Squeezing out.... some answers!
September 18, 2006 1:27 PM Subscribe
Now that I'm managing my pregnancy-induced-hypertension with Labetalol why are both my OBs so gung-ho about preparing me for an early induced-labor?
I'm being monitored constantly for preeclampsia. I'm doing the weekly lab tests. I'm tracking my blood pressure at home. I'm at 35 weeks now, so is my goal of just having a regular old childbirth so undiscussably unattainable? Letting the baby decide when to go into labor sounds so much more manageable and healthier and low stress than a chemical induction. I am, it must be admitted, quite skeptical of both these doctors (well, maybe all doctors, especially fancy New York ones, with their monstrous insurance premiums) but it does seem weird to me that they're unwilling to discuss going to term in any great depth with me at this point. Also, they've put me on modified bedrest (light activity around the house is okay) which means getting to Lamaze class is difficult - big subway trip, etc. so if I'm unprepared for labor, it strikes me as just one more reason for them to really push for a C-section when the pedal hits the metal.
I can't decide whether I'm being a control freak and not deferring to their expertise (I mean, I'd never heard of gestational hypertension before last week), or whether I should assert more control into my own first childbirth experience?
I'm being monitored constantly for preeclampsia. I'm doing the weekly lab tests. I'm tracking my blood pressure at home. I'm at 35 weeks now, so is my goal of just having a regular old childbirth so undiscussably unattainable? Letting the baby decide when to go into labor sounds so much more manageable and healthier and low stress than a chemical induction. I am, it must be admitted, quite skeptical of both these doctors (well, maybe all doctors, especially fancy New York ones, with their monstrous insurance premiums) but it does seem weird to me that they're unwilling to discuss going to term in any great depth with me at this point. Also, they've put me on modified bedrest (light activity around the house is okay) which means getting to Lamaze class is difficult - big subway trip, etc. so if I'm unprepared for labor, it strikes me as just one more reason for them to really push for a C-section when the pedal hits the metal.
I can't decide whether I'm being a control freak and not deferring to their expertise (I mean, I'd never heard of gestational hypertension before last week), or whether I should assert more control into my own first childbirth experience?
I don't know anything about the subject, but the doctors should at least be willing to discuss all options. I've found personally that you have to get very aggressive sometimes and make it clear that they will explain something until you understand it. It's in their interest, after all, to dispatch you quickly.
posted by callmejay at 1:38 PM on September 18, 2006
posted by callmejay at 1:38 PM on September 18, 2006
I know nothing about the subject either, but my mother has a conspiracy theory of sorts that many doctors prefer the convenience induction offers them, and so they schedule inductions (and c-sections), when it's not necessarily in the best interest of the pregnant woman/baby. At the least she thinks that doctors do this when it would do no harm to wait for the baby to come on its own.
Also, I've heard that induced deliveries can be more painful than those that begin on their own.
Anyway, I absolutely agree that if you're not comfortable/don't trust your doctors, you should get a new one. But I'm sure you've thought of this, and must have reasons for staying with them.
posted by n'muakolo at 1:50 PM on September 18, 2006
Also, I've heard that induced deliveries can be more painful than those that begin on their own.
Anyway, I absolutely agree that if you're not comfortable/don't trust your doctors, you should get a new one. But I'm sure you've thought of this, and must have reasons for staying with them.
posted by n'muakolo at 1:50 PM on September 18, 2006
Lots of good advice about induction in this thread http://ask.metafilter.com/mefi/32406
Most likely your OB is just trying to prepare you in case the hypertension gets worse and carrying to term isn't an option. But my theory is the docs secretly love to induce. Natural labor is too unpredictable.
posted by libraryhead at 1:52 PM on September 18, 2006
Most likely your OB is just trying to prepare you in case the hypertension gets worse and carrying to term isn't an option. But my theory is the docs secretly love to induce. Natural labor is too unpredictable.
posted by libraryhead at 1:52 PM on September 18, 2006
Induced labor means you give birth on your doctor's schedule - say, Tuesday morning, around 10AM. You know, when they're in the office anyway.
Uninduced labor means the doctor might get a call at midnight, or Sunday during their golf game, or, almost worse, that some other doctor will handle your birth, meaning your doctor doesn't get to bill for it.
At some point very soon, they're going to come up to you and say, "Well, the odds for your baby are just as good now as they would be full term. Let's induce next Tuesday." You need to get ready for that - what do you want to say?
About 40-50 percent of induced labors don't work - they don't really induce labor - and you end up with a C-section.
If you don't mind a C-section, early labor induction is fine. If you do, you need to avoid it and try to wait until labor occurs naturally.
posted by jellicle at 1:53 PM on September 18, 2006
Uninduced labor means the doctor might get a call at midnight, or Sunday during their golf game, or, almost worse, that some other doctor will handle your birth, meaning your doctor doesn't get to bill for it.
At some point very soon, they're going to come up to you and say, "Well, the odds for your baby are just as good now as they would be full term. Let's induce next Tuesday." You need to get ready for that - what do you want to say?
About 40-50 percent of induced labors don't work - they don't really induce labor - and you end up with a C-section.
If you don't mind a C-section, early labor induction is fine. If you do, you need to avoid it and try to wait until labor occurs naturally.
posted by jellicle at 1:53 PM on September 18, 2006
Could you get a doula? As I understand it a doula would be your knowledgable advocate in exactly these matters; might not be bad to get out the phone book and see if you can set up a meeting with one. She might be able to tell you more about the risks of preeclampsia vs. the downside of inducing.
posted by LobsterMitten at 2:06 PM on September 18, 2006
posted by LobsterMitten at 2:06 PM on September 18, 2006
Unless they can give a specific medical reason for induction, why induce?
