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Won't induce yet, though I'm 37w+

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Won't induce yet, though I'm 37w+

Postby kaxy » Mon Sep 23, 2013 02:18 pm

by kaxy (98 Posts), Mon Sep 23, 2013 02:18 pm

I mentioned this in another thread but I thought I'd start another here, too.

I'm 37w3d and my appointment today went well. Good BP at the OB (like 117/70s!) but this is on labetelol. No protein in the dip. Reassuring NST. No swelling. Just the dull headache.

I found out from the other OB that the hospital really is pushing against inductions prior to 39w unless mom or baby are seriously ill. So I guess I have to get really sick first? That part sucks hard. Maybe I *do* have some time yet before I get way sick, or before my baby starts to feel the effects. It just stinks that HYPITAT isn't swaying them. And heck this study suggests 38w should be a max point, right? http://www.ncbi.nlm.nih.gov/pubmed/21054760

Part of me doesn't want to induce yet, because I'm still early term. And of course, I don't want to push the baby out too soon and then have her develop problems because of that. But I'd rather have some NICU time than a stillborn baby, ya know? And at this point, I am not super ill. I'm fine on BP meds. My baby is fine. So...is this the right call, to just keep going?

I'm just frustrated and worried and I don't feel like there's anything I can really do about it.

I go back on Thursday for another NST and appointment. I will ask the OB to strip my membranes I think.

What else do I do with this?
DS born Dec. 2008 at 38.5w gestation. Mild PE diagnosed 3 hours before he was born
DD born Dec. 2010 at 40w1d. BP was slightly elevated since 37w, and climbed while in labor (started on my own). Severe PE diagnosed hours after DD born.
DD born Sept. 2013 at 38w. Induced (and I had to fight for it!) due to high blood pressure. No protein, but had brisk reflexes and clonus after delivery. Doc gave me a mild preeclampsia diagnosis anyway and said I'm likely to be a chronic hypertensive later in life.
kaxy
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Re: Won't induce yet, though I'm 37w+

Postby kaxy » Mon Sep 23, 2013 04:22 pm

by kaxy (98 Posts), Mon Sep 23, 2013 04:22 pm

I just got some fantastic resources from Caryn via Twitter, and I thought I'd post them here for archive's sake. This could be some other mama later!

- ACOG recommendation from April 2013: http://www.acog.org/Resources%20And%20P ... eries.aspx or
http://www.acog.org/~/media/Committee%2 ... 1639583723

- http://www.cdph.ca.gov/programs/mcah/Do ... veries.pdf

- http://www.obgmanagement.com/index.php? ... da03e20e36

- of course HYPITAT http://www.thelancet.com/journals/lance ... 40-6736(09)60736-4/abstract

- and for chronic hypertensives http://www.ncbi.nlm.nih.gov/pubmed/21054760

I plan to print this stuff out and just make my case for inducing already. Though of course if anything changes with me in the slightest, I'm getting my rear to labor & delivery without second thought. And hopefully I'll just go into labor asap anyway. UGHGHG.
DS born Dec. 2008 at 38.5w gestation. Mild PE diagnosed 3 hours before he was born
DD born Dec. 2010 at 40w1d. BP was slightly elevated since 37w, and climbed while in labor (started on my own). Severe PE diagnosed hours after DD born.
DD born Sept. 2013 at 38w. Induced (and I had to fight for it!) due to high blood pressure. No protein, but had brisk reflexes and clonus after delivery. Doc gave me a mild preeclampsia diagnosis anyway and said I'm likely to be a chronic hypertensive later in life.
kaxy
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Posts: 98
Joined: Tue Jun 28, 2011 03:56 am

Re: Won't induce yet, though I'm 37w+

Postby sam10 » Mon Sep 23, 2013 07:29 pm

by sam10 (1436 Posts), Mon Sep 23, 2013 07:29 pm

ugh....
I am sorry you are left in this limbo kind of situation where you feel you need to get sick first before anything happens that could be avoided. The timing of delivery is a balancing act and has been a topic of discussion amongst professionals and hospitals. Unfortunately, there is no standard that is mandatory across hospitals.
The good thing is that your BP seems under control. Very good idea to print it out all the materials and bring along to show your doctor if need be. Fingers crossed the babe will decide to make its entrance soon.
Thank you for posting these links. They are helpful to have on hand.
Please keep us updated as you are able.
~Julija (40)
MC 3/2009 and 3/2011
Henry (1/1/2010-1/7/2010) - forever loved and missed; severe PE with Hellp; partial placental abruption, classical c-section at 25.6 weeks
Matilda (Nov. 2012, born at 35.4 weeks) - severe PE


