High BP - consultant appt for "plan"?

[dadtobe19]

Hi all

Firstly, I hope you do not mind me posting on behalf of my lovely wife who has had a bit of a hard pregnancy! She knows I am posting and we are just looking for anyone who may have any experience with a similar scenario to let us know what we can expect. (First time parents!)

A long story short she is 38 wks today and 2 weeks ago was sent up to day assessment at her midwife appt as blood pressure was high (>140). Bloods and urine were clear and it eventually went down a bit after monitoring.

Same story again today (although this time higher again >150). The baby's happy and healthy when monitored.

The next step for us is to go to a consultant clinic on Friday to discuss a "plan". The midwife suggested that they potential would look to induce her or "see if she can get to 40 weeks before considering induction".

My wife had really been hoping to avoid induction (many horror stories?!) and also hoped for a water birth which we know wouldn't happen if she was induced. Has anyone ever had a similar experience with high bp at the late stages (otherwise low normally) and what one of these "plans" with the consultant may be?

Many thanks in advance from an anxious set of new parents!

With DC2, I had high BP from about 36 weeks. They put me on medication Labetalol(??) which brought it down and I went on to give birth without any interventions after going into labour spontaneously on DC2's due date. There was lots of monitoring but I don't remember induction being discussed as a real possibility.

However I was induced (at 38 weeks) with DC1, for medical reasons that had nothing to do with BP. The induction was a slow process over several days. I found it a really serene and empowering experience, certainly not what I would call a horror story.

I would say they will test blood pressure again and look for any other signs of pre-eclampsia. As your wife is full term, if her bp is still high they may well want to induce pretty sharpish. Not all inductions are bad experiences though, and she may well be able to remain active during labour if monitoring allows. Good luck with whatever happens- you'll be parents soon!

Thanks both. No other pre eclampsia signs yet.

Thanks for the positive induction stories and hope we did not offend for anyone who has had to go through it. We know a couple of people who have had an induction Nd basically told us how terrible it is and to hope we dont have to go through it. Even typing this We know everyones experience is obviously different and shouldnt take too much from that but I think we are just a bit anxious about it all right now!

She is having plenty of rest so hopefully it will keep low by Friday and we can figure out the next step then.

Thanks again

I had high bp at every midwife appointment from about 34 weeks onwards. Always clear urine and no other pre-eclampsia symptoms. I kept being sent to daycare for monitoring, sometimes for a trace as well. I ended up there about 7 times in total in late pregnancy.

My husband has high blood pressure so we have a pretty good home blood pressure monitor. I was able to keep track of my bp using this and it was always normal at home (120/80 or quite close to it - a small increase from early pregnancy is normal). Due to this I was quite convinced I had white coat hypertension rather than proper high bp. I never felt nervous at first about my bp being taken, but the more times I was sent to hospital about my bp, the more my heart started to race just before having it measured. I don't know whether this is common or not in late pregnancy. I wouldn't have known it wasn't genuine high bp had it not been for the home monitor.

As far as treatment went, all traces were perfectly fine. I was given a growth scan at 39+5 which also checked blood flow through the placenta. Blood flow was fine but there was an implication that baby had gone from 95th centile at an earlier scan to around 75th which they were slightly concerned about. This was nonsense, he turned out to be ridiculously enormous when born.

They offered me sweeps and inductions a few times at the hospital, which I declined (they weren't really pushing very hard tbh). I saw a consultant once at 40+5, declined a sweep and agreed to induction at 40+13 for post-dates. He accepted my home bp monitoring even though my bp was through the roof at that appointment.

Ironically, given how keen I was to body swerve earlier interventions, I did end up with induction at 40+13 which didn't go so well (big and mal positioned baby). Inductions can be unpleasant, it's really a question of balancing up the risks of an induction with the risks of continuing the pregnancy.

Anyway that was my story - I realise I might not be typical in that my high bp wasn't genuine, but you can see the suggestions that were made. Remember you and your wife have total control over any interventions and you can ask for a second opinion if you want.

Hello, I just wanted to let you know that although not because of high BP, I ended up with an induction 2 days before due date with my first. I was given the pill at about 9pm, and went into the bath. Partner sent home at about midnight, went into active labour at about 1am delivered at 3.50am. For me it was a fairly swift procedure, only gas and air. I too, wanted a natural water birth, but the induction wasnt awful and once my daughter was here, all thoughts of the water birth disappeared. Good luck

I had high bp last time from 38 weeks. I had two hospital stays to bring it down and they talked about induction, but then the Labour ward was full so they sent me home instead. Luckily for me I went into Labour naturally at 39+3. I had a sweep to try and hurry things up which may have helped. I recommend buying a home monitor as my bp stayed high after the birth and doctors wanted me to have it checked every day - much easier to do at home. Good luck! Second time around for me and my bp is still fine but only 36 weeks at the moment.

Okay great - thanks all thats certainly more reassuring.

I guess we will obviously know more on Friday but I think the mention of induction had just got us a little worried. Ultimately the health of our little one and my wife need to come first so we will take on board all their advice and do what ever is best.

Thanks again

That's the vicious cycle I got into - the more appointments I had where they mentioned induction, the more worked up I got at the thought of it, which made my blood pressure rise, which led to more appointments...

You could ask about the possibility of the hospital lending you a home bp monitor? They might be able to arrange for the type that you wear for 24 hours that takes readings at regular intervals.

OP watching with interest as my BP keeps skipping up towards high and then mercifully slipping back down again.

One thing I found is that my BP changes dramatically depending on the conditions in which it's taken. Tell your wife...

-make sure she is warm when her BP is taken as when you are cold your veins constrict and therefore BP goes up. So overdress for hospital appointments!

