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Induction for Pre Eclampsia
12 replies to this topic
Posted 09 November 2011 - 08:39 PM
Hi all. Just after some advice/ others experiences regards being induced for pre eclampsia.
A little of my story:
As of 36 weeks my BP has decided not to play ball. I rang the hospital last Monday to explain my symptoms of headaches (quite severe at times) with some visual disturbances, bad swelling in my ankles, hands and some to my face and generally feeling unwell. They got me to head in and found my BP was elevated around 145/93 (at worst) and I had a trace of protein in my wee. They agreed the swelling was bad but this is not always an indicator of PE. Had some urgent bloods which came back fine and they sent me home with a follow up with my Ob the next day. I saw my Ob the next day and BP was ok... she ordered some more bloods for the next week and told me to go back to hospital at the end of the week if the headaches were still happening.
On Friday I wasnt feeling right, and the headaches hadnt stopped. My legs and hands were still swollen so I headed back to the hospital for another BP check as instructed. This time my BP was worse (160/110 at worst) and never really went below 140/100 whilst in the examination room. On my CTG bub was quite sleepy and I needed sandwhiches and lemonade and position change to stir bub up. I was admitted for monitoring of BP. Once admitted I was given strong pain killers for my headache and this dropped my BP dramatically to 108/60 however after this it still slowly crept back up. It took two days of bed rest for my BP to come down to an acceptable level (130/80ish). Whilst in hospital there was no protein in my urine at all, however I was told you dont need all the symptoms of pre eclampsia to be diagnosed with it. I was sent home after two nights in hospital with a follow up with my OB, bloods whilst in hospital came back ok).
After having bloods on Monday I went back to my OB. She took my BP and it was back up to 135/95. My blood tests had also slowly been deteriorating (uric acid increasing but not yet elevated). So I am now booked in to have an induction at 39 +2 given I am still symptomatic (still having headaches although not as bad... but taking regular pain relief). OB says given they know how high my BP can get its safer to induce. I really really really didnt want to be induced but I want to do whats safest for my baby. I have read so many horrific stories about the painful labour associated with induction. I was hoping for a natural birth with maybe only gas for pain relief but its sounding less likely. The OB will try two lots of gel... then try to break my waters... then try a catheter insertion. I'm hoping to avoid the drip... but this is first time bub and bub is no where near engaged (-4 at last apt). Anyway I guess I'm just after other peoples experiences with this? Should I try and hold off the induction and just ask to be monitored more closely. I have another CTG, bloods and BP check booked in at the hospital on Friday... if that doesnt go well my OB says they may have to induce then.
Sorry about the long story... I was hoping to avoid intervention as much as possible. Any thoughts or experiences would be great. TIA.
Posted 09 November 2011 - 08:46 PM
Personally I would be listening to your OB. Sounds like she has sat on you for a little while to see if everything was at least stable and not worsening but with your bloods beginning to show signs of pre-eclampsia, she is obviously concerned. She may suggest an epidural in labour too if your BP is high - your BP will be elevated when experiencing pain so if it starts high, it may go higher once you get into established labour. An epidural can be an effective way to try and keep BP at a reasonable level whilst allowing you to labour.
Im not suggesting she will do this however and you can and should definitely sit down and chat things over with her so you know what she is planning on doing etc with your induction. With pre-eclampsia, it can deteriorate rapidly into full blown eclampsia which may cause seizures, strokes among other things. She is trying to get baby delivered before you develop this condition so that you and baby are healthy - pre-eclampsia tends to resolve fairly quickly once baby is born thereby minimising risks to you of seizures etc. An epidural is one way to keep BP lowered during labour.
Good luck with your impending labour and birth.
Posted 09 November 2011 - 08:58 PM
Hi OP, I have no experience or advice to give regarding your situation. All I can do is sympathise. As frustrating as it is to have things not go to plan, I would do as PP suggested and put my faith in the OB. It sounds like she's not making rash decisions, but doing what's best. At the end of the day you just want bubs here safely, so if the birth plan has to be amended (or completely thrown out the window), try not to let it get you down. Healthy baby and mum are the goals. Good luck with everything.