Our pain has been put into words, placed into empty cradles, to remember that all our babies lived, that they mattered and always will. - Field of Cradles http://www.fieldofcradles.org/
sam10
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Re: Won't induce yet, though I'm 37w+

Postby kaxy » Mon Sep 23, 2013 08:50 pm

by kaxy (98 Posts), Mon Sep 23, 2013 08:50 pm

Here's another helpful reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160133/

I am having some really minor but frequent braxton-hicks. So hoping they turn into something! Not likely but hey, I can hope :).
DS born Dec. 2008 at 38.5w gestation. Mild PE diagnosed 3 hours before he was born
DD born Dec. 2010 at 40w1d. BP was slightly elevated since 37w, and climbed while in labor (started on my own). Severe PE diagnosed hours after DD born.
DD born Sept. 2013 at 38w. Induced (and I had to fight for it!) due to high blood pressure. No protein, but had brisk reflexes and clonus after delivery. Doc gave me a mild preeclampsia diagnosis anyway and said I'm likely to be a chronic hypertensive later in life.
kaxy
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Posts: 98
Joined: Tue Jun 28, 2011 03:56 am

Re: Won't induce yet, though I'm 37w+

Postby kaxy » Wed Sep 25, 2013 04:08 am

by kaxy (98 Posts), Wed Sep 25, 2013 04:08 am

Ugggh. Earlier tonight my bp was up. I was getting 142/104. Stayed up, so I called and my main ob wasn't on call, it was the one I saw on Monday. She wanted me to give my bp meds more time to work, as it had only been half hour since I took my dose. Told me to try to go to bed and if I was awake, to take it in an hour and call back if it's higher than 140/100. What. How is 100 now ok?

An hour later, it was still high Imo, 140/96. I didn't bother calling since I didn't think the ob would care. Also, my headache did go away with two extra strength Tylenol.

I just am frustrated and stressed by this. Why is it okay for me to keep plodding along, waiting to get really sick? I am now 37w 5 days.

My main ob is off on Wednesdays I think. That other ob seems to not be concerned about my pressures or history.

I just don't know what I do with this. Just go to l and d if it gets high on Wednesday? Talk with the ob on the floor? Do they try not to step on the other OBs toes?

I don't like confrontation. I also don't like being a ticking time bomb. ACOG says induce at 37w. Why am I still pregnant?
DS born Dec. 2008 at 38.5w gestation. Mild PE diagnosed 3 hours before he was born
DD born Dec. 2010 at 40w1d. BP was slightly elevated since 37w, and climbed while in labor (started on my own). Severe PE diagnosed hours after DD born.
DD born Sept. 2013 at 38w. Induced (and I had to fight for it!) due to high blood pressure. No protein, but had brisk reflexes and clonus after delivery. Doc gave me a mild preeclampsia diagnosis anyway and said I'm likely to be a chronic hypertensive later in life.
kaxy
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Posts: 98
Joined: Tue Jun 28, 2011 03:56 am

Re: Won't induce yet, though I'm 37w+

Postby kaxy » Wed Sep 25, 2013 01:05 pm

by kaxy (98 Posts), Wed Sep 25, 2013 01:05 pm

Woke up this morning to decent BPs. Then this afternoon when I checked it, I had a 140/99. Sat down, drank some water, checked again and it was 130s/95, so still high but not terribly much. I called my OB and she had me take another 100mg of labetelol now (I took 150mg this morning) and she'll have me take 200mg tonight.

I'm now to call if I have readings of 160/100. Sheesh.

My next appointment is tomorrow morning. Hopefully my body chills out until then anyway. And hopefully tomorrow it won't be a battle to convince her to induce me.

Because come ON, are we just waiting for me to have way high BPs now?!
DS born Dec. 2008 at 38.5w gestation. Mild PE diagnosed 3 hours before he was born
DD born Dec. 2010 at 40w1d. BP was slightly elevated since 37w, and climbed while in labor (started on my own). Severe PE diagnosed hours after DD born.
DD born Sept. 2013 at 38w. Induced (and I had to fight for it!) due to high blood pressure. No protein, but had brisk reflexes and clonus after delivery. Doc gave me a mild preeclampsia diagnosis anyway and said I'm likely to be a chronic hypertensive later in life.
kaxy
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Posts: 98
Joined: Tue Jun 28, 2011 03:56 am

