Anonymous wrote:I am the PP who got induced for mildly high BP. OP you really should read up on the HYPITAT trial. I am not sure if there is any similar randomized trial in the field of obstetrics!

White coat hypertension is not innocent. It means that your body has difficulty keeping blood pressure regulated.

The most important thing is for you to discuss this at length with your OB. Bring in a list of questions and literally read them out loud. Bring your DH for backup to make sure you get everything answered.

I agree on the white coat hypertension. You may very well have underlying high bp which is what is showing itself. But that doesn't mean you will get pre-e.

Out of curiosity, why couldn't the mom who had magnesium see her baby for 20 hours? Was it a problem with the baby, or with the mom, or a standard protocol when magnesium is being administered?

thanks, PP - I wouldn't ASK for a c-section, but the idea of not being able to move around or help labor along without more drugs just makes me even more anxious.

I am going to see if I can come in for the blood work/urine test before my next appointment so that the results are there when I see the OTHER doctor.

I know HBP/pre-e/HELLP aren't easy to diagnose and it's obviously better to be cautious, and I definitely don't want to come across as minimizing the problems.

jindc wrote:ok, thanks all.
I'll ask about the additional blood work and all that - I see a different doctor Thursday.

If my normal BP is higher than Larla's, if it's normal for me, it's normal for me - until pregnancy I was very active and when I saw a PCP was never told my BP was high. I can ask if they can send my chart(s) to the OB to compare, but that'll be a pain in the ass since they're members only and don't really care to help former patients.

I'm sure I'll figure it out, but the responses are a mixed bag - I guess it is what it is.

And docs definitely DO push interventions on chubby mamas. Luckily my dr is not a fan of c-sections, but to me, at some point, when you're hooked up to so much and you can't help labor along in the ways you naturally should, it SEEMS counter productive to just lie there while they pump more drugs into you<shrug>

You probably won't have to go there but read up on pre-e and c-sections before you decide this. My OB was quite clear that a c-section is contraindicated with pre-e. Having pre-e adds a point to your Bishop score, meaning it makes successful induction more likely.

ok, thanks all.
I'll ask about the additional blood work and all that - I see a different doctor Thursday.

If my normal BP is higher than Larla's, if it's normal for me, it's normal for me - until pregnancy I was very active and when I saw a PCP was never told my BP was high. I can ask if they can send my chart(s) to the OB to compare, but that'll be a pain in the ass since they're members only and don't really care to help former patients.

I'm sure I'll figure it out, but the responses are a mixed bag - I guess it is what it is.

And docs definitely DO push interventions on chubby mamas. Luckily my dr is not a fan of c-sections, but to me, at some point, when you're hooked up to so much and you can't help labor along in the ways you naturally should, it SEEMS counter productive to just lie there while they pump more drugs into you<shrug>

I am the PP who got induced for mildly high BP. OP you really should read up on the HYPITAT trial. I am not sure if there is any similar randomized trial in the field of obstetrics!

White coat hypertension is not innocent. It means that your body has difficulty keeping blood pressure regulated.

The most important thing is for you to discuss this at length with your OB. Bring in a list of questions and literally read them out loud. Bring your DH for backup to make sure you get everything answered.

I'm sorry for your awful mag experience 12:16! That does sound like torture.

For what it's worth, OP, I was on mag after labor and it didn't prevent me from being with the baby the entire time.

Anonymous wrote:Do a 24 hr urine collection.

And get a PIH blood test. I had HELLP despite a negative 24hr-urine test and borderline BP.

jindc wrote:well, the whole "induction/magnesium" sounds completely awful - at some point, wouldn't I just rather have a c-section?

12:04 PP here -- I've heard from other pregnant women who were on magnesium for a long time to prevent pre-term labor and they didn't think it was that bad, but for me it was purely torture. I really wanted to labor vaginally, so I pushed for induction that day, and in retrospect I wish I had not done that since I was set up to fail from the start -- once they started the magnesium, they wouldn't let me stand or walk, and there was no way I could really progress (although, at least I can say I tried everything I could to be able to have a vaginal birth). But by the time I was admitted, my headache was torture, and the magnesium made it 100 times worse. Plus, the magnesium made it feel like it was 500 degrees in my head. (For the 12 hours I labored before giving in to a C-section, my husband put ice on my face and forehead, and I remember saying to him, "Why is the ice WARM? Can't you get any cold ice?"...meanwhile, his hands were blue from being in an ice bucket all day.)

