Making the call to deliver baby?

This section is for discussions with other women who have probably been through the same signs/symptoms that you may be experiencing. Please note, we cannot offer medical advice and encourage members to discuss their concerns with their doctors. New members, come on in and introduce yourself!
MaisiesMama
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Re: Making the call to deliver baby?

Postby MaisiesMama » Sun Feb 28, 639560 4:27 am

Mom29 - Wow, our little ones were close! I'm so glad to hear that your daughter is doing well :) My daughter weighed 3 lbs. 14 oz. She did really well, but we still had a 6 week NICU stay. She is now almost 17 months and is simply amazing. She is walking and climbing and talking, and tall for her age! But getting to where we are today didn't happen without a lot of fear and stress and work. It's true that it's a whole different ball game, having a preemie. People tend to think that "preemie issues" are over once you bring your little one home from the NICU, but as we know, it is a very different road for those of us with early babies.

I also know what you mean about having to wrap your head around delivering your baby "now". Even though I knew delivery was imminent, somehow it never actually seemed real... not until I came off of the mag anyway.
Mommy to Maisie, born 7.5 weeks early due to preeclampsia.

eliz_82
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Re: Making the call to deliver baby?

Postby eliz_82 » Fri Nov 29, 639557 6:09 am

With mny first child I developed pe at 26 weeks, but my DR was old fashioned and ignored all of my symptons until my kidneys shut down at 36 weeks. He was delivered the next day weighing 6lbs 5oz. My 2nd son I was monitored so closely by of course a differnt OB/GYN and a MFM. At 27 weeks I started having 2 bpp and nonstress tests a week. I was given steriod injections at the end of 33rd week. He was delivered at 34 weeks weighing 4lbs7oz. The day he was delivered my bp was 190/118. We were so thankful for our awesome drm

mom29
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Re: Making the call to deliver baby?

Postby mom29 » Thu Nov 07, 639557 8:50 am

My situation was similar to yours. I delivered at 33 weeks when I was admitted for the third time.

First time my bp was 190/100 at home, 172/99 on admission, and the spot protein check was 463. The 24 protein results were only 270. I was given mag., reglan for the headache, and steroid shots for a possible early delivery. When the headache stopped and my bp normalized I was allowed to go home on a doubled dose of labetalol.

Second admission 10 days later my bp was running 160's/100 despite the increased labetalol dose and I had a headache. I was given an extra 200 mg. of labetalol at admission, PET labs done at admission and six hours later showed mild pre-e. Bp normalized overnight, headache resolved, and I was allowed to go home to finish the 24 protein.

Third admission was five days later when my bp was 181/105 at home. This time mfm said they were going to take 24 to 48 hours to determine if it was worsening pre-eclampsia or my cht. That would determine if I was going to stay on bedrest at home or in the hospital for awhile or if I was going to deliver. I got my regular dose of labetalol and my bp remained elevated during the night. In the morning he came in and said I was having my baby that day. Apparently the spot protein check they did while the 24 hour protein test was being collected came up at 500. I had to wrap my brain around having my baby *now* instead of having at least 24 hours before a decision was made.

I had it in mind that I was going to get to my next nst and ultrasound before delivering, but I delivered the day before I was scheduled to have them. It felt very weird to have delivered early even though he told me at the first admission that we were now on a day to day basis and he wasn't making any predictions of when I would deliver. He did want to try to get me to 32 weeks though. Because I am an older mom and I have diabetes he was more inclined to deliver before things started getting really bad.

To this day I wonder if I could have gone at least until the nst & ultrasound if I hadn't called him when my bp was elevated again. I had taken a long restful nap that afternoon and it spooked me that it was so high after sleeping for a few hours.

My baby was 3 lbs. 15 oz. and now at almost six months she is 11+ pounds. She has done well, but it has been a whole different ball game having a preemie! How much did your baby weigh and how is she doing now?

MaisiesMama
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Re: Making the call to deliver baby?

