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Repeat cesarean due to 130/100 blood pressure?

Update 2/16/12:  I’m very happy to announce that Momtobeagain had a VBAC this morning!  Here are the details she left on this comment:

hi Jen,

I’m in the hospital right now and still in recovery(typing in one hand). just want to inform you that I had a successful VBAC with a very healthy baby girl!!! had it not been coz of all the resources I read here, i would have not known that vbac is possible. after all the scare tactics my OB told me, I still managed to achieve my goal coz I am well informed becoz of your site. thank u sooo much!

details:
- Bloody show at feb 15 @7:30am but did not go to hospital yet like what my OB told me. I tried laboring at home as long as I can. I got admitted 6cm already which was the next day Feb 16 @2:30am when my contractions are 5mins apart.
- they augmented my labor with oxytocin coz contractions stopped when I had the epidural which I refused but they won’t listen and my dilation got stuck at 6cm for almost 2 hrs.
- they gave me more epidural which I refused but gave me anyway(I was glad I had it or I would have quit, the pain was unbearable when I was 7cm, I almost wanted to faint). My wateer broke at 7cm, just few minutes after baby was out
-They transferred me to delivery room at 8:05 am
-I was pushing but can’t feel a thing but it took me just 5 pushes and baby girl was out @ 8:32 AM feb 16!!

-got a tear and is painful right now, I asked OB not to cut me and just let it tear naturally but I think she still did.

btw my baby was 6.13 lbs but I had a very big tummy which everyone assured me I can’t get it out coz it is big baby. well ha! they’re all wrong.

____________________________________

Momtobeagain left this comment on the article Another VBAC Consult Misinforms:

Hi Jen, me again.  I will be due next week feb 14 but Ob is now trying to convince me to CS.  I do have hi blood pressure of 130/100 and yesterday she was convincing me to have a CS asap this week and I said no.  But my husband is trying to convince me too and do not want to put baby in risk.  I am very confused. I already am under medication to lower my BP and it is now back to normal 110/80.  If my BP rises to 130/100, is it advisable already to give in to CS? she mentioned about pre-eclampsia, fetal distress etc, not to mention I was CS before.  In short, so many reasons for her to CS me and it is now me against everyone.  would not want to end up with stillbirth baby, high hospital bill and blame is all on me.  I am not sure If I still am being reasonable.  The nearer my due date is, the more my vbac goal is getting blurred.  thanks -momtobeagain

Momtobeagain,

For the benefit of my readers, I want to provide the Mayo Clinic’s (2011) definition and symptoms of pre-eclampsia before I address your question:

Preeclampsia is defined as high blood pressure and excess protein in the urine after 20 weeks of pregnancy in a woman who previously had normal blood pressure. Even a slight increase in blood pressure may be a sign of preeclampsia. Left untreated, preeclampsia can lead to serious — even fatal — complications for both you and your baby.

If you have preeclampsia, the only cure is delivery of your baby.

Preeclampsia can develop gradually but often starts abruptly, after 20 weeks of pregnancy. Preeclampsia may range from mild to severe. If your blood pressure was normal before your pregnancy, signs and symptoms of preeclampsia may include:

  • High blood pressure (hypertension) — 140/90 millimeters of mercury (mm Hg) or greater — documented on two occasions, at least six hours but no more than seven days apart
  • Excess protein in your urine (proteinuria)
  • Severe headaches
  • Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
  • Upper abdominal pain, usually under your ribs on the right side
  • Nausea or vomiting
  • Dizziness
  • Decreased urine output
  • Sudden weight gain, typically more than 2 pounds (0.9 kilogram) a week

Swelling (edema), particularly in your face and hands, often accompanies preeclampsia. Swelling isn’t considered a reliable sign of preeclampsia, however, because it also occurs in many normal pregnancies.

Regretfully, I am not a medical professional of any kind so I am unqualified to advise you.  I did post your question on Facebook and got many responses, several of which I’ll share below.