Re: Won't induce yet, though I'm 37w+

Postby sam10 » Wed Sep 25, 2013 02:37 pm

by sam10 (1436 Posts), Wed Sep 25, 2013 02:37 pm

these pressures make me nervous, especially since you are medicated. I would go to L&D directly if your BP goes that high again. once you are there it is harder for the doctor to ignore you, and if they send you home with pressures that high, ask to have a written copy of that decision.
I know it is not fun to be confrontational, but sometimes we need to put our foot down. Are you being seen by an MFM?
~Julija (40)
MC 3/2009 and 3/2011
Henry (1/1/2010-1/7/2010) - forever loved and missed; severe PE with Hellp; partial placental abruption, classical c-section at 25.6 weeks
Matilda (Nov. 2012, born at 35.4 weeks) - severe PE


Our pain has been put into words, placed into empty cradles, to remember that all our babies lived, that they mattered and always will. - Field of Cradles http://www.fieldofcradles.org/
sam10
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Posts: 1436
Joined: Sat Feb 20, 2010 12:04 am
Location: Boston, MA

Re: Won't induce yet, though I'm 37w+

Postby angieb » Wed Sep 25, 2013 02:39 pm

by angieb (1192 Posts), Wed Sep 25, 2013 02:39 pm

Honestly, I would start getting witchy with them.

Possible ideas:
Go to L&D every time it's high, do not bother calling them
Show them the research
Tell them to write in your chart that you have requested to be induced due to your high pressures, per ACOG recs, and they are refusing...
Switch ob's or go to another hospital

So frustrating and ridiculous. Good luck.
Me (29) DH (30)
#1-Olivia Caetlyn-9-28-09-9-28-09, 23+2 wks, emergency classic c-section, class I HELLP, IUGR
#2- Lucas Oliver (rainbow baby)- April 2011, 36+2 wks, HELLP and pre-e free! (lovenox and LDA pregnancy)
#3-Matthew, late October 2012...mostly normal, 37 wks, (lovenox and LDA again)
My blog: http://www.butterflies-and-rainbows.blogspot.com/
angieb
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Re: Won't induce yet, though I'm 37w+

Postby kaxy » Wed Sep 25, 2013 03:09 pm

by kaxy (98 Posts), Wed Sep 25, 2013 03:09 pm

I don't have a MFM but if I get resistance at my appointment tomorrow for induction, I will need to track one down and get a consult that day.

The hospital of choice is supposed to be a good one for birth -- it's "Baby Friendly" and has a level 3 NICU with a level 4 next door or something? And it's where high-risk moms would likely transfer to, from a smaller less-equipped hospital. So I'm really confused at the push back.

I still don't technically know if I have preeclampsia or "just" gestational hypertension at this point. They are only doing protein dips, despite me asking about 24 hour urine catches. I had a protein : creatine ratio done a few weeks ago when I was at L&D and that was it, aside from a 24h urine waaay early in my pregnancy.

If it is still gestational hypertension, then am I reading the ACOG recommendations right when it gives a range of 37w-38w6d? http://www.acog.org/~/media/Committee%2 ... 1639583723

I can see them pointing to that and saying see, we have another week?
DS born Dec. 2008 at 38.5w gestation. Mild PE diagnosed 3 hours before he was born
DD born Dec. 2010 at 40w1d. BP was slightly elevated since 37w, and climbed while in labor (started on my own). Severe PE diagnosed hours after DD born.
DD born Sept. 2013 at 38w. Induced (and I had to fight for it!) due to high blood pressure. No protein, but had brisk reflexes and clonus after delivery. Doc gave me a mild preeclampsia diagnosis anyway and said I'm likely to be a chronic hypertensive later in life.
kaxy
Registered User
 
Posts: 98
Joined: Tue Jun 28, 2011 03:56 am

Re: Won't induce yet, though I'm 37w+

Postby sam10 » Wed Sep 25, 2013 06:16 pm

by sam10 (1436 Posts), Wed Sep 25, 2013 06:16 pm

Oh, I would insist being seen by an MFM. Especially with your history. I am surprised your OB did not recommend that.
For a proper diagnosis, you need a 24-hour urine catch. I am not sure why your doctor would resist.
~Julija (40)
MC 3/2009 and 3/2011
Henry (1/1/2010-1/7/2010) - forever loved and missed; severe PE with Hellp; partial placental abruption, classical c-section at 25.6 weeks
Matilda (Nov. 2012, born at 35.4 weeks) - severe PE


Our pain has been put into words, placed into empty cradles, to remember that all our babies lived, that they mattered and always will. - Field of Cradles http://www.fieldofcradles.org/
sam10
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Posts: 1436
Joined: Sat Feb 20, 2010 12:04 am
Location: Boston, MA

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