Another childbirth thread

[Caribbean Queen]

Last week I had a prenatal check-up at the low-cost clinic and my blood pressure was something over 90 something. The doctor said my labor should be induced immediately. I was supposed to have ten more days until my due date, but my baby felt small to me. He hadn't dropped and I felt very unready for labor. Against my better judgment, I reluctantly went along with the induction.

 

My husband brought me a bag with something for me to wear home from the hospital: A dusty skirt I haven't worn in 5 years, a dress that is too small for me, and thong underwear - just the kind of undergarment a lady who has just given birth wants. Thanks, honey! :lol:

 

Anyway, the induction failed and thank goodness it did because my baby and I really were not ready for birth. To make a long story short, they figured out that my due date was incorrect. My new and improved due date is May 9th. I am on bed rest and blood pressure medicine. My blood pressure goes down to something over 70something when I am snoozing.

 

I don't want to be caught off guard and pressured into something again. I want to know more about what levels of blood pressure make induction necessary. I don't think my blood pressure is all that high. I have no headaches or pain. My motherly instincts tell me my baby is very happy. I had a biophysical profile (I thnk that is what it is called) and the baby was looking very good. His heart beat is great, he kicks, etc. He passed with flying colors.

 

Also, the clinic told me they don't "allow" anyone to be pregnant over 41 weeks. A nurse in the labor and delivery department told me some people never do into labor and need C-sections. They never would go into labor. She was serious. :confused: I remember going to the clinic when I was one day overdue with my daughter and the nurse telling me I need to go straight to labor and delivery before my baby just falls out. !?! :lol: It was easy to refuse an induction that day because she was ridiculous. The next week I came for a check up and a doctor talked me into induction and it was horribly, horribly, horribly painful, and my daughter was not post-mature at all.

 

As long as my blood pressure is controlled, is it reasonable for me to refuse an induction at 41 weeks, and wait another week?

 

Any support for standing up to medical professionals is welcome.

[Veritaserum]

As long as my blood pressure is controlled, is it reasonable for me to refuse an induction at 41 weeks, and wait another week?

 

It is reasonable to refuse a procedure that is not medically necessary. In order to gauge whether or not it is reasonable to wait for spontaneous labor with a blood pressure issue that is controlled, it would be important to find out what risks, if any, there are to mother and/or baby if the pregnancy lasts longer than 41 weeks. It would then be a matter of comparing risks of induction with risks of continuing the pregnancy and waiting for labor. I'm already very familiar with the risks of induction, so if I were in your shoes I would now research potential risks of waiting for labor with blood pressure that is controlled. :)

[usetoschool]

I have had past due babies (10 days) and though she was my biggest baby, it was not a big deal - no c-section or anything.

 

I have also had preeclampsia so I would want to make sure that your high blood pressure is just that and nothing more or not leading to anything more. If you want to go full term I would be really careful about resting or whatever it is you have to do to keep it down. The doctor sent me to the hospital when mine got to 150/90. I am usually at 120/70.

[Melissa in Australia]

I had one pregnancy that was 2 weeks over. I was induced at 42 weeks.

all of my babies except one was at least 4 days over.

[KJsMom]

As long as you are mentally competent you can refuse any medical procedure. They can't force you to have an induction. My first dd was 10 past my due date and my second was 7 days past. Both were healthy with no complications and under 8 lbs. That said, you want to do what is best for your baby. If your blood pressure becomes a problem you have to do what is neccessary.

[Quiver0f10]

Unless you are having medical issues ie: High BP etc there is no reason to induce at your due date or even at 41 weeks. Remember your due date is just an estimate.

 

Do some research on going past due date and make your descision based on that.

Edited April 25, 2010 by Quiver0f10

[phathui5]

As long as my blood pressure is controlled, is it reasonable for me to refuse an induction at 41 weeks, and wait another week?

 

I was born at 43 weeks gestation (maybe the due date was off?). I would think that if everything else were fine, being "postdates" isn't dangerous in and of itself.

[cillakat]

As long as my blood pressure is controlled, is it reasonable for me to refuse an induction at 41 weeks, and wait another week?

