high blood pressure - water birth / refusing induction etc.

[goldenegg]

Hi - hope somebody can give some advice. I am currently 35 weeks (first baby) and have high blood pressure which i'm being treated for. It's only borderline at the moment (145/93) so not sky high. Before this issue came about I really wanted a natural birth, preferably water birth. I've asked whether this is still possible but none of the midwives will commit to anything at this stage. The problem is the not knowing is now stressing me out! From reading I understand that if the blood pressure can't be controlled then I may be induced early - this I am quite fearful of as it seems to be a lengthy/painful process. It may sound ridiculous given my initial wishes to want a natural birth, but i would actually rather have a c-section over induction. So my questions are:

1. Has anyone been in a similar situation with high BP and gone on to have a natural / active / water birth?

2. Has anyone refused induction and gone straight to c-section for blood pressure reasons?

2 is easy to sort out. You'll come up against resistance but as soon as you make it clear that 'if your baby is in danger then get him out NOW with a knife, if he's not, leave us be' then it will be okay!

No 1 is more tricky. Ultimately you can have whatever you want if you had a homebirth but if you want to be near medical stuff it will be hard to do it on anything other than their terms.

Fwiw I was a 'not in my lifetime' gal wrt induction. It wasn't gonna happen for ANY reason. It got a bit silly when I went overdue but I just stood my ground and whenever anyone starting talking about risks to baby I asked if they were serious enough to warrant a c/s. they never were.

I'd be guided by the HCPs as pre eclampsia is extremely dangerous. Though it would be lovely to have a natural birth, your priority now must be you and your baby getting through the next 5 weeks safely. When are they checking your BP again.

Thanks for your replies! I'm obviously very cautious of the health implications -but actually I have no signs of pre-eclampsia at this stage, it's just High BP. I'm being monitored twice a week for the blood pressure. It's just frustrating because nobody will talk about next steps and being the slight control freak that I am (!), it would really help me a lot to know the possible outcome of all of this.

I have found in all 3 of my pregnancies no-one wants to talk to me about what happens until d-day. It's kind of like 'not my problem yet and there is time for it to be someone elses......'

My birthplan was unconventional. Every mw shrugged or nodded when I mentioned aspects of the plan. I thought that meant it was all okay. As soon as I got to 40 weeks I was getting lots of gasps and 'you want to do WHAT?' kind of comments!?

Just know what you want to do. Do your own research. Then tell them how it is going to be.

Thanks Starlight McKenzie! I'm intrigued about your birth plans -tell more if you're ok with sharing!

My first was overdue by 10 days and I had high borderline high BP for the last few weeks. Both factors together and a failed natural labour (started 3 days prior - had 6 hours of contractions but nothing after that for 3 days) led to me being induced.

I have not heard of doing a section over an induction for those reasons to be honest. I'm not sure why it would be preferable. I thought the induction was fine though to be honest.

I don't agree. I think that you need to follow the advice of the HCPs, then if you get to 40 weeks happy and healthy, then think about water birth and so on. If your bp is still high, they will want to monitor you continously, so water birth will be more difficult.

Nothing especially dramatic. I had a home water-birth with guaranteed gas and air in the latent stage rather than active, no internals, no restriction on when I get into the pool. No-one 'delivers' the baby. He just comes out into my arms.

I also delivered the placenta IN the pool physiologically and the cord was cut AFTER that.

No-one was allowed to touch either me or the baby without express consent, which was made clear was unlikely until after the cord was cut.

No vit k and absolutely no weighing etc for at least an hour after the birth.

Goldenegg, that is a highish BP for a young healthy woman. I would advise caution. Have you thought about getting your own bp monitor? You could keep an eye on it daily and have a sense of control over your care ie ringing triage if it it gets any higher. It also avoids "white-coat" hypertension (where it is increased by the medical situation).

I do have my own monitor and keep an eye on it at home. As i said it is high, but only at the borderline stage. Pre pregnancy I have been diagnosed with white coat syndrome and can have completely normal readings at home - I have a very long history of this hence why it might seem that i'm not hugely concerned. Though obviously I have a sensible level of concern and do obviously care about the health of me and baby. One of my main reasons why I wouldn't want induction is that I think I would find the whole experience so stressful, hence raising my BP more.

Goldenegg - is your monitor the same kind as the doctor uses? Arm not wrist?
I had high bp throughout my pregnancy. TBH, it's really unlikely that you'll be allowed to have a water birth if you continue with high bp as you'll need to be in the delivery suite and you'll need to be monitored.
As AmyFarrahCooper said, pre-eclampsia is really dangerous both for you and for baby and it's caused by raised BP. We have a friend who ended up needed to be resuscitated after she'd given birth due to pre-eclampsia.Not trying to scare you, just passing on experiences.
I got induced at 38 weeks with DS. It was fine. Obviously the giving birth situation itself is stressful, I don't think the induction would necessarily mean your BP would be raised even more. I'd got myself worked up about being induced from everything that NCT had told me about it. In the end though, it was fine. Managed on just gas and air and DS arrived after a 12 hour labour so very lucky.

Thanks Crispyjojo, v. reassuring. My NCT class also painted an awful picture of induction. Were you able to active labour whilst also being monitored for BP? I really don't want to be stuck on my back during labour.
Yes, my monitor is an arm one and doctor approved.