Postby MaisiesMama » Thu Oct 24, 639557 2:53 pm

Thank you ladies so much for your thoughtful replies. If only we had a diagnostic test! When I was admitted to the hospital, the MFM thought I would make it another 7-10 days, which meant the world at 32.5 weeks (I ended up delivering the following evening). Either way, there was no way I was leaving that hospital pregnant. In my heart, I really felt that the headache was due to the mag, but I guess it just wasn't a gamble I was willing to take. I was incredibly afraid of the situation becoming grave and having to go under general anesthesia for a c-section. I think in my situation, delivery may have been easier to swallow at the time if my doctor had said "we have to deliver your baby NOW." But he didn't. Not that I wouldn't have ended up questioning things anyway. Trish and Lauren - you're right! So much seems to depend on the individual doctor.

Amjon, I am so sorry you lost your daughter to this horrible disease. And your story provides an important perspective on this question.

Trish, thank you for digging up those other threads! It's so odd how we get these ideas in our heads of how things should be - like how you just wanted to be home and normal for Christmas, and then how we stick to them! The night I ended up in the hospital, I was in complete denial. A hysterical mess and refusing to go to the hospital because I *knew* what was going to happen and I just did not want to have to give birth so early. Thank goodness for my husband stepping in!

Lauren, I had a lot of the same questions about how things might have played out if a different doctor had been on call. I was started on mag by the doctor who came on in the morning, and then the evening doctor actually said he would not have put me on the mag! Hard to have confidence in anyone...

Caryn, thanks for clarifying the medical/science end of it. That makes perfect sense.

Thanks all around ladies. I've been poking around these boards for the last 14 months or so, and just finally decided to actually sign up. Your comments have all given me something to think about as my hubs and I plan for the future. :)
Mommy to Maisie, born 7.5 weeks early due to preeclampsia.

amjon
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Re: Making the call to deliver baby?

Postby amjon » Mon Oct 14, 639557 11:58 pm

I would want to deliver if there was ANY sign of pre-e. I was sent to be evaluated at 26+1 and sent home (borderline readings, small amounts of protein at MW, none at hospital) and she died at 26+5, so if the doctor says to get the baby out I'm going to 100% agree.
ImageImage

MomTimesThree
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Re: Making the call to deliver baby?

Postby MomTimesThree » Thu Oct 03, 639557 4:20 pm

We were hospitalized with pressures and protein similar to yours at 36 weeks... no headache though and were "allowed" to stay pregnant until 36w6d when my bp spiked again to the 170s and we were induced and delivered at 37 weeks.

It does seem that what a doctor is most comfortable with plays a lot into what happens, as well as their personal history with you as well as your medical history. I've been on mag sulfate twice, once to try to stop PTL and the second while we were being induced because of pre-e. Both times it gave me nasty headaches... on top of the general blah that it makes you feel.

I often go back and question a lot about my care... about why one decision was made and wonder about how different a decision would have been if a different doctor had seen me that day. While there is a lot of science involved, it sure isn't perfect, leaving us with so many unanswered questions. I hope as you wade through your records and discuss your situation you find peace with the decisions made.

Lauren
2008-Our Baby Girl, PTL born too early at 30w6d, Fought so hard... Forever Loved & Missed
2010- Lil' Bro, Pre-E at 29 weeks... Induced at 36w6d, Born 37w
2012- Lil' Sis, Super-imposed pre-e at 25 weeks, PTL & GD at 35 weeks, Evicted 36w

trish
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Re: Making the call to deliver baby?

Postby trish » Thu Oct 03, 639557 3:07 pm

It's so hard to know when to make the call and it seems like each Dr. has their own "comfort zone" or guidelines they follow. It sounds like I was delivered for many of the same reasons you were except mine waited until 36 weeks. I went back & looked up some of my old posts (from more than 4 years ago) because I made 2 different trips to L&D *specifically* for headaches on top of high BP (even on BP meds) at 34/35 weeks and I already had 1+ protein.
viewtopic.php?f=12&t=25711&p=279478#p279478

viewtopic.php?f=12&t=25728&p=24532#p24532


As you can see, I got sent home with a shot of Demerol after Tylenol with codeine didn't make the headache go away & I was 2 weeks further along than you! They gave me to choice to stay & see if it went away or take the shot & leave but I was so anxious to get home to my 2 & 4 year olds that I just wanted to leave. Having worked with the PE Foundation for the past 4 years I think/know that was probably a pretty stupid decision! It was the week before Christmas and I just wanted to be home and be normal. I basically just took Tylenol all the time & made it to my amnio appt on Dec 26th. Well I was in bad shape by then with the headache, high BP, 1+ protein (never had a 24 hour test - crazy!) & had 2+ reflexes. We skipped the amnio & started an induction and had my baby just after midnight on the 27th.