The bottom line is, if you're uncomfortable with it, don't do it. I've heard the pain of an induced labor is much more than a regular labor - this is from several friends who've given birth both ways.
posted by agregoli at 2:10 PM on September 18, 2006
The bottom line is, if you're uncomfortable with it, don't do it. I've heard the pain of an induced labor is much more than a regular labor - this is from several friends who've given birth both ways.
posted by agregoli at 2:10 PM on September 18, 2006
why are both my OBs so gung-ho about preparing me for an early induced-labor?
Because they're trying to prevent possible harm to you and your baby. Pre-eclampsia puts you and the baby at higher risk, and the longer you remain pregnant, the longer you and the baby are exposed to that risk.
Since they know that at any time their best judgment may call on them to recommend inducing labor immediately, they want to prepare you for that possibility so you can think about it ahead of time. That way, you don't dither when your and your baby's health are at stake.
If you discount the idea that pre-eclampsia causes 76,000 preventable deaths every year - if you think that doesn't matter one whit - why then, sure, no explanation remains but a conspiracy of doctors to reduce their hours on call. After all, the training that doctors voluntarily undergo clearly demonstrates their reluctance as a profession to work long hours for little reward. All doctors are lazy, profit-minded scoundrels intent on maximizing harm to their patients while minimizing their own efforts. Right?
More about gestational hypertension and pre-eclampsia here and here.
posted by ikkyu2 at 2:22 PM on September 18, 2006 [8 favorites]
Because they're trying to prevent possible harm to you and your baby. Pre-eclampsia puts you and the baby at higher risk, and the longer you remain pregnant, the longer you and the baby are exposed to that risk.
Since they know that at any time their best judgment may call on them to recommend inducing labor immediately, they want to prepare you for that possibility so you can think about it ahead of time. That way, you don't dither when your and your baby's health are at stake.
If you discount the idea that pre-eclampsia causes 76,000 preventable deaths every year - if you think that doesn't matter one whit - why then, sure, no explanation remains but a conspiracy of doctors to reduce their hours on call. After all, the training that doctors voluntarily undergo clearly demonstrates their reluctance as a profession to work long hours for little reward. All doctors are lazy, profit-minded scoundrels intent on maximizing harm to their patients while minimizing their own efforts. Right?
More about gestational hypertension and pre-eclampsia here and here.
posted by ikkyu2 at 2:22 PM on September 18, 2006 [8 favorites]
I do actually know a little about this. My first question is, what are your symptoms? How high has your blood pressure gotten, and does it come down (A person who is having high blood pressure in a moment of stress will have lower blood pressure after spending 1/2 an hour relaxing on her side in a dark room). Have you had protein in your urine (proteinurea)? WHat lab tests have been conducted so far? There is a new-ish blood test that can indicate whether you have pre-eclampsia or not. I couldn't give my opinion without the answers to any of these questions.
Having said that, here's what I can say about pregnany induced hypertension aka PIH aka preeclampsia:
No one knows exactly what causes PIH. It is one of the most persistant mysteries of medical science. A recent New Yorker article elaborates on just how mysterious it is, and on some recent breakthroughs in the science of the disease. PIH is controversal and there are a number of divergent ideas about treatment ranging from nutrition based to pharmacutical (which you are currently engaged in).
What we do know is that preeclampsia leads to eclampsia (siezures) and can be deadly. There is only one 'cure' for preeclampsia, and that is birth. There are occasional incedences of eclamptic siezures after birth, but usually they occur within 24 hours or so (I think I have this right, I didn't double check but it's unheard of after a couple days of birth).
Someone with rapidly progressing pre-eclampsia should have an induced labor as soon as the baby can safely live outside. On the other hand there is a lot of subjectivity in the question of how severe someone's preeclampsia is. Again, this is why I asked what your various lab results and blood pressure are.
I know that this can be very frightening, and also very frustrating. Most people don't want a more interventive birth than they need. I aplaud your effort to avoid an induction if you don't need one. I recommend asking your doctor for as many specifics as possible, writing all those numbers etc down, and then doing researh online. There is a lot online about this disease; other posters have already posted useful links.
Good luck and take care.
posted by serazin at 2:38 PM on September 18, 2006
Having said that, here's what I can say about pregnany induced hypertension aka PIH aka preeclampsia:
No one knows exactly what causes PIH. It is one of the most persistant mysteries of medical science. A recent New Yorker article elaborates on just how mysterious it is, and on some recent breakthroughs in the science of the disease. PIH is controversal and there are a number of divergent ideas about treatment ranging from nutrition based to pharmacutical (which you are currently engaged in).
What we do know is that preeclampsia leads to eclampsia (siezures) and can be deadly. There is only one 'cure' for preeclampsia, and that is birth. There are occasional incedences of eclamptic siezures after birth, but usually they occur within 24 hours or so (I think I have this right, I didn't double check but it's unheard of after a couple days of birth).
Someone with rapidly progressing pre-eclampsia should have an induced labor as soon as the baby can safely live outside. On the other hand there is a lot of subjectivity in the question of how severe someone's preeclampsia is. Again, this is why I asked what your various lab results and blood pressure are.
I know that this can be very frightening, and also very frustrating. Most people don't want a more interventive birth than they need. I aplaud your effort to avoid an induction if you don't need one. I recommend asking your doctor for as many specifics as possible, writing all those numbers etc down, and then doing researh online. There is a lot online about this disease; other posters have already posted useful links.
Good luck and take care.
posted by serazin at 2:38 PM on September 18, 2006
And I agree that a doula could be very helpful here if you can afford one. She can both provide technical information and advocate for your desires during the birth. Lot's of women with preeclampsia have normal, vaginal births. good luck!
posted by serazin at 2:41 PM on September 18, 2006
posted by serazin at 2:41 PM on September 18, 2006
Our son was born 10 weeks early, induced, as a result of preeclampsia. It should be said my wife's situation was considerably more acute than yours - they couldn't really effectively control her blood pressure and she was confined completely to a hospital bed.