Posted 09 November 2011 - 09:03 PM
I was induced with DD at 39+ weeks because of preeclampia. She was nowhere near engaged either.
I had two lots of gel, then really mild contractions for that night (I stayed in hospital). The next morning they broke my waters and then put the drip in. I had pethidine for pain relief. I didn't have an epidural. DD was monitored the whole time and was born within 6 hours!
I would be going with what your OB recommends. Really at the end of the day you want your bub to be born well and that's what matters most.
Being induced is the only experience I have, I don't have anything to compare it to as I only have one child (so far). So I can't say that it was more painful than not being induced. But it was certainly the right thing in my situation. And DD was born healthy and all was good.
Posted 09 November 2011 - 09:07 PM
Thanks ladies. The funny thing is... I thought I didnt have a birth plan and was happy to just 'go with the flow' but as things progress I think I actually do have a birth plan in my head its just not written down as such.
I find your comments reassuring... so thank you. As you say I think I need to have a bit more of a chat with my OB about her plans for me for induction.
Posted 09 November 2011 - 09:17 PM
Hi OP, sounds very much like myself. Started out with low BP with my first then on the day I was induced which was at the beginning of my 39th week with my DD had a BP of 160/110. I had a migraine which didn't stop for at least 24hrs, pressure on my chest and was vomiting. My doctor put me straight into a dark room until my DH arrived to take me to hospital and I was induced. While for me I ended up having a CS, this was due to my DD being distressed. It won't automatically end up in a CS. Just depends on how you go. With health issues like preeclampsia, considering what can happen, I'd go with what the OB says.
With my second, no preeclampsia and I went naturally however still ended up having a CS. I figured that it's me. That I am just not able to deliver without complications.
Posted 09 November 2011 - 09:35 PM
I went thorugh the same thing, well sort of.
My BP and uric acid went high at 30 weeks with DS1 so I spend a couple weeks in hospital but then my BP went down and I ended up making it to 38 weeks.
With DS2 my BP and uric acid (I have never had protien with either pregnancy) went up at 36 weeks. Swelling was so bad along with toxic uric acid levels and high BP. I was induced at 38 weeks again.
I was induced with 3 sets of gels each pregnancy. After the gels my water was broken once labour established. Each labour after labour established ( a day or two of mild 7 min contractions) was less than 2 hours with no drip. Very fast! They say PE can make for quicker labours.
I only had gels and gas, and my waters broken and I had a very unfavourable cervix so they said the gels wouldn't work and I would need the drip (Well I didn't lol). So I figure thats a pretty low intervention considering what can happen.
I would listen to your OB, as they have you and your baby's best interest at heart. A woman can die and so can the baby if left to progress too long. Its not worth the risk IMO. I am just thankful I got the option of induction because they wanted to do a c-section but they let me try induction first with CONSTANT monitoring of bub on CTG.
Good luck OP. I hope all goes well and you get the birth closest to your birthplan. I have been in the same position so I can understand how you're feeling!
Posted 10 November 2011 - 10:29 AM
I think you need to be guided by your Ob. PE is very dangerous especially with your really high BP. It is common to have protein in your urine at least 1 x + however with your headaches and visual disturbances it does sound like PE. The only way to cure is management and plan for delivery, BP usually stabilises once placenta is out. They may want you to have an epidural in labour mainly due to if you decrease the pain and anxiety therefore you decrease BP and respiration rate. Good luck, if you have any questions make sure you ask the midwife or Ob why they suggest something, they should be able to give you the rationale behind it.
Posted 10 November 2011 - 11:34 AM
Thanks again for the responses ladies. I have a check up tomorrow at the hospital. OB says I may go home with my baby in my arms depending on how the results of my bloods and BP go. I've had a long think about things and like I said I'm happy to do whatever is needed as long as my baby is healthy and happy. We shall see...