Two VBAC supportive OBs left these comments on my Jen vbacfacts Kamel profile:

Jen, High BP alone is not a reason to have a c/section.  It is, however, at term, a reason to consider delivering the baby as the treatment for high BP is medication, rest, diet changes and such but the cure for pregnancy induced hypertension is delivery.  So, if we are talking delivery then we are left with repeat c/section or induction.  According to ACOG, prior low transverse c/section is not a contraindication to induction (other than the use of misoprostol [Cytotec]) so a foley balloon or pitocin may be used safely in these women.  The problem arises when a practitioner does not believe in doing inductions on women with prior c/section.  Despite the evidence and the ACOG clinical guideline the reality is that many doctors will just not want to deal with it.  In your client’s case that may be what is going on here and therefore her choices may be limited as finding another practitioner at this time is nearly impossible. She could refuse and wait for labor but that would be unadvisable with the little I know from the narrative above.  Plus, that would make her labor in a less than nurturing environment.  Tough problem if her doctor will not induce.

and…

Hi Jen, I would have to agree with Dr. F.  Our hospital is only willing to do inductions on women with a prior c/s if they have had a prior vaginal birth.  I guess there would be more to know….Gravidy, Parity, cervical exam, etc.  She is in a sticky situation, as is her obstetrician.

A CNM (certified nurse midwife) left this comment over on the Midwifery Today page including many questions you can ask your OB:

BP is one thing, but what is the level of proteinuria and other labs?  Is there a diagnosis of severe preeclampsia?  Is she symptomatic?  What is status of baby?  Is there a medical need to get delivered asap? Is cervix favorable?  Sorry, there are many variables that need to be answered.  No matter the route of delivery remember what is most important is to have a healthy mom and baby by means of the safest route of delivery even of it means a repeat c/s.
More comments were left on the www.vbacfacts.com Facebook page including this one from a mom:
this happened to me.  I ended up giving into a c-section, but I knew it was no other option.  My blood pressure was normal laying down, so they kept me on bed rest.  However eventually even lying down it was around the same as yours.  And I had protein in my urine.  I bought some urine strips to test for sugar in my urine and actually the final straw for me, was when it finally read black (which was not good).  In my heart I want to say keep going, but I also want to say listen to the doctors.  Actually the best advice, I can give is really just think what would be best without letting any outside thoughts sway that decision.  But if she mentioned pre-e?  did they do a 24 hour urine test on you?  If not, do you have protein in your urine?  I was also told if I was dilated to at least a 2 or 3 they could sit down and explain the risk of doing an augmented induction.  your risk for uterine rupture go up but I believe only slightly.  I wouldn’t give up on your goal.  And again is it high laying down…..I think that is important factor….mine was high standing, sitting but as soon as I laid down, it was normal…until about the day, we gave in….but at that point, it became clear to me and my hubby that it was the right decision to do a repeat c-section…..it wasn’t easy for us to decide that.  we both wanted the dream of a vbac.  I know one day, I’ll have it.  I’m not giving up on that goal. :)
Another women, who sounds like a midwife, left this comment:
I had a client with chronic hypertension in August, who was a primary vbac, planning a hb.  We made it to 40 wks with medication, but bp was continuing to be high w terrible headaches, etc. no protein.  We scheduled a “gentle” pitocin induction with the back up hospital.  No reason to jump right to a c/s if you have a physician who will induce a vbac with a slow, no hurry, take your time pitocin induction.  Through labor (medicated for hypertension) her bp still went up to high 180s/ 115+ and they just kept a close eye on her and let her keep going.  She had a successful induction and was thrilled to get her vbac.
A doula said this:
Most doctors around here don’t do anything until bp is 150/110 and that is only one symptom. If you aren’t suffering in other ways (protein in urine, uric acid, liver enzymes, swelling, sudden weight gain, head aches, etc) then I would stay on track. As a Doula I’ve worked with quite a few preE moms lately. If it were me, knowing what I know, I would start rippening my cervix and plan for my vaginal, spontaneous delivery. Your bp sounds controlled.