The lead physician told us that they had been collected data for years and believed the evidence showed that extending acute preeclampsic pregnancies to term provided no benefits to the mother or the infant and carried considerable risks for both. It's not like we ever verified this, I believed him. This was at Fairview Riverside in Minneapolis, I understand it has one of the more advanced NICUs in the midwest.
My wife and I hadn't been through any birth training. She had a normal (under the circumstances) vaginal birth. Vaginal delivery is the desired outcome for the health of the mother and than infant. Our son was hospitalized for 40 days subsequent to birth. He has had no further complications.
I honestly don't think "being prepared" in that sense has an effect on the possibility of having a C-section (but someone correct me if I'm wrong). I'm not a doctor, obviously but my opinion is that yours are acting in your and your baby's best interest. If you really doubt it you need to talk to them about that and arrange for a third opinion (mine doesn't count). And you should absolutely not be pushing the activity limits, your condition can really be genuinely dangerous, it is a leading cause of pregnancy related deaths!
posted by nanojath at 2:57 PM on September 18, 2006
The lead physician told us that they had been collected data for years and believed the evidence showed that extending acute preeclampsic pregnancies to term provided no benefits to the mother or the infant and carried considerable risks for both. It's not like we ever verified this, I believed him. This was at Fairview Riverside in Minneapolis, I understand it has one of the more advanced NICUs in the midwest.
My wife and I hadn't been through any birth training. She had a normal (under the circumstances) vaginal birth. Vaginal delivery is the desired outcome for the health of the mother and than infant. Our son was hospitalized for 40 days subsequent to birth. He has had no further complications.
I honestly don't think "being prepared" in that sense has an effect on the possibility of having a C-section (but someone correct me if I'm wrong). I'm not a doctor, obviously but my opinion is that yours are acting in your and your baby's best interest. If you really doubt it you need to talk to them about that and arrange for a third opinion (mine doesn't count). And you should absolutely not be pushing the activity limits, your condition can really be genuinely dangerous, it is a leading cause of pregnancy related deaths!
posted by nanojath at 2:57 PM on September 18, 2006
Oh and ikkyu2, I understand where you're coming from, but I do think sometimes medical professionals don't do the best job explaining their reasoning and motivations (we had a lot of confusion and misunderstanding until the physician I mentioned sat down and broke it down for us in a really clear and convincing way - a couple days into the hospitalization). Give DenOfSizer a break, she's under a lot of stress and you're putting a lot of words into her mouth.
posted by nanojath at 3:02 PM on September 18, 2006
posted by nanojath at 3:02 PM on September 18, 2006
There has been controversy recently about whether bed rest even actually helps with hypertension during pregnancy. I'm not a doctor and haven't been pregnant, so I'm not claiming any expertise on whether your particular condition falls within the bounds of the studies being done, but it does sound like you could use someone who could explain all this to you, and doesn't make you feel like a control freak for wanting to know what's going on in your life.
So, another vote for doula or midwife, or another doctor who listens to you and explains what's going on.
posted by occhiblu at 3:05 PM on September 18, 2006
So, another vote for doula or midwife, or another doctor who listens to you and explains what's going on.
posted by occhiblu at 3:05 PM on September 18, 2006
Nanojath, DenOfSizer's concerns are perfectly appropriate, and I'd even echo your advice to make sure that the docs are communicating clearly the way we all think they should.
Other commenters in this thread, however, like jellicle, have instructed the original poster that decisions are being made on behalf of the OB's golf game. This is wrong-headed foolishness and I'm calling it out.
posted by ikkyu2 at 3:32 PM on September 18, 2006
Other commenters in this thread, however, like jellicle, have instructed the original poster that decisions are being made on behalf of the OB's golf game. This is wrong-headed foolishness and I'm calling it out.
posted by ikkyu2 at 3:32 PM on September 18, 2006
I had both of my children induced at about 37 weeks because of high blood pressure, although it did not advance to pre-eclampsia, so I know a little of where you're coming from. When you say they're "preparing you", do you mean that they are telling you all the possibilities for your birth or are they actually wanting to set up the appointment for delivery asap?
It is a scary concept, because some studies show that Pitocin causes more pain, which leads to wanting an epidural, which may slow down labor, which may lead to a C-section. Ugh. But, the alternative for pre-eclampsia can be a LOT worse. Get more info, make the doctors spend time with you about what to expect if you have to stay on bedrest longer. Do they think the Lebetatol is dangerous or may stop working? Are they worried that the hbp is hurting the baby and want to be sure that NICU is ready for a high-risk birth?
For me, the first birth was longer and the doc "threatened" me with a c-section, but he eventually came out vaginally, although he needed a little oxygen. Second birth didn't even need a Pitocin drip, labor started after they gave me medication to ripen the cervix, and delivery was within an hour of my water breaking. She was perfectly healthy.
Oh, and I didn't go to any Lamaze classes, but the nurses knew what to do and were great at coaching me through the first birth.
posted by saffry at 3:42 PM on September 18, 2006
It is a scary concept, because some studies show that Pitocin causes more pain, which leads to wanting an epidural, which may slow down labor, which may lead to a C-section. Ugh. But, the alternative for pre-eclampsia can be a LOT worse. Get more info, make the doctors spend time with you about what to expect if you have to stay on bedrest longer. Do they think the Lebetatol is dangerous or may stop working? Are they worried that the hbp is hurting the baby and want to be sure that NICU is ready for a high-risk birth?
For me, the first birth was longer and the doc "threatened" me with a c-section, but he eventually came out vaginally, although he needed a little oxygen. Second birth didn't even need a Pitocin drip, labor started after they gave me medication to ripen the cervix, and delivery was within an hour of my water breaking. She was perfectly healthy.
