14w,5d. This pregnancy of mine doesn’t seem to be getting any easier. After an alarming first visit with my homebirth midwives because of my (unbeknownst to me) high blood pressure, I was referred to a maternal fetal medicine specialist (an OB/GYN with this as a subspecialty). Luckily, I haven’t been booted from my midwives’ practice (despite being a bit higher risk than the typical homebirth client at the moment)—I’m just under a closer watch for the time being.
While my blood pressure was quite high when the nurse checked it before my meeting with the doctor last week, the doctor was less alarmed once I showed her the log I’ve been keeping of my BP readings from home (I’ve been checking it about twice a day for the past couple of weeks). The good news? I don’t have to go on blood pressure medication at this point—just a baby aspirin once a day. And the specialist will be monitoring the pregnancy carefully—meaning that in addition to more blood and urine testing, I’ll have more frequent ultrasounds (once a month until 36 weeks and then weekly thereafter) to measure the baby’s growth (fetal growth restriction can be one result of high BP). The less-than-awesome news? I have chronic hypertension, apparently, and am officially at high risk for preeclampsia. And because protein in the urine and high blood pressure are signs of preeclampsia, I now have to do a 24-hour urine collection to check for the former. That’s right—every drop I pee I make within 24 hours has to be collected in this fine red plastic jug pictured above—and kept cold the entire time. Rest assured, I will not attempt to do any portion of this at the office (I know some folks feel awkward when there’s colleagues’ breast milk in the communal fridge—I can’t imagine how others would feel if they knew there was a giant jar of pee in there).
Typically, preeclampsia occurs after 20 weeks gestation (I’m just shy of 15 weeks right now), so all of this is still just early monitoring—but it’s still completely and utterly terrifying. For example, here’s a bit of info from the maternal-fetal medicine specialist group I saw last week:
- Chronic hypertension complicating pregnancy is associated with an 8-15 percent risk of fetal growth restriction and a 12-34 percent risk of preterm birth. Placental abruption and perinatal death are two- and two to four-fold more common in pregnancies complicated by chronic hypertension.
- Hypertension in pregnancy is the 2nd leading cause of maternal death in the United States, accounting for 15 percent of all deaths.
- One in four women with chronic hypertension will also develop preeclampsia.
- Some serious complications of preeclampsia include pulmonary edema (2-5%), kidney failure (1-2%), cerebral hemorrhage (<1%), and eclampsia (seizures: <1%).
- In the developed world, the risk of maternal death in cases of eclampsia is 1-2 percent, and the risk of perinatal mortality is 6-12 percent.
Anyhoo, I’m continuing to do all that I can to keep my blood pressure from going crazy high and am trying some new things too, including a visit with an acupuncturist my midwives recommended (some of their clients actually hire her to come while they’re in labor to help with the pain!). I’m trying hard not to think about worst-case scenarios, but after seeing friends suffer from preeclampsia and have their babies delivered super-early (and spend several months in the NICU subsequently), it’s hard to shut out those real-life nightmares. But while I’m nervous and stressed about how bad all of this could get, I trust my midwives and the specialist I saw last week, and I’m thankful that it’s still fairly early in the pregnancy... Sigh.
Did you suffer from high blood pressure during pregnancy or have any preeclampsia scares?