Posted 10 November 2011 - 12:54 PM
Hi Hazely, even though you seem to have it sorted now, I just thought I'd share my experience with you
I have been induced twice due to Preeclampsia, both times around 38 weeks. I have what my doctor termed 'Sudden Onset Severe' and had no symptoms (visual disturbances, unusual swelling etc) I was aware of, but during a routine check my BP had skyrocketed and Protein +++. In both cases the gels were deemed unnecessary, and I was induced with ARM and the drip.
With my first DD, my 'birth plan' included asking my support people (my DH was deployed so I had lots of potential support people lined up lol) to try and talk me out of an epidural if I asked for one. As soon as I found out I was being induced, I told them to ignore that request because I had read so many things about how induction is more painful etc and you are more likely to need pain relief. I no longer believe that is true and I wish I hadn't been led to believe it. I think there is no way of predicting how painful a labour is going to be, or of knowing if it would have been less painful if it started a different way. I think that when I expected I would need an epi because of the induction, that became a self-fulfulling prophecy. Sure enough, I begged for an epidural about 4 hours in, my labour stalled, the epidural made me feel horrid and sick, and because I couldn't push properly my DD was pulled out with forceps and ventouse 4 hours later. It wasn't by any means a traumatic experience, but I was determined to have a different mindset the second time round.
With DD2 I was again induced in the same way - with ARM and the drip. But I was not scared about the fact that it was an induced rather than natural labour. I had read Juju Sundin's Birth Skills book, hired a Doula, and this time I got my DH back from overseas just in time. My instructions to my support people this time were that if I asked for an epi, that they were to remind me of it's ill effects - that my baby might get stuck, that I'd feel like crap, that labour might last longer, that I wouldn't feel my baby being born etc. I even wrote these things down on cards to remind myself. Labour progressed almost exactly the same as with DD1, except that I stayed moving around, chanted my affirmations, and held off using the bath for pain relief until I really really really needed something. 4 hours in I was in exactly the same position as with DD1 - only 4cm dilated, nearing the limit of my pain threshold. But instead of an epi I asked for the bath to be run, and I got on my hands and knees on the floor with a beanbag for support. I didn't end up using the bath as there was a delay in running it (Doula was called away and I wouldn't let DH go lol), and then only an hour later, when I thought I just might not be able to handle it anymore and so asked for the bath again, I realised I was in fact pushing! 5 minutes later DD2 was born
So although I cannot compare to a labour that begins naturally, my advice to you is not to get any ideas or fears based on the widespread expectation that induction will lead to further intervention. I personally think the fear and expectation of this happening plays a big part, and it is unnecessary. I have had two full inductions, and two very different experiences and I think my mindset played a big part in how my labours went.
Good luck for your appointment tomorrow, and I hope that whenever or however you birth your little one it is a wonderous experience for you and you are both healthy
Posted 10 November 2011 - 03:01 PM
I have a close friend who was in a coma for 3 weeks for ignoring her ob's wishes. She didn't understand how important pe was, and went on a trip to Adelaide for 8 hours and the day they got home got taken to hospital that night with severe pe. Her baby was 34 weeks.
Her second child was 32 weeks gestation.
Another friend had both her boys at 30/31 weeks due to sudden skyrocketing bp- 200/230 etc!!
But either way I believe it is safer to follow your ob's advice.
They recommend these things for reasons and IMO I think yours is reason enough. Your bub will be more than safe gestation wise to be born now and you never know how favorable you might become with just a bit of gel or arm.
Posted 10 November 2011 - 08:47 PM
I hope your appt goes great tomorrow I thought ild share my story I was induced with PE with DS at 38 weeks after putting on over 30kgs high blood pressure swelling allover and protein in urine my dr admitted me straight away..i was no where near ready wasnt at all engaged the dr put the gel in contractions started 3ish hrs after made it through the night breathing they gave me the drip at 11am they broke my waters and I asked for an epi as had no sleep got one 45 mins later went to sleep woke up had some lunch went back to sleep and got woken up at 5 to start pushing after 1.43 mins of pushing DS was born I lost 17kgs two days after his birth...so I really hope everything goes well for you I just went with the flow for labour and came out the other end very happy with the result even though I had an epi I would have it again (although I want to try calmbirth techniques this time) but I know it's there if needed
Good luck xx
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