slight pressure increase, midwife recs transfer?

[expert@preeclampsia.org]

hello, i am new to your forum. i just want to thank you for making this available and helping so many people.

my question is this; i have a midwife and have planned a home birth. over the last month and a half some issues have come up between us and i feel she is unhappy and not comfortable with me anymore.
all of my tests have been great all along and i have been very healthy throughout the pregnancy.
my bl pressure was last recorded a week ago after discussing some stressful events in my life and some crying.. it was 138/80. i have no other symptoms, no protein in the urine, only a small amount of swelling in the ankles, which go away when i rest.the baby is very active and growing and doing very well.
i am due within 5 days. this week i was not able to go to my appointment due to illness, and now my midwife says that because i didnt come in she is not comfortable being here for the birth. she is now claiming i may have pre eclampsia and she will not deliver at home, when there is no actual evidence to claim this.

i felt that she is covering up for some thing else, and after reading the forum, where people have very elevated levels and symptoms i feel her "concern" at the last minute is completely unfounded.

what would you suggest at this point? does it sound like she has reason to claim any of these things. i am very stressed at this point, for now it appears i have to find a new midwife days before i am to give birth. thanks so much, i am sure this is probably a bizarre question, but i figured since you have so much experience regarding this syndrome, you would be able to give me some good insight.

[expert@preeclampsia.org]

I successfully advocated for a midwifery practice at our University practice and initiated a program to welcome women to our obstetrical facility who had been planning an out of hospital birth but developed complications. We hope to be able to continue to help these women meet as many of their birth objectives as possible while safely addressing their complications.

The issue of triaging candidates for the appropriateness is critical to achieving relative safety in of out of hospital birth. Over the last decade, our community of providers has evolved to a more conservative position regarding who should deliver out of hospital. I think they are motivated to best serve all of their clients. A single complicated birth impacts not only the woman affected but also other women. The time commitment to achieve a safe transfer of care is extraordinary. Bad outcomes out of hospital negatively impact relationships for referral and the practice of all providers. As providers matures in experience, they come to value the routine birth experience much more than extending the experience to higher risk women.

That said, I cannot evaluate all of the factors involved in your midwife's decision. Your BP of 130/80 is not sufficiently high to qualify for the diagnosis of preeclampsia. It clearly qualifies as a risk for developing preeclampsia. In labor, there is a relatively high probability that you will have BP's greater than 140/90. I suspect that this is the threshold (short of full blown preeclampsia) is the midwife's criteria for an intrapartum transfer. If that is the case, she is trying to let you get aligned with a sympathetic in hospital birth attendant prior to labor. She is trying to avoid the difficult process of intrapartum referral.

It is your midwife's job to "look into her crystal ball" and accurately see your future. She cannot, for many reasons, allow herself to make a mistake and have you out of hospital with a serious complication. Her "crystal ball" is not very good. Therefore, she is making a conservative decision. I would encourage you to value her judgement and ask her to recommend a provider in the community who will work to address your concerns in the hospital.