The worst thing about the magnesium is that I had to be on it for at least 12 hours postpartum (apparently that's standard with Pre-E), which ended up dragging out to 20 hours, so I was separated from the baby that whole time, and it was awful awful awful. So if you can avoid magnesium, do it. In the end, I gave in to have the C not because the labor pains hurt or the baby was in distress, but because I couldn't stand the pain from the headache worsened by the magnesium, plus the threat that the magnesium would need to be continued for so much longer, so the longer I labored, the further away my reprieve from headache pain would be.

That said, I think you are 100% correct that your doc is making weight-based assumptions. I fired my first OB office because they immediately assumed I'd have GD and need a C-section. A C is no picnic -- you are right to want to avoid the cascade of interventions if you can!!!

jindc wrote:well, the whole "induction/magnesium" sounds completely awful - at some point, wouldn't I just rather have a c-section?

I'm fairly certain mine runs high, but I have a pretty strong case of white coat hypertension (fairly common in my family)

if the only indicator is BP, no protein, other blood tests fine, is that enough for them to order an induction?

I'm trying to stay calm, but I am frustrated like I'm branded with a certain diagnosis from week one because of my weight vs. being treated as a patient who is trying for the most natural outcome possible.

my doctor told me I'd probably get GD, for example. Based on nothing but weight alone.

This is strange. I'm overweight (but not obese) and my OBs (I go to RHJN, so I've seen several) have never suggested I'd be prone to get GD or pre-E because of my weight. I have low BP, but I've had swelling in my legs and feet since 24 weeks and I've gained 25lbs (I'm 33 weeks now). There are plenty of overweight women who don't get GD or pre-E and plenty of thin women who do. Yes, you're weight is a factor, but it is not causal.

Is there another doctor at the practice who you can see? If you don't feel comfortable with this doctor's prognosis, there is no harm in talking to someone else. Your baby is full term, so there isn't a significant danger to inducing, but it is better for it to stay in as close to 40 weeks as possible.

jindc wrote:well, the whole "induction/magnesium" sounds completely awful - at some point, wouldn't I just rather have a c-section?

I'm fairly certain mine runs high, but I have a pretty strong case of white coat hypertension (fairly common in my family)

if the only indicator is BP, no protein, other blood tests fine, is that enough for them to order an induction?

I'm trying to stay calm, but I am frustrated like I'm branded with a certain diagnosis from week one because of my weight vs. being treated as a patient who is trying for the most natural outcome possible.

my doctor told me I'd probably get GD, for example. Based on nothing but weight alone.

If you actually developed pre-e induction is generally preferred to a c-section for medical reasons. They won't operate on you unless they have no choice. They will first bring your blood pressure down so you'd be on mag anyway. Mag wasn't that bad for me. I threw up once, felt a little out of it, and that was it.

Standard guidelines for what counts as pre-e or pregnancy induced hypertension are pretty clear. If you don't meet those standards, don't go for an induction unless the OB has another medically appropriate reason.

Docs like to go for c-sections on larger women. Unless that is what you want or it is medically better for the baby, don't go there.

OP, the good news is that if you had to induce today, your baby would likely be really healthy - you're almost to 37 weeks! - and might not even need a NICU stay. That's awesome. Breathe. You're ok.

Secondly, I echo those who urge you to push back on the idea of early induction for pre-e. The PP above with the studies about high bp may have a point about bp, if that's your OB's concern, but then the idea of pre-eclampsia should not be mentioned. Pre-e does not mean "high bp and fatness combined". There are specific diagnostic criteria that have to be met. If you've never had protein in your urine and have only had one elevated bp, I can't imagine why it has even come up. I share your concern that your doc may be just making assumptions about your health because of your body shape.

