a case of mysterious hypertension
Posted November 2, 2012on:
Tonight I came down to the in house doc, pointed at my really weirdly swollen right foot and said, “Son, look at this! I think this is what my OB/GYN has been asking about and I said I didn’t have until now.” After a few more exchanges, Son said, “I think if you want to get pregnant again, you’ll have to be very careful. Maybe you might not want to consider having more kid, since pregnancy seems to wreak havoc on your body. It might cause damage to your heart. With May it was the same thing but resolved in shorter length of time, but this time it’s dragging out. There’s a condition called….”
I can’t claim to be the pregnant champion anymore I guess ? Because although I have felt fine and very healthy during May’s pregnancy, and to some extend, this past pregnancy as well, the last 4 weeks of both pregnancies had the same symptoms of blood pressure climbing and climbing, but no other signs of preeclampsia. On Sunday when the contractions barely begun again in the evening, Son and I went for a walk and tried to reach a decision. Should we take May and go home, or should we head for the hospital ? The perinatal nurses had been urging me to go to the Hospital since the day before, and reiterated their request again on Sunday when they heard that my blood pressure was still something like 140/100. Resting brought the top number down a bit, but nothing I’ve done managed to bring the diastolic number down. Since I knew that I was just in early labor, going to the hospital would mean I get admitted for my blood pressure and end up being induced one way or another. Still, I figured the baby was going to come anyway, might as well get it over with instead of scrambling for childcare in the middle of the night later on.
So we left May after I fed her dinner, got to Walnut Creek Kaiser around 8:30. In the triage area, the contractions seemed frequent enough while the blood pressure was rising, so the OB/GYN said to admit me. She came in to check around 9pm and said I was about 3cm, no other signs of preeclampsia, so it just seems like severe gestational hypertension. Got into Labor and Delivery by 10pm and got hooked to 3 IV lines, and, same as last time with May, got strapped down once and for all. Made no difference that I was delivering in this facility that is run mainly by midwives, that they have a birthing tub and many other awesome tools for women who would like natural birth. The OB/GYN was going to deliver Tim, with me monitored closely, strapped down in one spot.
Blood pressure continued to climb as the contractions intensified. First course of treatment = magnesium. The doctor said that this is based on the latest guideline updated about 1.5 years ago, meaning when I gave birth to May, it wasn’t in use. Basically the guideline said, if blood pressure is high, treat it like an abnormal form of preeclampsia and pump magnesium to prevent seizures. It might bring BP down as well, but main purpose is to prevent seizure. As soon as that stuff reached my system, I was burning. It felt like having hard liquor pumped into me all at once, and I have to immediately experience a hang over. My head felt heavy and dull at the same time, also burning and disoriented. Blood pressure still climbed, and Son was not happy with the magnesium treatment because he felt that I didn’t have preeclampsia. But we talked, he and the doctor talked (just very diplomatically and briefly) because I said I really felt lousy with that stuffs in me. She said I could refuse treatment, but would have to sign consent…
By midnight, I was about 6cm (still flat on my back this whole time) and BP was still climbing. During contractions, BP would reach 187/115 ( or maybe 125, I can’t remember) and the doctor was alarmed. She wanted to bring it down with BP medication, but I asked to wait a few more rounds. By 1:00 a.m. the numbers were 150/100 between contractions, and Son said that hasn’t changed for the past 2 weeks (true) so it seems like my system is stable, but, during contractions, the doc argues that the numbers would peak into dangerous stroke zone, and that’s not acceptable. When I was 8cm along, I said OK, let’s put BP medicine in, because that was about the same time I had BP drug in my system with May’s birth. Son still remembers the drug’s name, so he picked hydrolyzine.
They started with 1/2 dose that didn’t do much, so it was upped to full dose. Soon, I felt this crazy pulsing of my body was distracting and compounding the contraction pains. It made me felt really tired at the same time. Son explained that it’s the hydrolyzine making my heart beat faster.. But the BP was coming down to about 138/36, so at least it was working. If only the pounding would stop…. I asked for pain killer at this point, knowing that I was approaching the final 9-10cm. Good thing Son was with me because he continued to help me figure out my options. The nurse was about to hook me up with 100ml when Son said, wait, that’s a bit too much, perhaps I might want a lower dose. The nurse said 50ml was the lowest, so I said OK. Son was suggesting 25ml.
He was right about the dosage. I think 25ml would have made me more coherent after I delivered. As it was, I pushed for 25 minutes while feeling really really crappy, and getting more and more sluggish because of the pain killer’s side effects. Tim came out pink and healthy, but with a true knot in his umbilical cord – scary. I wanted to wait until the cord stops pulsing before they cut, but the doctor said my body was pushing the placenta out and it was coming, so they had to cut the cord right away. Son said no thanks, he wasn’t cutting. i said no thanks. Lol. We were so enthusiastic. Baby was simply placed into my arms, I latched him and just kinda felt the fog enveloping my brain in the aftermath of adrenaline rush + drugs side effects + fatigue. I’m pretty sure it was mostly the drugs, because last time with May, I was pretty clear headed.
Tim was born at around 3 a.m. on Monday morning. By Tuesday afternoon, we were discharged (per our request, gotta run home to check on the other kid !) . Before I left the hospital, the nurse measured my BP at 137/86. Not bad. Then on Wednesday, I continued to get calls from the perinatal center asking about my daily BP reading, I said, oh, I’ve delivered already, I guess your job is done? The nurse said, no, your OB/GYN ordered us to follow you for 1 week postpartum. Uhm, OK, let me go measure. 144/98 again. WTF. It has been sort of like that. So I’m not sure if the blood pressure monitor they gave us is continuing to inflate the numbers by 10 points or I’m still hypertensive.
The swellings have not gone down. My right hand’s fingers are still mostly numb – if not increasingly so. I occasionally get a headache, but I’m not sure if it’s from engorgement or I’m developing postpartum preeclampsia. I’m in touch with my OB/GYN daily via email, so he knows what’s going on. …
Son has truly been helpful and useful this time around. Last time with May, it was pretty straight forward probably because things happened so fast, not much could be done. This time the 6 hours I spent in labor, I needed Son there to be the clear head for me.
I hope this BP will resolve soon, or I’m seeing the accupuncturist on Saturday. Our family has just expanded, I need a long healthy life.