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 it 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.