You are in a hard spot.  It’s hard to know if your OB is truly supportive of VBAC and your high blood pressure together with other symptoms are pointing towards an immediate birth either by repeat cesarean or by “gentle” induction with Pitocin and/or a foley catheter or if they are simply using your high blood pressure as a convenient excuse to perform a repeat cesarean.  If your OB is unsupportive of VBAC, it can be hard to determine where their desire to eliminate the option of VBAC ends and the need for a medically necessary induction or surgery begins.

But, it is possible for your OB to be unsupportive of VBAC and you still require a medically necessary cesarean.

You can also learn more about pre-eclampsia at the Mayo Clinic and the Pre-Eclampsia Foundation.

I wish you the best and hope everything turns out well!

Warmly,

Jen

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7 comments to Repeat cesarean due to 130/100 blood pressure?

  • momtobeagain

    Hi Jen,

    Thank you for the prompt reply and all the replies I have read above. I had urinalysis that day and did not know that it was needed for them to know if I am a candidate of preeclampsia and repeat cs or I can still pursue my goal of vbac.

    here is my urinalysis output:

    Color – lt. yellow
    Transparency – slightly turbid
    reaction – acidic
    sp. gravity – 1.010
    protein – negative
    glocuse- negative
    pus cells – 2-7
    rbc – 1-2/hpf
    epithelial cells – moderate
    amorphous urates – some

    During my check up Ob said my baby’s heart is still okay but my cervix is not yet ‘open’ and she claims it is small and worries that if I TOLAC, I would still end up in CS so might as well CS is this week which I declined.

    I just had my BP taken few secs ago and it is 100/80 and I have not taken my meds yet but will take it until nxt week as adv by OB. I have already started my no-salt diet 2 days ago to make sure I maintain a good bp.

    My husband and I talked it over and he gave me ultimatum that if my BP rises again on my due date(which is also my next checkup), I will agree to CS if OB advise it(sure she will duh!) but if my BP is maintained to normal, I will TOLAC and push thru vbac and he also agreed.

    Thanks a lot for the support here.
    -momtobeagain

    • Jen Kamel

      Momtobeagain,

      The fact that there is no protein in your urine is excellent! As to the other readings, I don’t know if they have any significance, but I’ll share it with people who would know!

      Warmly,

      Jen

  • Jillian

    Gentle pitocin in one of the comments might be a really good choice. No misoprostol or cervadil though. Good luck Mom and babe

  • I just wanted to respond here to momtobeagain’s mention of going on a no-salt diet, in case there are other pregnant women reading this that have high blood pressure or pre-eclampsia. Restricting your salt intake during pregnancy, especially if you are already having worrisome blood pressure readings, is a dangerous idea. Your body is physiologically different during pregnancy and your body needs to be getting enough salt and other minerals to be able to support the increase in blood volume that happens while you are pregnant. If you have blood pressure that is already climbing, then restricting your salt intake (or attempting to cut salt out completely) could ultimately be what pushes you over the line from having high blood pressure to having full blown pre-eclampsia (and compromised liver and kidney function). Please please ask your midwife or doctor about this before you decide to restrict your salt intake.

    -Becky, Student midwife and a woman who had mild pre-eclampsia and did loads and loads of research!

    • momtobeagain

      Hi Becky, I am not sure if it was a bad idea but that was the advice of my ob gyne at that time. I also googled a lot and all research articles are saying the same thing, to limit your salt intake. I only had 1 week to do that so I opted for a meals that are saltless. Nonetheless, It was effective. My hi-blood went down to normal. But anyway, I am not a doctor so to whoever may read this, try to consult with your doctor first. thanks.

  • mometobeagain

    Hello Jen, I am back again. I am expecting again due this JUne 2013..I got pregnant 6 months after my VBAC last feb 2012. I know right? I am again planning on doing VBAC, hopefully. So far, I am polyhdramnios 21, 23 and 21 cm for the last 3 consecutive ultrasound and still under going a lot f lab exams coz my OB is not sure why I am ployhydramnios when I am not diabetic, I took 2 lab tests for that too and resulted to negative.. My baby measurement is also 2 weeks behind her age. I just had my Congenital scan today and will be able to get result after 2 days. I am not sure what to expect. Hopefully, nothing complicated not to have another VBAC. :)

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