Oh, and I didn't go to any Lamaze classes, but the nurses knew what to do and were great at coaching me through the first birth.
posted by saffry at 3:42 PM on September 18, 2006
Response by poster: Thanks for all the interesting answers so far! I should point out I don't have preeclampsia, and that it is not the same thing as gestational hypertension, but which is also serious, I realize. I am of course reluctant to endanger myself or my baby for an impossibly ideal "natural" birth, but I'd rather not risk an induced labor or a C-section unnecessarily either. My question is quite specific, but I could've worded it better: why would I need to have an induced labor if I the medications are keeping my blood pressure low (and continue to)? Neither doctor has, in my estimation, clearly explained this to me, and the many links I've read about PIH have not spoken to this question.
In answer to y'all's questions, I have had two series of blood and urine tests, including a 24 collection (more thorough), in which there was no protein. My highest pre-medicated BP readings ranged from 130-150/95-105 (classifiable as moderately high) and my medicated BPs put me in the 120/85-99 range (none to mildly hypertensive.) And I don't hate my doctors, but I've spent no more than 2 hours with each of them over the last 8.5 months; it's not like we have a real relationship of any kind. They - and hospital monitoring - have assured me is thriving and that the Labetatol is ok.
posted by DenOfSizer at 4:21 PM on September 18, 2006
In answer to y'all's questions, I have had two series of blood and urine tests, including a 24 collection (more thorough), in which there was no protein. My highest pre-medicated BP readings ranged from 130-150/95-105 (classifiable as moderately high) and my medicated BPs put me in the 120/85-99 range (none to mildly hypertensive.) And I don't hate my doctors, but I've spent no more than 2 hours with each of them over the last 8.5 months; it's not like we have a real relationship of any kind. They - and hospital monitoring - have assured me is thriving and that the Labetatol is ok.
posted by DenOfSizer at 4:21 PM on September 18, 2006
My mom's a Certified Nurse-Midwife. From my discussions with her, it would seem that, far from some Pitocin conspiracy, most docs and midwives would much prefer natural labor in the absence of complicating factors. She says she spends a substantial percentage of her office visits explaining to pregnant women that no, there's no reason for them to be induced, and that absence of reason extends to not wanting to have to get up in the middle of the night if contractions progress rapidly.
posted by oats at 5:49 PM on September 18, 2006
posted by oats at 5:49 PM on September 18, 2006
"... I should point out I don't have preeclampsia..."
posted by DenOfSizer at 7:21 PM EST on September 18 [+fave] [!]
The problem is, when you do have it, you may only have it for a couple of hours, before you and/or your baby are dead. And you may not even feel particularly bad, until you go out. Or, you could get lucky and get through the crisis alive, with your baby, and only have some permanent paralysis due to ancillary stroke complications. Or your baby could be permanently handicapped, and you'll be living with that for the rest of the child's life, etc. Preeclampsia onset can be quite sudden, and relatively symptom free.
Your baby, your life, I guess.
But ikkyu2 has a long history with the AskMe community, and a lot of respect around here, justifiably, and he has given you some pretty valuable free advice, which is to take your doctor's recommendations for taking the safer, managed delivery route. IANAD, but he is, and that's golden advice, and you may not get a chance to change your mind if you don't, and things go wrong.
posted by paulsc at 5:52 PM on September 18, 2006
posted by DenOfSizer at 7:21 PM EST on September 18 [+fave] [!]
The problem is, when you do have it, you may only have it for a couple of hours, before you and/or your baby are dead. And you may not even feel particularly bad, until you go out. Or, you could get lucky and get through the crisis alive, with your baby, and only have some permanent paralysis due to ancillary stroke complications. Or your baby could be permanently handicapped, and you'll be living with that for the rest of the child's life, etc. Preeclampsia onset can be quite sudden, and relatively symptom free.
Your baby, your life, I guess.
But ikkyu2 has a long history with the AskMe community, and a lot of respect around here, justifiably, and he has given you some pretty valuable free advice, which is to take your doctor's recommendations for taking the safer, managed delivery route. IANAD, but he is, and that's golden advice, and you may not get a chance to change your mind if you don't, and things go wrong.
posted by paulsc at 5:52 PM on September 18, 2006
DoF - I can't really help you at all with the specifics of you situation, but I can say that I understand a little where you are coming from - doctors can be very brusque when it comes to dealing with and giving information to patients. It doesn't mean they're bad doctors, it probably just means they're short on time or have been through this same situation a million times (forgetting that you haven't!) I completely agree that it can help having a knowledgeable advocate who can act as a go-between for you and your doctor. Failing that, it might be best to schedule an informational appointment to explain your concerns and discuss this situation with your doctors. If they gripe about it, maybe you should ask if they know any doctors that DO have time to treat you as an individual.
posted by muddgirl at 5:53 PM on September 18, 2006
posted by muddgirl at 5:53 PM on September 18, 2006
Despite certain parties' protests to the contrary, every study and metric on the subject would indicate that a large number of the childbirth-related procedures in U.S. (scheduled inductions, active labor management, scheduled c-sections, ultrasounds, electronic fetal monitoring, etc.) are being performed on a "let's cover our asses, just in case, action is always more defendable than inaction" basis, rather than an individual evidentiary basis.
If your doctors are not answering your questions now in a way that demonstrates that an induction at some vague future date is going a necessity for you because of the specifics of your situation, with the supporting specifics enumerated, then they're not the people you want there in the crucial moments.
This is not to say that your doctors are more concerned about their schedules than you, their interests may well be entirely proper. However, an inability to effectively communicate with you in a way that allays your concerns and addresses the needs that you have, is as great a liability in a doctor-patient relationship as misplaced priorities. (On either side.) And if they're not spending enough time to answer your questions thoroughly, all the more reason to think twice about relying upon them to help ensure the wellbeing of both yourself and your child. It is never too late to find a new doctor.