Starlight that sounds like my birth plan this time round

I had pre-eclampsia and was admitted for induction when I went for an appt at 37 weeks (my systolic bp was 168). They were awfully busy and I actually went into active labour and delivered before my induction slot.
I had a natural labour on the mid-wife led unit with absolutly no monitoring. I had been in and out of the ante-natal ward for weeks with my bp, too much protein in wee, significant but not extended dips with DDs heartbeat so had worked myself up to having some intervention but it seems DD wanted things her own way, she even delivered while midwife was on her tea break so I had a student midwife with me.

sleeping/resting on your left really does help get bp down.
Also, have you, in your quest to be a good mum, improved your diet and cut too far back on salt?
Homebirth gives you control over things like water. You have to decide what you're comfortable with. Don't be afraid of being stroppy and decline induction if you feel the need.

Please don't decline induction if its advised. Pre eclampsia could kill you and baby and you wont be advised to induce before term unless its essential. Pre eclampsia can only be cured by delivering the baby.

Amy, the op is considering declining induction and requesting a cs in it's place. Arguably a sensible course of action. I don't think she's in any doubt about the seriousness of pre eclampsia. It's hard enough to stand up for individualised care, and the medications used to treat high bp in pregnancy make you dopey and vulnerable. Scaremongering from random strangers on the net doesn't help.

did you have the high blood pressure prior to pregnancy, or is it "new"?

I'm another who would caution against refusing any monitoring (i.e. a water birth) with high blood pressure. Pre-eclampsia can develop very suddenly and occasionally very severely too (that happened to me - I was ok but my baby died as a result). Again, I don't want to alarm you, what happened to me was awful but very rare, but that is the reason for the close monitoring.

There was a good randomised study published a few year ago (HYPITAT - you can google it) which found that women with even relatively mild BP like yours did better if they were induced early compared with those offered "expectant management" i.e. just waiting for labour. That is because there were no adverse effects on the baby of delivery early (around 37 weeks or so) but some of the women who continued pregnancy became very sick. That is why they want to offer you early induction - for your health.

I guess I'm a bit pro medicalisation (it saved my life) but I think you could refuse induction and ask for a section if you wanted though

I'm pro accepting hcp advice too, as I had severe pre-eclampsia and their prompt and knowledgable treatment saved mine and my life too. I'm not asking the OP to follow the advice of scaremongering randoms on the internet, just the advice of her hcps who will use their professional knowledge and judgement and the OPs notes to guide her through her birth as safely as possible.
It's lovely to have a low intervention birth, but this is a nice to have, not a course to be followed at all costs contrary to medical advice.

C-section has potentially serious complications for the mum. A successful induction leading to vaginal birth is a good option - which is why it's being suggested.
OP - you cannot muck around with high BP. I am very keen to avoid medicalising pregnancy but pre-eclampsia is a killer of mums and babies and it does not follow a predictable course. Plenty of women will progress to the more serious symptoms without warning other than 'marginal' BP changes. What was your BP on booking btw? It's not just about your BP being 'high', it's the degree of change that's important.

Jules - sorry I missed that your baby died. I'm so sorry to read that, must have been awful for you.

Haven't had time to read other posts but I wanted to share a hit if my experience. I experienced borderline high BP from 31 weeks and when I hit 36 weeks I was running to feral assessment on a daily basis. By 37 weeks I was preeclamptic so for the baby's sake and mine the doctor decided to induce me at 38+2. It was fine

I wanted a waterbirth but due to my BP couldn't have it because they had to monitor the baby and I during labour. I was given my first gel at 10pm and DD was born at 11am the next morning, I had a horrible time until I got my epidural, and had to have a vacuum delivery but only had 2 stitches. In all it was a positive experience but trees no way they would have let me in ye pool.

High BP can get progressively worse, mine did no matter how much I rested and the walk to the front door to let my midwife in had it sky high, I started getting protein in my wee at 36 weeks.

Do what's best for you and baby and stop worrying about the birth not being how you planned, births rarely are.

Sorry for spelling that was quite rushed.

Golden egg.

I am currently going through what you are just a few weeks ahead at 40+3.

I was diagnosed with high bp in my last pregnancy which ended in mc. I was kept on tabs as we were going to ttc again.

Fast forward through to this pregnancy and my bp was on the high side even under meds 158/93 at its peak. I was obviously anxious about another mc, going through a lot of stress with the business and to top it off being scare mongered at each app regarding pre eclampsia and risks etc.

However i have stuck to my guns throughout, aslong as my bp is controlled and baby is fine and there are absolutely no further issues however small i will not be induced and ideally i would like a home waterbirth but failing that the option of the maternity led birthing unit.

My midwife was fully supportive, i have done a tonne of research and made an informed decision about whats right for my baby and me. My midwife booked me an app with the senior midwife to discuss options, again she was fully supportive and we agreed on a waterbirth in the MLBU. This was discussed at 37 weeks and since that date my bp has condistently been 110/75. Its taken the pressure off completely and ive relaxed.

I think as long as you are open to all eventualities there is nothing wrong with preparing for YOUR ideal birth and not being scare mongered by health professionals.

This is my 3rd pregnancy(and last)

Are u on medication at the moment?