-make sure she hasn't eaten a meal recently

-make sure she doesn't need a wee as your BP goes up then

• drink lots of water the day before a test to "flush out" any salt

• don't talk during the test and make sure her ankles are uncrossed and both feet on floor

• I do a relaxation cd beforehand too

I have read up a bit on the meds they might give you if BP is high. Basically, it looks like they use labetolol (sp?), methyldopa, or nifedipine. All of these cross into breast milk so I am not keen. Nifedipine has been associated in one study with birth defects if you use it long term. I am thus keen to stay off meds, personally. But it reslly depends how high the BP goes and the risks to her and your baby.

So far mine is only mild so hoping to labour naturally and stay off meds.... Good luck!

I think this is known as gestational hypertension if you want to read up on it.

I had hypertension from the very early weeks which is unusual as I don't have high BP the rest of the time. I was monitored throughout and had no signs of pre-eclampsia, but consistently high or very high BP.

No one mentioned induction to me and DC was delivered in a speedy labour at 41 weeks. My BP went very very high during labour so I was moved from the MW unit to delivery. Based on my experience, I'd recommend to your wife that she delivers either in a hospital, or in a MW unit which is attached to a hospital, in case her BP becomes dangerously high. Of course, her diagnosis is different from mine because of the late development of hypertension, so take the lead from the professionals on that front. After all sorts of panic, panic buttons, emergency transfers etc, I was examined by a registrar (ouch) and given a pill to take. Not so scary after all.

I did have to stay in for monitoring for a week after the birth, which was quite a shambles and deeply unpleasant as my meds were continually adjusted, giving me crashing highs and lows of BP and the associated headaches. eventually I was discharged and put on some meds - nifedipine - for a few months until my BP returned to normal.

Second suggestions to arrive early before monitoring, have a wee, and lie on her left side if possible, which will lower BP a bit. if she suspects white coat syndrome, you can ask for 24 hour monitoring with an automatic cuff at home, which will give a better idea of her true BP.

Have a read of the NICE guidelines for the managent of hypertension in pregnancy. That'll give you a really clear idea.

Oh and OP Shoot's post reminded me - my MW said that her "high BP ladies" tend to have nice quick labours so you can take that as a positive :)

I am still hoping for a home birth but if I have to go in due to raised BP I'm hoping at least it won't be one of those marathon labours you hear about.

Also you know if they do recommend induction, you can ask them for the a Bishops Score and see if it's favourable or not, and if not, discuss options. If her body is ready induction might not be so bad but if not, you could ask about further monitoring.

Hhhh

Hi All

Just to update you on how we got on today.

Appointment with the consultant was fine, basically the same as the same as a midwife usual appointment. My poor wives blood pressure was really high again so we were sent back up to day care to get checked out. We are just back now and, the same story as before, its settled enough for her to get home.

We have also been booked in for an induction on Monday morning so things will be moving. Not really what we had hoped for as it has ruled out a water birth which she had been hoping for, but we need to trust what is best.

Thanks again all

Best wishes and good luck for Monday.

Dadtobe, it sounds like it's all in hand - a water birth would risk raising her BP unfortunately (I was gutted to miss out on mine - but then again I would have been yanked out at 10cm and the only thing worse than being wheeled through a hospital with a sheet over my bum would have bee doing it while wet through!)

But be prepared that her BP may spike in labour - do your best to be sure of her preferred birth options so you can be her advocate if she can't speak for herself. She will need you to be informed and decisive.

They are very good at monitoring and treating BP. Try to find out if she will need to stay in after the birth so you can be prepared - my DH spent a lot of time travelling and bringing clothes for me and the baby (in for a week in the end). And if so be prepared to bring her food and drink, and to help her push for painkillers if the BP meds give her headache.

Good luck!

It isn't a bad thing to be induced. I was induced with DD two days after her due date after preeclampsia had started. The reason the induction didn't work was because the medication for the preeclampsia slows labor. Far better your DW be induced now!

Having said that my obn here in the U.S. was very pro alternative therapies and had me see an acupuncturist plus a chiropractor the week before and during my labor. If you can arrange it I would strongly suggest the acupuncture. The chiropractor was good for getting DD in a better position but that was all.

Overall I would see if you can find an acupuncturist who can work on your wife over the weekend and then as close to the induction appointment as possible if she feels like the first session was helpful.

Thanks all

We understand induction is definitely not the worst thing and can end up being a really positive experience. Its just not what we had "planned" for and, as I had mentioned in my OP, we have heard a few horror stories.

We are starting to come to terms with it all now and its sinking in so getting there (all of your positive stories are helping!!!). The thought of having our little baby in our arms this time next week is also helping

Hi all

Wanted to check in and quickly let you know how it went.

We were taking in on Monday for induction with the pessary etc but were fortunate enough that things had already begun for my wife by herself. She was already 2cm dilated and fully effaced so we managed to avoid having to get them.

On tuesday afternoon she thrn had her waters broken snd started on the hormone drip. Her contractions came really quite fast and she ended up having our beautiful baby boy delivered in under 5 hours all on gas and air.

She did amazing and despite the horror stories we had heard that inspired this thread, the induction and labour itself was great.

Unfortunately after the birth my wife suffered a post partum hemorrhage and lost >1ltr of blood, it was really quite a scary moment but she has gotten through it all and is on the road to recovery.

We are now all home and finding our way into our life as a family (as you can probably tell by this 2am post!!!).

Thanks again for all your stories and advice.

Thank you for the update and fabulous to hear everyone made it through. Sorry to hear your wife had post delivery bleeding. It is quite shocking when that sort of thing happens.

Enjoy those newborn snuggles!

Lovely news, glad it all worked out well :)

That's lovely news. I also had a pph and it is indeed very scary -especially for partners- but don't worry it soon becomes a distant memory!