I also second (third?) the suggestion that you hire a seasoned labor doula and have a consultation with her ASAP. (Obligatory Disclosure: I am a doula. I do not, however, benefit in any way from the hiring of any other doula, and I'm not in your area, so you won't be hiring me.)
I'd also strongly suggest picking up a copy of A Thinking Woman's Guide to a Better Birth by Henci Goer which will help you get a handle on the objective information you will want to ascertain in order to help you make the crucial decisions that are upcoming.
posted by Dreama at 5:53 PM on September 18, 2006
If your doctors are not answering your questions now in a way that demonstrates that an induction at some vague future date is going a necessity for you because of the specifics of your situation, with the supporting specifics enumerated, then they're not the people you want there in the crucial moments.
This is not to say that your doctors are more concerned about their schedules than you, their interests may well be entirely proper. However, an inability to effectively communicate with you in a way that allays your concerns and addresses the needs that you have, is as great a liability in a doctor-patient relationship as misplaced priorities. (On either side.) And if they're not spending enough time to answer your questions thoroughly, all the more reason to think twice about relying upon them to help ensure the wellbeing of both yourself and your child. It is never too late to find a new doctor.
I also second (third?) the suggestion that you hire a seasoned labor doula and have a consultation with her ASAP. (Obligatory Disclosure: I am a doula. I do not, however, benefit in any way from the hiring of any other doula, and I'm not in your area, so you won't be hiring me.)
I'd also strongly suggest picking up a copy of A Thinking Woman's Guide to a Better Birth by Henci Goer which will help you get a handle on the objective information you will want to ascertain in order to help you make the crucial decisions that are upcoming.
posted by Dreama at 5:53 PM on September 18, 2006
Sorry to report that gestational hypertension IS preeclampsia. Or rather, any concern your doctor has about your hypertension, since it didn't exist before pregnancy, is about preventing eclampsia. The two conditions are interchangable in the mind of your doctor. Also unfortunately, even in a medicated state, you have high blood pressure. If you continue to exhibit zero other symptoms, you could make the argument that you'd like to continue your pregnancy with close monitoring, but there are incidences of eclapmtic siezures with no symptoms besides high blood pressure. (Pre-eclapmpsia is defined by having 2 or more symptoms of the disorder or having blood pressure over a certain point).
ikkyu2, your response really raised my dander. Even the most competent, principled doctor is sometimes WRONG! There is no harm in researching and understanding the conditions that we are effected by. And our health is likely to improve if we are active participants in our own health care. As a health care provider, I try to share as much as I can with my clients and then encourage them to make their OWN decisions about their bodies.
posted by serazin at 6:23 PM on September 18, 2006
ikkyu2, your response really raised my dander. Even the most competent, principled doctor is sometimes WRONG! There is no harm in researching and understanding the conditions that we are effected by. And our health is likely to improve if we are active participants in our own health care. As a health care provider, I try to share as much as I can with my clients and then encourage them to make their OWN decisions about their bodies.
posted by serazin at 6:23 PM on September 18, 2006
I'm a labor and delivery nurse, and I want to echo ikkyu2's sentiments. Your doctors are trying to prepare you for all the possibilities, and induced labor is a very real one.
Something to consider regarding your specific question is that hypertension is a symptom of the disease process, not the sum total of the disease process itself. Taking labetolol to control your blood pressure is a band-aid solution meant to carry you as close to term as possible before delivery, but it isn't a cure for gestational hypertension--only the delivery of your baby is a cure. The disease process is continuing despite the so-far effective control of your major symptom. (For a very technical look at the pathophysiology of gestational hypertension, check out emedicine.com.)
At some point the continuation of the disease process will outweigh any benefit your baby might derive from another few days/weeks of intrauterine development. That's when your doctors will say, "We should induce." They're trying to prepare you for that now by mentioning it.
And I'm always kind of boggled that people think their doctors schedule inductions based on their recreational pursuits. An induction can take days, and delivery is never on a schedule. Starting someone on Pitocin at 7 a.m. is no guarantee of a delivery by tee off.
All this said, you're absolutely right to insist that your doctors clearly discuss all your options and the relative risks and benefits of each with you.
(On a side note: a doula can help you prepare for labor and assist you during delivery [and they are totally awesome at it and I would definitely recommend that you get one if you can!] but she will not be trained nor qualified to provide you with the kind of medical advice you'd receive from a doctor or nurse-midwife. If your doctor says, "You need an induction because your condition has progressed in a, b, and c way," and your doula says "No, you don't," I urge you to listen to your doctor.)
posted by jesourie at 6:51 PM on September 18, 2006 [1 favorite]
Something to consider regarding your specific question is that hypertension is a symptom of the disease process, not the sum total of the disease process itself. Taking labetolol to control your blood pressure is a band-aid solution meant to carry you as close to term as possible before delivery, but it isn't a cure for gestational hypertension--only the delivery of your baby is a cure. The disease process is continuing despite the so-far effective control of your major symptom. (For a very technical look at the pathophysiology of gestational hypertension, check out emedicine.com.)
At some point the continuation of the disease process will outweigh any benefit your baby might derive from another few days/weeks of intrauterine development. That's when your doctors will say, "We should induce." They're trying to prepare you for that now by mentioning it.
And I'm always kind of boggled that people think their doctors schedule inductions based on their recreational pursuits. An induction can take days, and delivery is never on a schedule. Starting someone on Pitocin at 7 a.m. is no guarantee of a delivery by tee off.
All this said, you're absolutely right to insist that your doctors clearly discuss all your options and the relative risks and benefits of each with you.
(On a side note: a doula can help you prepare for labor and assist you during delivery [and they are totally awesome at it and I would definitely recommend that you get one if you can!] but she will not be trained nor qualified to provide you with the kind of medical advice you'd receive from a doctor or nurse-midwife. If your doctor says, "You need an induction because your condition has progressed in a, b, and c way," and your doula says "No, you don't," I urge you to listen to your doctor.)
posted by jesourie at 6:51 PM on September 18, 2006 [1 favorite]
DenOfSizer, do listen to your doctors, because -- as you have probably found out since you were diagnosed -- your condition can be life-threatening. Overwhelmingly, doctors have the best interest of their patients as their #1 concern, so don't buy into any paranoid anti-medical-establishment theory -- especially at a time when you have a potentially very dangerous condition.
