Tuesday, November 25, 2008

PIH Update

My wife delivered her 24hr specimen to the midwife's office yesterday. We decided she would go by herself rather than all of us go--including the 2 y/o teething her 2 y/o molars at the moment.

Her BP was elevated again, and was back to normal after resting for a few minutes. More alarming though was the fact that she had gained 7 lbs since Friday. There was no midwife in the office yesterday, so we have yet another appointment on Wednesday where I can only hope we can stave off admission. One note of good news is her UA dipstick showed no protein again, we'll see what the 24hr catch shows.

It's been very frustrating actually. My wife has been keeping meticulous records, (she IS a nurse after all.) Our scale at home has never varied from the office scale by more than 1 lb in the past. Yet when she got home yesterday, our scale read 4 lbs lighter than the office scale. Her wedding rings still fit. Her ankles aren't swollen, she has no evidence of edema anywhere. If someone had gained 7 lbs in 3 days, shouldn't there be at least some sign of water retention? Because even with a baby growing, it would certainly be difficult to gain that much weight that quickly anabolically.

I also took her BP immediately after she got home. She had been driving for 20 minutes, and picked up the 2 y/o on her arrival home--yet her blood pressure was totally normal--120's over 60's. I'm pretty comfortable taking BP's, it was a required element of our exams at school, so I've done it hundreds if not thousands of times...

The clinical picture we see at home is not what is showing up in the office. I don't understand why that is. And I'm afraid we're going to end up admitted which will for SURE get her stress level up, her BP up, our risk for many, many things up... I feel like we're on the apex of a slippery slope, one small slip and we'll set in motion the American intervention nightmare birth. And the worst part about it is those professionals that we selected to help us navigate this fine line between safety and a completely natural birth, instead of steadying us, are tugging and pushing at us trying to knock us off balance, or so it feels.

I have never doubted that I would always put my family's health foremost in our healthcare decision making. From my independent reading and research during chiro school I developed a serious sense of mistrust of the medical profession as a whole. I think a healthy dose of skepticism is a good thing. And I honestly think that in an emergency situation, there would be no hesitation on my part. But this experience with the midwives office has only strengthened my mistrust. It just feels like they are trying to funnel us into the baby mill machinery, which is exactly what we wanted to avoid.

But, is their scale off? I don't know, I didn't see her zero it. Are the intake nurse's BP readings really that inaccurate? I don't know, she was getting ridiculously low readings in the past, and no one has independently verified her readings... Even my wife who is notoriously willing to accept what she's told in a medical office without question, is telling me that in her gut she doesn't think she gained that much weight.

It's just a very scary thing, because this clinical picture they've assembled could very well get us admitted.


  1. I'm sorry this is going on. It is unfortunate that in the checking and rechecking to make sure pregnant mom's are healthy this type of cycle could happen. Unfortunately it is also a lot of CYA from the midwives point of view but you already know that. "If she was to have PIH and no one interevened then what?" (talking as if I am the midwife). But is the testing and retesting causing stress to then increase your wife's BPs?

    Hopefully the 24 hour urine collection is negative for protein, hopefully she is not having any clinical signs like headache and epigastric pain. Hopefully the scale in the office is incorrect and your appt on Wed will reveal that. Have they done PIH labs?

  2. Yes, they drew blood for the PIH labs--another let down. The intake nurse who does all the blood draws for the office looked at my wife's veins and chickened out. So my wife got to sit in a Quest Diagnostics waiting room for another hour...

  3. Oh the fun.. Were the labs OK? Hope so. That's usually the big decider if someone needs to be admitted or not, where I work anyway. Good luck to you guys!

  4. We haven't gotten the results back from the labs yet. My guess is they aren't bad though, otherwise we'd have heard from the office.

  5. So here is my take--(and of course, I can't give healthcare advice, but anyway):

    I am fresh off a pre-ecclamptic seizure on a patient that was sectioned after docs were VERY conservative and gave her the chance to deliver vaginally. That said, I see the value in being hospitalized for observation WHEN there is an indication. If your wife starts having honest-to-goodness s/s of PE/PIH, then by all means follow your midwives advice--that is what you are paying for, right???

    On the other hand, you guys need to advocate for your own healthcare--which it sounds like you are doing, but might I suggest that you find another healthcare provider?? I know it is "late in pregnancy" but the reality is, it seems you don't trust the practice your wife is seeing. Something has clued you in to this feeling--a gut instinct--and I would say go with it! Is there anywhere else you can go?

    I have had friends change practices "late in the pregnancy-game" and they were so thankful they did. They felt like they avoided a disaster.

    At any rate, keep staying on top of these midwives. I would present the home evidence you have--keep a journal--and work diligently to receive the quality healthcare you deserve. These days, quality healthcare does not happen without a huge amount of diligence from the patient, unfortunately.

    Take care.

  6. Consider these things as well: she could have "white coat syndrome" from just being in the stressful environment of the office setting, falsely elevating her BP readings. I would keep a record of her BP readings at home (side lying and sitting, and note what position she is in with each BP reading). Also - edema/weight gain is not considered an indicator of PIH/PES as it used to be. The 24 hour urine for protein is going to be one of the bigger issues - if it's normal, things are ok for now. If it's elevated, follow up should definitely happen. Even the blood labwork isn't 100% diagnostic of PES/PIH anymore. So you can't rely totally on blood work either.

    When in doubt, get a second opinion from another OB/CNM office.

  7. I am sosorry that you are experiencing this. I'm keeping you guys in my thoughts.