I was released with a high BP (which they blamed on me being "stressed" because my baby had to stay). Was back in the ER 4 days PP with a BP of about 180/110 (on BP meds) & a worse headache than I'd had pregnant - they gave me IV morphine & that just took the edge off! Here's that story: viewtopic.php?f=12&t=25855&p=24620#p24620

Anyway, I guess what I'm trying to say is my story is kind of the opposite of yours. I find myself second guessing the decisions that were made NOT to deliver. In hind sight I find myself wishing I had pushed (or had a Dr who pushed) for delivery at 34 weeks when I first started the bad headaches. I feel like I would have been much healthier for it because I spent a year trying tons of BP med combos to try and get my BP under control. I still wonder if all of that could have been avoided by not letting me get so sick.

I hope this helps. (((HUGS)))
Trish: mama to my 3 PE Princesses:
Elizabeth 11/6/03 induced at 37 weeks for PE
Katie 4/13/05 induced at 38 weeks for PE
Allison 12/27/07 induced at 36 weeks for PE then PP PE & BP issues for over a year

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caryn
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Re: Making the call to deliver baby?

Postby caryn » Wed Oct 02, 639557 5:04 pm

You know, I don't think there's a good test to predict who will start seizing or stroking - and that's why they deliver for headache, IIRC. Some researchers are busily looking for good biomarkers for eclampsia, but insofar as stroke is just mechanical and related to pressure, headache is probably the only warning marker that would count, for some cases at least (the ones that are just triggered by the fact of high pressures and not by high pressures plus some other biomarker.)

So even if the tests for HELLP came back cleanly, they'd probably *still* want to deliver anyone with a bad headache if she were already a severe preeclamptic case like you were!
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
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Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

MaisiesMama
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Re: Making the call to deliver baby?

Postby MaisiesMama » Wed Oct 02, 639557 2:59 pm

Thanks for your reply. Yep, I have already had one consult with an MFM from the practice who saw me at the end of my pregnancy. At the time, the deepest I got into this topic was to ask if we would could have done anything differently on that night. He told me no, which was what I expected. As far as I know, they did not run any last minute blood tests, check liver function, or anything like that. I have copies of my medical records and there is nothing in them about any tests. Also, my daughter was doing really well on the inside, at least for the time being. BPP scores of 8/8, reactive throughout all of the fetal monitoring, and on target for growth. I know that even if I might have been stable that night, it could have been a completely different story the next morning. I guess I just wonder if any of those tests (blood tests, etc.) can be run quickly. If a mother has high bp, measurable protein on the low end of the pre-e spectrum, and a headache, would it even make sense to run tests? And I'm curious if there are other women who may have been in a similar situation and how their docs handled it. Going to check out that link now, thanks!
Mommy to Maisie, born 7.5 weeks early due to preeclampsia.

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kerisue
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Re: Making the call to deliver baby?

Postby kerisue » Wed Oct 02, 639557 12:40 pm

I assume you will be consulting with a MFM prior to ttc again. If that's the case, you might ask them what factors they look at when deciding whether to deliver or try to manage preeclampsia and prolong delivery. I don't know that there is one set of guidelines that doctors use when trying to decide this. Here is some information from this website on various organizations and countries' recommendations. http://www.preeclampsia.org/care-providers
As for tests while in the hospital they will often look at fetal indicators- heart rate, growth, fluid levels, etc., and also various tests of you- how your liver is doing, kidney function, platelet function, etc. Did they do any of those tests in your case? Those may have contributed to your doc's decision to deliver.
Mama to Millie
born June 2010 @ 24 wks. gestation due to my severe PE and CHF
lived 25 days, loved and missed


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