Posted by Larry

PIH and Homebirth the pre-birth story

This is NOT Neil Michaels birth story. That will come in
another post. This is the pre-birth story describing the
the last three weeks up to the birth.

This story is dedicated to those women who risked (or opted)
out of home birth in the last few weeks because of high
blood pressure or post dates. Fortunately, we made it through.
This story tells how.

The baby was due on June 25. Our regular midwife had gone out
of town on June 22, and we were in the care of one of her
associates (the substitute midwife). When the 25th came and
went with no baby, and we waited a few more days, she called
and suggested an appointment. We met with her at a friend's
house on July 1 (40w 6d). When she took Monika's blood pressure,
the reading was 160/100, and the midwife acted really worried.
After talking about it for a while, whe took it again with
Monika lying down, and it was 150/90. At this point, she
suggested complete bed rest for Monika. Since she was also
taking care of a 22 month old, Monika just laughed.

We talked some more. We had had some marginal high blood
pressure with Clara, which we had treated using some herbals
suggested in Susan Weed's _Wise Woman Herbal for the
Childbearing Year_. We suggested using this method again.
The midwife made another appointment for us on Saturday.
When Monika was out of hearing, the midwife confided in me
that at the clinic where she worked, anyonw with blood
pressure that high would be sent to the hospital to be
induced immediately. Not great news. I didn't repeat
this to Monika, who is a champion worrier.

When we got home, I suggested that Monika should not even
go out to buy groceries, and that I could pick them up on
my way home from work. Clara was very cooperative, and would
let her mom lie on the couch and read to her. We started
the supplements of calcium, garlic, read raspberry leaf,
hops tea, and cream of tarter and lemon juice. Monika's
friend, Kristin would come over and pick up produce or
mineral water when she could. Monika hung out on the couch.

Friday was particularly hard for Monika, she was terribly
afraid of being sent to the hospital. I was taking her
blood pressure several times a day, and I did not tell her
about the late afternoon reading of 178/116 after she had
been running around. Fortunately, it came down to 158/95
when she lay down. I just told her that she could only go
from the bed to the couch, and that her total standing time
was limited to two hours a day. She was pretty good about
obeying my seemingly absurdly restricitve rules.
Fortunately, during all of this Monika was not
swelling or passing any protein in her urine. Both of
these were good signs.

Saturday (41w 1d), the midwife came over. She did a 10
minute non-stress-test, which Monika passed with flying
colors. She also got a reading of 150/80 for bp! Based
on this, she decided we were doing the right things to
keep Monika's bp under control. However, she still
insisted on doing an ultrasound ASAP. We kind of wanted
to talk to our regular midwife when she came back first,
but she wasn't due in til Tuesday and the substitute was
very insistent.

We scheduled the ultrasound on Monday, July 5 (41w 3 d).
The tech came into the office just for us. The u/s
showed large amounts of amniotic fluid, a very good
heartbeat, and a large placenta functioning well with only
moderate amounts of calcification. The baby was functioning
very well in there. We also had a liver enzyme test to
rule out HELLP. We would also find out in a few days
that this test was normal, too. In addition we were
also keeping the blood pressure in the low 90s range
with more readings in the 80s.

We talked to our regular midwife on Wednesday. She had
gotten the u/s report and talked with the substitute m/w.
She was not worried at all. She thought everything looked
fine.

The week came and went. When Saturday came without a baby,
we went to visit the midwife again. By this time Monika's
blood pressure had dropped mostly back into the 80s range
again. Monika had also started to have some more frequent
Braxton_Hicks contractions. This has also been a pattern
with Clara. About three weeks before the birth her blood
pressure had gone up, then come back down when she started
having intermittent contractions several days before the
actual birth. We hoped we were out of the woods with the
blood pressure thing. It turns out we were right.

The regular midwife also suggested another ultrasound.
I thought that we were so close that we were just throwing
away another $150, but it helped to reassure Monika, so I
said OK. We scheduled it late Monday (42w 3d), hoping we
would go into labor by then. No such luck.

The second ultrasound was as good as the first, except
that the baby was now posterior. As it turns out, this
was no big deal, since the baby seemed to be able to
spin around at will. But we did go right home and Monika
started doing pelvic rocks to turn the baby back around.

On Tuesday, another diastolic BP reading near 100 called
for another dose of cream of tartar, and this seemed to
work since it went right back down, and Monika had
irregular contractions off and on all day. By Wednesday
(42w 5 d) the contractions were more regular, and by the
time that I got home and Kristin left in the afternoon,
Monika would stop what ever she was doing to breathe through
them. At this point she was about to go into active
labor, but that is another story :-) and we will post it
as soon as we get it written.

However this is the conculsion to this story. We had
weathered the storm. Monika's blood pressure was
behaving, and although we were almost three weeks overdue
she was starting to have regular contractions like she
was about to go into REAL labor. :-)

A few points in retrospective. We like the way our regular
midwife handled the situration MUCH more than the substitute.
She was much calmer and matter of fact, and did not seem to
use fear as a motivator so much. She also seemed to actually
feel more confident herself about what needed to be done and
how far we could go before we had to call for help. The
substitute seemed to be somewhat afraid to make that decision
herself. However, under the circumstances, we though she was
also helpful and we appreciate her activities on our behalf.

I would also like to note some things, that our situation,
although "anecdotal" seems to prove.

1. High blood pressure alone, if it can be managed well,
is not a contraindication to home birth. Fortunately we
did not have any protein spillage or significant edema.
We also tested to rule out HELLP. If you can rule out
other complication of which it might be a symptom, it is
less of a worry.

2. Going overdue alone, even more than two weeks, is not
a reason to automatically induce. Again, it is critical
to look at factors like fluid volume and placental function
to determine whether there is a danger. However, some
women just "cook the baby" longer than others. Monika is
one of them. With careful monitoring, post-dates babies
can be safely allowed to deliver on their own schedule.

Follow Ups:

Post a Followup