 

Any support for standing up to medical professionals is welcome.

 

It really is more complicated with your situation.

 

Be sure you're doing all you can with diet -

produce at every meal

palm sized portion of protein 4x per day

1000 IU vitamin D per 25 lbs body weight

1000 ish mg magnesium from supplements (divided doses)

3-4 servings dairy per day.

 

blood pressure and starting labor at term (rather than early or late) are heavily controlled by nutritional factors (there are some other minor factors as well) but optimal levels of long chain Ω3 fatty acids (from fish), zinc, iron, calcium, magnesium, protein and vitamin D3 are the big players here.

 

If you do one thing, do D3.

 

If you do two things, do D3 and magnesium

 

:)

K

[cillakat]

I was born at 43 weeks gestation (maybe the due date was off?). I would think that if everything else were fine, being "postdates" isn't dangerous in and of itself.

 

the placenta is on a timer essentially. It starts to be a less effective nutrient delivery system. The tipping point is a guessing game. If you get too close or go over, the chances of fetal distress in labor are very high.

 

Higher 25(OH)D levels are associated with less preterm and less postdates births. Same form Ω3 EFA's (long chain...fish oil).

 

IME, post dates past 41 weeks is essentially the expression of multiple nutritional issues - as are PIH, pre-eclampsia, HELLLP, preterm birth, PROM and several other complications.

 

K

[Mommyof4ks]

I remember being sent straight to the hospital when my bp was 145/90 with my dd. I was told that they would keep an eye on my bp through the night and I would be induced the next morning unless my bp went up anymore and then I would be induced immediately during the night. It turned out that my dd was ready to meet us, because my water broke 1.5 hours before I was scheduled to be induced. I nearly had a c-section because she would not engage and my bp was going up, but thankfully the vacuum thing worked and my bp dropped rapidly to the point I was VERY sick after her birth.

 

Talk with your doc to see what is safe for you and baby. My doc was nervous.

[Heather in OK]

I'm confused....

 

He said a bp of 90/? was high?? What is your baseline?

[cillakat]

I'm confused....

 

He said a bp of 90/? was high?? What is your baseline?

 

x/90

 

K

[IsabelC]

It is reasonable to refuse a procedure that is not medically necessary. In order to gauge whether or not it is reasonable to wait for spontaneous labor with a blood pressure issue that is controlled, it would be important to find out what risks, if any, there are to mother and/or baby if the pregnancy lasts longer than 41 weeks. It would then be a matter of comparing risks of induction with risks of continuing the pregnancy and waiting for labor. I'm already very familiar with the risks of induction, so if I were in your shoes I would now research potential risks of waiting for labor with blood pressure that is controlled. :)

^^^Yes, that ^^^

 

And don't waste your energy at this stage in pregnancy with 'standing up to medical professionals' on your own. Get somebody else to help you with it! The ideal situation (assuming that you're not prepared to avoid the clinic and the hospital like the plague, which is what I'd do) would be that you get yourself and independent midwife who can advise you and talk to the docors if necessary. Failing that, your husband, sister, mother or friend - whoever you can trust to be well informed, assertive and respectful of your wishes - can help you deal with it all.

 

The bottom line is that as an intelligent, sane, adult patient, you are perfectly within your right to manage your pregnancy and labor in whatever way you believe is optimal for the health of your baby and yourself. Your doctors are there to offer advice and administer treatment only if you agree to it. They should not be pressuring you into anything. I would run (waddle? lol) a mile from any care provider who talks about "allowing" you to do things.

 

Regarding if and when to induce, yes, an induction can be necessary and lifesaving. However, it is also a fact that over 90% of inductions carried out are unnecessary and dangerous. The cut-off date is purely arbitrary. Did you know that in some places they will not perform an induction until 42 weeks? I personally know of many women who have gone to 42, 43, 44 and even 45 weeks and ended up with healthy babies. I am certainty not suggesting that you should wait that long before consenting to any intervention! I'm just saying that you should try not to be frightened into anything, and instead insist on getting all the facts so that you make a reasonable decision based on the risks of induction vs the risks of watchful waiting as they apply to your particular health situation. (Personally I would not even be discussing induction or cesarean before 42 weeks unless there were indications that the baby was in trouble, but it may be different for you. However don't forget that asking an obstetrician whether you need obstetric interventions is like asking a barber whether you need a haircut.)