The risk of ignoring their advice is that you could go eclamptic and die. The risk of letting them ride roughshod over your own desires is that you might have a birth experience that is not what you wanted.... This would obviously not be ideal, but compared to possibly dying, I would pick the non-ideal birth experience every day of the week.
But it sounds like what you need in the meantime is someone knowledgable who will take the time to talk this over with you in person, knowing the particulars of your case. Can you expect to safely have a natural delivery? We can't tell you and neither can other internet pregnancy message boards. Maybe your doctors were just trying to prepare you for a possible induction scenario, or maybe they think it's inevitable. Can you ask them? If not, I think the best course is to try to find a doula who will at least meet with you once to talk over the options and likely outcomes. Good luck!
posted by LobsterMitten at 8:21 PM on September 18, 2006
The risk of ignoring their advice is that you could go eclamptic and die. The risk of letting them ride roughshod over your own desires is that you might have a birth experience that is not what you wanted.... This would obviously not be ideal, but compared to possibly dying, I would pick the non-ideal birth experience every day of the week.
But it sounds like what you need in the meantime is someone knowledgable who will take the time to talk this over with you in person, knowing the particulars of your case. Can you expect to safely have a natural delivery? We can't tell you and neither can other internet pregnancy message boards. Maybe your doctors were just trying to prepare you for a possible induction scenario, or maybe they think it's inevitable. Can you ask them? If not, I think the best course is to try to find a doula who will at least meet with you once to talk over the options and likely outcomes. Good luck!
posted by LobsterMitten at 8:21 PM on September 18, 2006
I wouldn't change doctors at this point unless you are referred to a specialist. Your hypertension is severe enough to warrant medication, so take it seriously. Your odds of a surgical (c-section) delivery are higher because you are now at higher risk.
Lamaze classes are good, but you can have a natural birth without them. Resist medication early in labor. Make sure your doctor knows you're committed to natural birth, and really don't want surgery unless it's unavoidable. Don't go to the hospital too soon. If you end up being induced, keep a positive attitude; it's not so bad.
If you have a surgical delivery, do your best to have someone there (Dad?) to hold and snuggle the baby while you get stitched up. See if someone can take pictures of the baby being lifted up at birth. Limit the number of pelvic exams and the number of examiners. Check the hospital's infection rate before you go. Post-surgical infection + newborn sucks. Otherwise, focus on the goal of a healthy baby and healthy you.
posted by theora55 at 8:53 PM on September 18, 2006
Lamaze classes are good, but you can have a natural birth without them. Resist medication early in labor. Make sure your doctor knows you're committed to natural birth, and really don't want surgery unless it's unavoidable. Don't go to the hospital too soon. If you end up being induced, keep a positive attitude; it's not so bad.
If you have a surgical delivery, do your best to have someone there (Dad?) to hold and snuggle the baby while you get stitched up. See if someone can take pictures of the baby being lifted up at birth. Limit the number of pelvic exams and the number of examiners. Check the hospital's infection rate before you go. Post-surgical infection + newborn sucks. Otherwise, focus on the goal of a healthy baby and healthy you.
posted by theora55 at 8:53 PM on September 18, 2006
I would do everything I could to avoid pitocin - I hear it makes labor a LOT more painful.
posted by IndigoRain at 2:35 AM on September 19, 2006
posted by IndigoRain at 2:35 AM on September 19, 2006
Ikkuyu2's advice is spot on as always. IANAD but hearing my S.O. one or 2 horror stories ( anesthetist, he gives the epidurals or GA for emergency C sections) about sudden pre-eclamptic fits and the outcome (maternal and fetal death, Maternal stroke, hemiplegia) you will have to weigh the risks.
In the absence of proteinuria, you can still hope for a vaginal delivery, and I think your OBGYNs are trying to make sure you know of the most likely scenario so you are not devastated that the delivery may not be all you want. Monitor your BP ruthlessly and research the symptoms of pre-eclamptic fits. Unfortunately there's a reason they are called sudden. So inform all those around you of what to look out for. Over 20 years of practise my S.O says the waiting for tee-off brigade have completely disappeared from Obs/Gynea here, but that's the UK. I would imagine that their unsafe practises have also largly killed them off litigation wise in the USA, but I may be wrong.
Having said all that and with 2 natural births experience I would not want to enter second stage (the pushing) with your current BP. I would simply be too afraid of bursting a blood vessel where it matters.
Best of luck
posted by Wilder at 2:56 AM on September 19, 2006
In the absence of proteinuria, you can still hope for a vaginal delivery, and I think your OBGYNs are trying to make sure you know of the most likely scenario so you are not devastated that the delivery may not be all you want. Monitor your BP ruthlessly and research the symptoms of pre-eclamptic fits. Unfortunately there's a reason they are called sudden. So inform all those around you of what to look out for. Over 20 years of practise my S.O says the waiting for tee-off brigade have completely disappeared from Obs/Gynea here, but that's the UK. I would imagine that their unsafe practises have also largly killed them off litigation wise in the USA, but I may be wrong.
Having said all that and with 2 natural births experience I would not want to enter second stage (the pushing) with your current BP. I would simply be too afraid of bursting a blood vessel where it matters.