My story -- I am a fat FTM in her 40's, so I was hypervigilant about pre-e. Happily, I had an OB who did not have automatic assumptions about my health based on my weight, and he fully expected I could do a full-term natural labor, since I am pretty active, my sugars are great, and my BP had never been high. I had a pretty smooth pregnancy (aside from a lot of medical anxiety) until a high BP reading at 33 weeks at the doc office. Urine was +1, so I did a blood panel and 24 hour urine collection (OMG, what a pain that was) and they both came back fine, and my BP came down after resting 20 mins, so OB dismissed it and said it was probably just exertion and to come back in a week and take it easier at work.

Just because I was hypervigilant, I got a portable BP monitor (with a large size cuff) and started monitoring my own BP at work. Four days later, I didn't feel right, took it, and it was 200/100. Got put on bed rest, did another 24 hour urine collection, got a giant headache during that 24 hours, called the doc at 3AM, rushed to the hospital, and was in full blown pre-e at 34w 1d. It can happen that fast.

(My happy ending -- my sweet son who seems ok and healthy at 5 months, but it was hard going -- v scary birth, separated from him for 20 hours afterward, NICU stay, v tough first 6 weeks, fears of delays now...but he's a lovely, sweet child and seems ok.)

So, my advice would be, push back very strongly (do not agree to induction unless you've at least done a 24 hour urine to confirm pre-e), but also monitor yourself very closely, as everything can go from good to bad very quickly.

well, the whole "induction/magnesium" sounds completely awful - at some point, wouldn't I just rather have a c-section?

I'm fairly certain mine runs high, but I have a pretty strong case of white coat hypertension (fairly common in my family)

if the only indicator is BP, no protein, other blood tests fine, is that enough for them to order an induction?

I'm trying to stay calm, but I am frustrated like I'm branded with a certain diagnosis from week one because of my weight vs. being treated as a patient who is trying for the most natural outcome possible.

my doctor told me I'd probably get GD, for example. Based on nothing but weight alone.

Try to relax some. Remember in terms of your mom's stillbirth that they were much more common before the level of prenatal care that we have now.

Your typical BP is probably around what it was when you first started being monitored for pregnancy. Mine runs high - about 130/80 normally. Now at 33 weeks it's 122/70 (typical to be lower than normal in mid/late pregnancy I think, because of increased blood flow).

You are nearly full-term. Your baby, in all likelihood, will be completely fine even if born today.

No one is 'ready to deliver' when they get induced. That's what induction means

You'll be fine. Really. At your next appointment, just ask your doc flat-out why she thinks you need to be worried about these things, and if they are real concerns. As I mentioned above, I'm heavy too (at 200 at 33 weeks, what 175 before - am fairly tall but still overweight) and had creeping up BP at the end of my last pregnancy. My sugar reading was 117. I've had no mention of any concern about anything from my doc. Sounds like you don't need to, either.

jindc wrote:also, how does monitoring your BP during delivery work?

If I have to be induced, I'd like to avoid magnesium and all that (and I know the risk doesn't go away right after delivery).

are you just hooked up to monitors? catheters for your urine?

and what happens if you're not ready to deliver and you get induced? I worry about forcing my body to do something it's not ready to do.

Sorry about all these questions...I want to be prepared and it sounds like there's no sure fire way to understand if a patient has pre-e or not, so they just error on the side of inducing.

I had my BP checked at various intervals during labor - usually about once every 10 minutes but at one point it was once every 2 minutes. You just keep the cuff on and the machine times it to auto check at whatever interval they set.

My doctors told me they did not expect that I would need magnesium as my pre-e was mild - however once I had a few "severe" bp readings, they pushed up the induction to immediate and put me on mag. It wasn't fun but I did not have the terrible side effects some people had - only a bit of extra warmth but nothing else. It did suck though because it meant I was on mag for 48 hours (the labor/delivery and then 24 hours afterwards) which meant I was bed-ridden that entire time. I had to get a catheter - twice, once at the beginning and then they removed it for pushing and then they put in a new one after the delivery.

My induction went okay because I was prime for it - I think I was about 2cm dilated and 40% effaced for a few weeks ahead of time and then 3cm dilated and 70% effaced when they started the induction. They said they expected the induction to go well because of this and it did go fairly smoothly.

Not going to lie though, it was tough having baby girl at slightly less than 37 weeks - feeding has been the main challenge. I would have held off if it had been at all medically possible.