[Caribbean Queen]

However don't forget that asking an obstetrician whether you need obstetric interventions is like asking a barber whether you need a haircut.)

 

Ha, that's a good one!

 

 

 

Thanks for all your responses. It feels good to "talk" about this with someone.

 

cillakat, having more protein and dairy sounds good. I live in the sunny Caribbean. Do you still think I need vitamin D?

[HootyTooty]

Ha, that's a good one!

 

 

 

Thanks for all your responses. It feels good to "talk" about this with someone.

 

cillakat, having more protein and dairy sounds good. I live in the sunny Caribbean. Do you still think I need vitamin D?

Yes. Especially yes. Many people believe that just because they live in sunny locales they get enough vit D from the sun, most of the time it is the opposite, especially if you have darker skin.

[cillakat]

Do you still think I need vitamin D?

 

You may or may not. It's tough to say. Can you see about getting your 25(OH)D level tested?

 

You're definitely in a part of the world where it's possible to maintain reasonable to optimal D levels year round if you get sufficient midday sun exposure on most exposed skin.

 

Can you get outside each day around noon *with no sunscreen* to the point just before you'd burn? Whether it's 5 minutes (very fair) or 15 min minutes (lighter european tones), 30-50 minutes (darker mediterranean, indian) or several hours (even six hours for the darkest skin tones) the key things are midday, no s/s, most skin (ie bathingsuit/bikini) then come inside and/or apply s/s. The reason that many folks even in tropical environements don't maintain good D levels is that it's too hot midday so outdoor time is too early or too late in the day.

 

You may be interested in reading up on magnesium and blood pressure. We know it works - the evidence supports it: afterall, what do moms with PIH or pre-eclampsia get via IV when they are in labor? magnesium sulfate.

 

:)

K

 

Wishing you the best right now and

[ThatCyndiGirl]

First of all I would encourage you to know your ACTUAL blood pressure readings. "something/90" is not accurate. Can you record them in a notebook so that you can chart trends?

 

No Dr can FORCE you to be induced. I was induced with my first two and it was horrible! With my last I was NOT induced and it was wonderful!

 

I DO NOT believe the statement, "Some women would just never go into labor on their own". That is too broad of a statment.

 

Your pregnancy is NOT a disease from which your Dr needs to cure you. It is a normal natural process that you have HIRED your Dr. to help with. HUGE difference.

[SnowWhite]

There are also more natural methods of induction.

 

My last baby was born at 41 wk 3 days (went into labor naturally). If I had gone to 41 wk 5 days, I was going to allow the midwife to try a more natural induction. She was going to "strip my membranes" (not break my water) and use a breast pump to stimulate my own natural oxytocin rather than use pitocin. I did have to have an ultrasound and monitoring (nonstress test?) of the baby's heart rate during his movement times to make sure he was doing well at week 41.

 

I would imagine your new and improved due date will help with you getting to "go into labor" versus being induced.

[LizzyBee]

As long as my blood pressure is controlled, is it reasonable for me to refuse an induction at 41 weeks, and wait another week?

 

 

With two of my pregnancies, my increased bp was a symptom of HELLP Syndrome, which can rapidly spiral out of control. With my first, my liver or kidney function (can't remember which) was being affected by the time I was induced, and that recovery was tougher than the C-section I had with #3 (also HELLP syndrome, but dx at an earlier stage).

 

In addition to keeping BP under control, I would want bloodwork at every appt to confirm that I don't have preeclampsia or HELLP syndrome. At home, watch for extreme swelling, sudden significant weight gain, visual disturbances, severe headache, or jaundice.

 

I hope you go into labor on your own and have a great delivery. :001_smile:

[cjbeach]

Any other s/s other than a high BP like swelling (edema) or spilling proteins? If it was more than just a high BP maybe it would be a bit more understandable.