Best of luck
posted by Wilder at 2:56 AM on September 19, 2006
Mod note: a few comments removed, please take metadiscussion about golf and ethics to metatalk or email
posted by jessamyn (staff) at 3:49 AM on September 19, 2006
posted by jessamyn (staff) at 3:49 AM on September 19, 2006
Just my personal anecdote here:
With my oldest child I developed eclampsia within 36 hours of first being diagnosed with gestational hypertension. I was sent home with directions to rest and to return the next day for my 24 hour urine collection. The next day when I went back to the office I was already seeing spots in front of my eyes, dizzy and I was retaining so much water that even my lower back was squishy. With 3+ protein according to the urine dipstick, I was immediately admitted to the hospital. I was given magnesium sulfate (which is awful, it makes you feel like you've been beaten all over your body with a board) and pitocin to induce labor. I am not sure exactly what time it was when I had a seizure but they damn sure got the baby out right away by c/section in the middle of the night.
I spent another few days on the mag until they felt any danger of seizure passed. The baby was fine, a little stressed from the seizure but otherwise ok. I was 41 weeks at that point so prematurity wasn't an issue.
posted by hollygoheavy at 8:14 AM on September 19, 2006
With my oldest child I developed eclampsia within 36 hours of first being diagnosed with gestational hypertension. I was sent home with directions to rest and to return the next day for my 24 hour urine collection. The next day when I went back to the office I was already seeing spots in front of my eyes, dizzy and I was retaining so much water that even my lower back was squishy. With 3+ protein according to the urine dipstick, I was immediately admitted to the hospital. I was given magnesium sulfate (which is awful, it makes you feel like you've been beaten all over your body with a board) and pitocin to induce labor. I am not sure exactly what time it was when I had a seizure but they damn sure got the baby out right away by c/section in the middle of the night.
I spent another few days on the mag until they felt any danger of seizure passed. The baby was fine, a little stressed from the seizure but otherwise ok. I was 41 weeks at that point so prematurity wasn't an issue.
posted by hollygoheavy at 8:14 AM on September 19, 2006
Best answer: ... why would I need to have an induced labor if I the medications are keeping my blood pressure low (and continue to)?
To answer your question directly, your labetolol may be effectively reducing your blood pressure. This in turn effectively reduces the risk of one of the major complications of PIH, namely a Stroke.
What Labetolol does not do is significantly reduce your risk of seizure (though frankly a low probability at this point). More importantly what Labetolol will not do is reverse the effects on /from your placenta.
Gestational hypertension and Preeclampsia are best viewed as existing on a single spectrum. It is a slippery slope from one to the other, so what you call it doesn't really matter. The reason your pressure is increasing is that your placenta is starting to poop out. (Your placenta is ageing prematurely and blood perfusion is decreasing). As a natural response to this, your placenta is sending out signals (or so the theory goes) that cause your pressure to increase which in turn perfuses the placenta better. More blood to placenta = more oxygen and nutrients to your baby. Unfortunately, the increased pressure also further damages you placenta, which in turn, sends out more signals, and so the cycle goes.
In PIH, eventually your baby will no longer benefit from being inside the womb. A detrimental environenment can even be harmful to your baby, while at the same time you are incurring risks (stroke, seizure, renal impairment, liver damage).
I understand that you want a natural delivery. But is having a labour that starts spontaneously and progresses in a totally natural fashion more important than your baby's health or yours? (It is possible for spontaneous labour to start too late!)
To be honest, you do have a greater chance of having a caesarean. There are a few reasons for this. Yes it is true that inducing any labour confers greater risk of caesarean - especially when the cervix is "unfavourable" as your's probably is. But you also have to consider that baby's of preeclamptics are usually less resilient and may not tolerate the stress of contractions as well. (If the placenta isn't working as well as it should, oxygenation may be suboptimal, and the baby may not be able to "catch it's breath" that well between contractions).
The last reason you may end up with a caesarean is if the situation gets too dire for induction. I agree with Jesourie, induction of labour can take days, and if you are too sick, 3 days may not be an affordable luxury. In that sense resisting the advice of your doctors in an attempt to avoid a c/s could end up as a self fulfilling prophecy.
However, the good news is that patients with PIH tend to labour more successfully and rapidly than those without.
In the end, there is so much about you that you and your doctors know that we don't that should contribute to your decision. (How many labours have you had? What is the estimated weight of the baby? How do the dopplers look on ultrasound? How are the NSTs? What is your underlying health? What is the cervix like? How have the labs changed over the past day/week/month? As well as other logistical questions like, how busy is the labour floor right now? Is there an L&D nurse available to look after an induction? Is it a friday, and is it safe to let you go over the weekend with less intense monitoring?)
I have to say, as this turns into more of a rant, that I really resent the antagonistic position society seems to have taken with their doctors. There are double standards. People want the autonomy to make their own informed decision (which I think is good), but then fail to do the background research, and usually don't take responsibility for the outcomes of their decisions. It is no wonder that the medical profession is increasingly guided by legalities.
Everybody wants a natural labour (whatever that means), but can't consider for an instant that their pregnancy may not be going 100% smoothly. I don't understand why people who insist on doing their own thing their own way even bother seeking out medical attention.
I do applaud you for seeking out answers to your question, and hope that you've checked out some of the links people have provided. It is true thta PIH is the leading cause of maternal death world wide and there is tons of ongoing research. You should do whatever research you need to make yourself feel comfortable with your decision, but unless you are going to become an expert on the issue, you are going to have to trust you OBs on some level.
posted by commissioner12 at 10:03 AM on September 19, 2006 [4 favorites]
To answer your question directly, your labetolol may be effectively reducing your blood pressure. This in turn effectively reduces the risk of one of the major complications of PIH, namely a Stroke.
What Labetolol does not do is significantly reduce your risk of seizure (though frankly a low probability at this point). More importantly what Labetolol will not do is reverse the effects on /from your placenta.
