with my first) so you might want to start to plan to have as stress free and peaceful hospital birth as possible. It is possible, even with an induction. A managed induction is better than a hospital transfer or emcs.

How long ago were your dodgy bp readings taken?

Unfortunately it is not true that with PE your bp goes up and stays up - it can "spike", so be normalish, jump up for a bit and then go back down. I spent 4 weeks in hospital with PE having my bp taken every 6 hours and it was all over the place. Have you had any bloods taken? That might give a clearer picture as to whether PE is likely.

Although it's not a bad idea to monitor your bp at home, automatic bp machines do not always detect high bp in pre-eclamptic women for some technical reason that I don't understand. Your mw should be using a cuff and stethoscope.

The generally accepted "number to worry at" is 140/90. So if your top number is consistently around 140, this could be another reason that the consultant is concerned. 140/90 was when I was put on meds (although I did have other markers of PE).

I really do sympathise as I wanted a hb with my dc1, but sadly ended up with a prem cs due to raging PE. I would certainly be extremely reluctant to agree to induction based on two bp readings and nothing else. Is there anyway you could get a second opinion? Hopefully you will be able to get more info out of the cmw.

It sounds as though as much as anything else the consultant is not being clear and/or is not able to explain why they feel induction would be the safest option for you and your baby (or cannot explain in a manner that is consistent with other information, such as the NICE guidelines you have read).

I'm not anti-HB, and nor am I one for following medical advice blindly (I had a planned HB for a breech baby) but I will advocate gaining as much understanding as possible before taking that step. If it were me I would probably:

• Write a very polite letter to the consultant commenting that you've looked at the NICE guidelines and they seem to be inconsistent with what she said and could she please clarify this difference. Putting things in writing can yield much more informative answers than those given face to face.

• Ask for a 2nd consultant's opinion (your CMW should be able to facilitate this).

• Discuss in detail with the CMW and/or a Supervisor of Midwives/Consultant Midwife (either should have a great deal of experience, and experience in more unusual cases).

One the basis of all of that I'd try and decide whether I still felt home was the most appropriate option.

Does your hospital only offer water birth in the MLU? Is the MLU on the same site as the CLU? It might be worth considering a compromise position - point out that some of the reasons you wanted to stay at home were more relaxed environment and pool. Would you agree to a hospital birth if you weren't induced and could be admitted to the MLU and pool on the proviso no problems developed (so same basic terms as any other woman)?

If you decided that home was still the best place, it might be worth writing a letter to the Head of Midwifery stating that you've had these discussions with the consultant and you understand the risks but that you are still planning a home birth and look forward to their support - both AIMS and the homebirthUK mailgroup can be very helpful in that kind of situation.

Lastly, I hope you can find the information to allow you make a decision you are comfortable with and feel supported in - and that things work out well wherever and however they happen.

HoneyDuke
"Your medical staff aren't trying to stop you having a home.birth, they are trying to do their best for you and your baby"

I agree with much of what you say, but from my experience this particular statement is a dangerous assumption for a few reasons. One is that, from my experience, too many HCP's offer advice on the basis of population wide statistics rather than considering the individual in front of them. Another is that in many instances, there isn't the data to say what the "best" course of action is. A third is that many consultants are pretty unsupportive of HB and will not even countenance HB for anything other than the most straightforward pregnancy for a woman who has had at least 1 (but not too many) babies before - even though there may be no evidence to suggest that being in hospital will improve outcomes.

Most importantly to me, however, is that we all perceive and evaluate risk in a different and personal way. Ultimately, whatever happens and whoever decides, I am the one who will be living with the consequences of what happens and, as such, I get the casting vote on what the "best" option is for me and my baby - especially in situations where there are risks and benefits to all the options and so the "best" option isn't clear.

(Incidentally, I would include DH in decisions such as this as I feel there's the potential for quite a big impact on him as well - but as I'm the patient I'm the one that has to convey the decision and it makes it much easier to write!)

I just thought when I woke up, you might interested to know what my consultant advised when I was pg with dc2. I was lucky to have both dc in a hospital with a high risk pg unit that has a world wide reputation for being experts in PE, so hopefully her advice was good!

I was hoping for VBAC with dc2 so had to go into spontaneous labour. By 39 weeks my bp was up around 140/90, I had some markers of mild PE in my bloods, and obviously had a history of severe PE. She was happy to wait until 40+3 to book my cs to give me a chance to go into labour. Based on that, I would definitely be getting a second opinion in your situation.

Hope you got on better with the cmw yesterday.

Thanks all. Didn't go brilliantly with the CMW yesterday as I was far too anxious to get any sort of decent reading for BP - I could feel my heart thudding in my chest the minute she rang the doorbell. However, she did agree with me that induction was completely daft and unneccessary as I was in no way unwell and she is going to talk to the consultant today to try and agree a care plan for me that allows me to labour in the MLU (and hopefully in the pool there) rather than being admitted to labour ward - obviously if my BP starts getting silly I will be more than happy to transfer down there as it's only down a couple of floors.

I'm still showing absolutely no signs of PE and she doesn't think it's likely I am going to, although she's taken some extra bloods etc to make sure that's still the case, more to help convince the consultant than because she is actually thinking they may show anything bad. Going to up the dose of the beta blockers as well as they are doing nothing - although having spoken to my mum last night she says she'd had them and they did nothing for her either so maybe that's some weird genetic thing.

I'm not pushing for home birth as DH is too stressed about it and it would not be fair on him. He has been there during all the discussions so he's had a good chance to ask questions too.

Tangle having worked in the NHS/healthcare sector for 10+ years now I totally agree with you - I've seen far too many patients railroaded into care plans that weren't right for them and I've seen how that can pan out - people genuinely traumatised long-term and suffering horrible birth injuries that could have easily been avoided. Yes, it's most important that the mother and baby survive. But it seems insane to see that as the only goal and anything else as acceptable damage which seems to be the doctors' viewpoint - thankfully not one that the MWs share.