[Caribbean Queen]

You may be interested in reading up on magnesium and blood pressure. We know it works - the evidence supports it: afterall, what do moms with PIH or pre-eclampsia get via IV when they are in labor? magnesium sulfate.

 

 

Ah, I will hit the health food store on Tuesday.

 

 

I have swollen feet. They have been swollen since December. If I rest a lot, they are just a tad swollen. If I am on my feet a lot, or sit with my feet down they get badly swollen. They don't look like normal-pregnant feet. They look really bad. They never feel painful so I am thankful for that. I have been wearing flip flops everywhere, even to church. Sigh.

[Heather in OK]

Ah, I went back and reread it. Makes sense now.

 

Ditto knowing your baseline. How high is that bottom number from what it normally is? Was the systolic also high? Did you have any additional stress going on that day? Were you well hydrated? What did your UA look like? All of this should have been taken into consideration before jumping straight for induction.

 

Recommending induction based on ONE reading alone seems off to me. Even with ten days until your EDD more monitoring can be done, dietary changes (such as ones suggested here), etc.

 

Hey cilla - Great posts! Are you a midwife by chance? I am but taking a hiatus from midwifery for the time being. :)

[juelle]

Praying for wisdom and strength for you.:grouphug:

 

As I went past 41 weeks with my 7th last September, I was so scared of being pressured into an induction. I talked with a midwife who was not my provider, and she was so encouraging. She feels that more women must be strong to tell their care providers what they DON'T want. If there is no real medical emergency, then go with your wishes.

 

Read, research, then stand up for your decision. We even asked our lawyer to take a look at our rights regarding refusing procedures, and the possible repercussions on our custody of the baby. That's how threatened I felt!

 

We stripped my membranes really thoroughly at 42wks less 2 days, and after several hours of irregular contraction, the baby came fast and furious that afternoon. 7lb something, so not post-mature. Beautiful!

 

The nutritional info above is so good. Hang in there, take good care of yourself, be informed, and be patient. This time seems SO long, but in 4 weeks, it will be a distant memory as you hold your precious little one.

[Caribbean Queen]

My blood pressure has been high for the past month. The week before last I was hospitalized from Monday to Thursday in order to do my failed induction and blood pressure watch. I had my blood pressure measured all the livelong day. When I was snoozing did it go down to a good level. Something over 70something. When I am not pregnant, my blood pressure is fine.

 

I had a check up today with a high risk doctor. Remember, I go to a low cost clinic so I get the doctor or nurse they give me. My blood pressure was something over 89. Sorry, I can only remember one number. I have been taking my medicine, Nifediphine, and have improved my diet. I got magnesium and D3 vitamins and started taking them yesterday. The doctor recommended I take walks, which contradicts the bedrest advice I have gotten from other doctors and nurses. I feel good when I walk, so I believe it will be fine for me. I went shopping after my appointment. :D

 

The doctor said her policy is to induce her patients a week and a half before their due date when they have high blood pressure. We have had some confusion on what my due date is. I don't know the date of my last period. She looked at an ultrasound I had done in December and detremined a due date of May 15th, so I should be induced next week on Thursday.

 

I am concerned that the baby is not ready to be born. He feels much smaller than my other babies did at birth. I am only 5"2 and my other babies were average length. They had their head engaged and butt up in my ribs for weeks. At the end, all they could do is wiggle a little. This baby is rolling around and playing. I haven't even 'dropped.' I have a Bradley Childbirth method book around here somewhere that says when doctors induce labor they occasionally "pick a green apple" and I am afraid of that happening to me.

 

I went into labor at 42 weeks with my first and was induced at 41.5 weeks with my second. My first was postmature - skinny, flakey skin, very alert, meconium staining. My second was floppy and slept through everything, even having blood drawn. She was 8 pounds but seemed not all 'baked.' The labor was horribly painful. I was on Pitocen and Cytotec (the labor inducing pill, I don't know how to spell it.) PAIN! HORRIBLE! She was healthy, though. My last was as healthy as could be. 8 pounds 9/10 Apgar scores. I had sketchy medical care and never knew my due date for my third. I had a fabulous, almost pain-free labor. I reached the hospital so late there was no time to change into the hospital gown or get an IV. :D I wish I could have that kind of experience again.