Gestational hypertension and Preeclampsia are best viewed as existing on a single spectrum. It is a slippery slope from one to the other, so what you call it doesn't really matter. The reason your pressure is increasing is that your placenta is starting to poop out. (Your placenta is ageing prematurely and blood perfusion is decreasing). As a natural response to this, your placenta is sending out signals (or so the theory goes) that cause your pressure to increase which in turn perfuses the placenta better. More blood to placenta = more oxygen and nutrients to your baby. Unfortunately, the increased pressure also further damages you placenta, which in turn, sends out more signals, and so the cycle goes.
In PIH, eventually your baby will no longer benefit from being inside the womb. A detrimental environenment can even be harmful to your baby, while at the same time you are incurring risks (stroke, seizure, renal impairment, liver damage).
I understand that you want a natural delivery. But is having a labour that starts spontaneously and progresses in a totally natural fashion more important than your baby's health or yours? (It is possible for spontaneous labour to start too late!)
To be honest, you do have a greater chance of having a caesarean. There are a few reasons for this. Yes it is true that inducing any labour confers greater risk of caesarean - especially when the cervix is "unfavourable" as your's probably is. But you also have to consider that baby's of preeclamptics are usually less resilient and may not tolerate the stress of contractions as well. (If the placenta isn't working as well as it should, oxygenation may be suboptimal, and the baby may not be able to "catch it's breath" that well between contractions).
The last reason you may end up with a caesarean is if the situation gets too dire for induction. I agree with Jesourie, induction of labour can take days, and if you are too sick, 3 days may not be an affordable luxury. In that sense resisting the advice of your doctors in an attempt to avoid a c/s could end up as a self fulfilling prophecy.
However, the good news is that patients with PIH tend to labour more successfully and rapidly than those without.
In the end, there is so much about you that you and your doctors know that we don't that should contribute to your decision. (How many labours have you had? What is the estimated weight of the baby? How do the dopplers look on ultrasound? How are the NSTs? What is your underlying health? What is the cervix like? How have the labs changed over the past day/week/month? As well as other logistical questions like, how busy is the labour floor right now? Is there an L&D nurse available to look after an induction? Is it a friday, and is it safe to let you go over the weekend with less intense monitoring?)
I have to say, as this turns into more of a rant, that I really resent the antagonistic position society seems to have taken with their doctors. There are double standards. People want the autonomy to make their own informed decision (which I think is good), but then fail to do the background research, and usually don't take responsibility for the outcomes of their decisions. It is no wonder that the medical profession is increasingly guided by legalities.
Everybody wants a natural labour (whatever that means), but can't consider for an instant that their pregnancy may not be going 100% smoothly. I don't understand why people who insist on doing their own thing their own way even bother seeking out medical attention.
I do applaud you for seeking out answers to your question, and hope that you've checked out some of the links people have provided. It is true thta PIH is the leading cause of maternal death world wide and there is tons of ongoing research. You should do whatever research you need to make yourself feel comfortable with your decision, but unless you are going to become an expert on the issue, you are going to have to trust you OBs on some level.
posted by commissioner12 at 10:03 AM on September 19, 2006 [4 favorites]
Response by poster: Thank you all very much. Outside of what this has meant personally, this has been a fascinating conversation about the nature of medicine in society. It would seem that some genuinely caring doctors do get a bad rap from ill-informed controlling patients with just a dangerous bit of knowledge and some hoity-toity ones condescend to their patients and fail to make the time for the issues beyond the clinical ones. They're all human, right?
Just to let you all know, I took the most basic advice I got from this thread and spoke with a high-risk specialist OB this morning who basically took the time to explain things to me along the same as commisioner12's thorough description (which, after 2 weeks of researching online, was not clear from my own internet research), in a way that my regular OBs have failed to articulate meaningfully. Funnily enough, I randomly ran into my Lamaze teacher, too, who confirmed all that, too. So, now, finally, I get it: if going to term is potentially harmful to my kid (who is thriving, if today's ultrasoud is any indication), I'm out. Cool. I had been looking forward to seeing what my body could do on its own, but that's not the point of having a kid, I'm not slavishly attached to the notion.
I'm thinking, though, that #2 will be an adoption!
posted by DenOfSizer at 2:42 PM on September 19, 2006
Just to let you all know, I took the most basic advice I got from this thread and spoke with a high-risk specialist OB this morning who basically took the time to explain things to me along the same as commisioner12's thorough description (which, after 2 weeks of researching online, was not clear from my own internet research), in a way that my regular OBs have failed to articulate meaningfully. Funnily enough, I randomly ran into my Lamaze teacher, too, who confirmed all that, too. So, now, finally, I get it: if going to term is potentially harmful to my kid (who is thriving, if today's ultrasoud is any indication), I'm out. Cool. I had been looking forward to seeing what my body could do on its own, but that's not the point of having a kid, I'm not slavishly attached to the notion.
I'm thinking, though, that #2 will be an adoption!
posted by DenOfSizer at 2:42 PM on September 19, 2006
Oh, and we want updates! Okay I want updates.
And on the off chance you check back in, ikkyu2, I'm sorry I assumed you were jumping down DenOfSizer's throat, I hadn't carefully read the prior responses in the thread. It's like we want to believe the worst of people sometimes, hmm? (Sigh).
posted by nanojath at 10:05 PM on September 19, 2006
And on the off chance you check back in, ikkyu2, I'm sorry I assumed you were jumping down DenOfSizer's throat, I hadn't carefully read the prior responses in the thread. It's like we want to believe the worst of people sometimes, hmm? (Sigh).
posted by nanojath at 10:05 PM on September 19, 2006
Oh and a previous C section does NOT mean you will not have a normal delivery on No. 2! Hopefully you will not have these symptoms again. But you know, whatever delivery you have, we're dying to find out how it went for you because this really is a community!
Please do update us with your news!
posted by Wilder at 4:33 PM on September 20, 2006
Please do update us with your news!
posted by Wilder at 4:33 PM on September 20, 2006
This thread is closed to new comments.
posted by frogan at 1:37 PM on September 18, 2006