[juelle]

Praying for just the right timing for you. Blessings and :grouphug:

[Caribbean Queen]

Okay my blood pressure today was 144 over 91. The doctor wants to induce me on Thursday because of my blood pressure. My due date is May 15th. I am swollen, but it just looks like a little, normal-pregnant swelling. I have no pain, blurry vision, headaches or anything. I can feel that the baby is small. My first baby was 6.5 pounds and this baby feels smaller than that. I haven't 'dropped,' and his head is down, but not engaged. It's off to one side or the other.

 

I concerned that

 

1. The baby may be premature. (I know the doctors think it won't be.)

2 I may end up with a C-section due to a failed induction.

3. The induction may be horrifically painful. I was induced before and it was horrible.

 

Some may say, "All that matters is a healthy baby." but I domatter and I don't want a C-section or a horribly painful labor unless it is really necessary.

 

Any advice?

Edited May 4, 2010 by Caribbean Queen

[elfinbaby]

Aw mama, I feel for you. I am fortunate to have uneventful pregnancies and births so I don't have personal experience with HBP. Also, I consistently, in all 4 pregnancies, passed the 41 wks. mark (I homebirth). There was absolutely nothing wrong w/me or my babies. My babies just aren't done until after 41 wks.

 

Henci Goer (author of Thinking Woman's Guide to Pregnancy) has always been my favorite resource when I'm educating myself on the possibilities of intervention. Find it if you can. I googled her and HBP. It turned up a query from a 37 wk. pregnant woman w/hbp. Her dr. wanted her to save up urine for 24 hrs. Have you peed on the "protein stick" to see if you are spilling?

 

Your dr wants to test your urine for protein because whether you have protein in your urine and how much will help your dr decide how much concern there should be over your high blood pressure. Protein in the urine is an indicator that kidneys are not working as well as they should. Spilling a little protein is common because pregnancy--especially at the end--pretty much stresses every organ, but having high blood pressure and more than a little protein is a more worrisome combination than high blood pressure alone. Of course, how high your blood pressure is also enters into the equation.

 

Blessings to you!

[Caribbean Queen]

Thanks. My pee is fine. I had a blood test done a week and a half ago and that turned out fine.

[GoVanGogh]

"High blood pressure" can turn into "life threatening emergency" very, very quickly. I thought my own doctor was just being paranoid, as I didn't have any of the symptoms you listed - headaches, blurry vision, etc. But I ended up in the hospital for back pains at 33 weeks. They were monitoring my blood pressure and testing my urine every 15 minutes. I went from "everything is fine" to "seizure" in literally minutes. We later found out the back pains were from swelling in my liver. (Visual swelling in hands and feet - internal swelling in liver and brain.) I generally tend not to share our birth story, as it is/was frightening. But I am sharing now to say: Things can and do change very quickly. Be aware, know your risks, talk to your doctor.

I didn't really want a very small premature baby via c-section, either. But I am forever grateful to my doctor. I truly didn't appreciate the risks until I saw things from the other side.

[Veritaserum]

Because you're concerned about your dates and baby's maturity, it may make sense to request an amniocentesis to check that the baby's lungs are mature. If the baby's lungs are mature and your symptoms continue to be concerning, induction may be the safest option. If the baby's lungs are not mature, it may be safer to wait another week.

 

Also, you can calculate your Bishop's Score to determine how likely an induction is to result in a vaginal birth.

 

If induction is needed, there are ways to make it a better experience. For one, pitocin doesn't have to keep getting cranked up. I've seen care providers stop increasing pit or even turn it off and unhook the IV once contractions are established. That may not be something the hospital staff has done before, but it is a reasonable request. Worst case would be having turn to the pit back on.

 

I hope things go well for you! I'm sure this is stressful. :grouphug:

[Caribbean Queen]

Thanks for sharing your story Suzanne.

 

Veritaserum, none of the doctors have suggested an amniocentesis, so thanks for that info.

 

Good idea about the pit. I believe I had the pit on full blast the entire time when I had that painful induction.

 

I didn't calculate my Bishops' score because I could tell it would be bad, sigh.