Managing Hypertension in Pregnancy

Managing Hypertension in Pregnancy

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Ok ladies, let’s get real about hypertension in pregnancy. I want to cover the very basics about what can cause it and how we can mange it.

Sometimes I feel like every other client I see has some hypertension issue and I hate to see that looming over them for their pregnancy. Especially because we know that being worried about hypertension can actually CAUSE hypertension. That’s just not fair!

There is so much fear when we hear about high blood pressure because we know that hypertension is often one of the first symptoms of the dreaded pregnancy complication preeclampsia. No one wants that! Additionally, hypertension in later pregnancy can often lead to being induced which if you’re of a certain mind, you might not want.

Some women are predisposed to having hypertension even when not pregnant; if that is the case then  it is more likely that they will have hypertension issues in pregnancy. This type of hypertension is called essential hypertension and ideally should be treated before pregnancy with diet and lifestyle changes as well as some herbs if needed. Some women who are not able to control their blood pressure with these natural methods need to be under the care of a physician who may recommend some type of blood pressure medication.

What I have found is that sometimes women enter into my care and they don’t usually have their blood pressure checked outside of pregnancy so they really aren’t aware of what their normal readings are. Naturally in the beginning of pregnancy blood pressure readings are lower because hormonal changes will cause the blood vessels to dilate which causes blood pressure to be lower. Blood pressure readings tend to be the lowest around 16 weeks and then usually increase a bit in the third trimester to about what they would be pre-pregnancy. However, this can sometimes be an issue when in the third trimester we see the blood pressure increasing to the mid to upper 130’s over 90’s. Maybe that is totally normal for that momma pre-pregnancy but that’s starting to get out of the “normal” range for a home birth.

Also, you may be asking “Why is hypertension even a big deal?” For example, maybe you have hypertension and your doctor has done all the tests for preeclampsia and they are totally fine and the ONLY problem is that your blood pressure is elevated. Isolated hypertension can still be dangerous for a few reasons but the biggest ones are…

  • Hypertension can put the baby at increased risk for intrauterine growth restriction (IUGR). This is because the blood flow to the placenta is restricted which means that the baby might not be getting everything he/she needs to develop normally which can result in restricted growth.
  • Hypertension increase the risk of your placenta abrupting from the wall of the uterus. This is much less common of course and is usually only seen in situations when the blood pressure is VERY high, but nevertheless it is a risk and a concern with extremely high blood pressure readings.

So, what can be done to stabilize blood pressure and keep things in the “normal” range?

Lifestyle

  • Get a blood pressure cuff and know what your normal readings are pre-pregnancy
  • Exercise regularly! Cardio especially helps to lower blood pressure. This can be as simple as going for a brisk walk a few times a week.
  • Take steps to lower stress levels. Blood pressure is very sensitive to stress levels! Some ideas for lowering stress levels:
    • Meditate each day, even if it’s just for ten minutes a day it can really make a difference
    • Eliminating extra activities or commitments that are causing undue stress
    • Setting healthy boundaries in your personal life
    • Listening to peaceful music throughout the day
    • Diffusing essential oils to calm and center your mind; I love lavender for this.
    • Schedule a prenatal massage

Herbs/Supplements

  • Healthy Heart Pregnancy Tea – This is a tea blend that I made specifically for clients who have had hypertension issues in a previous pregnancy or who’s blood pressure is starting to rise in pregnancy. It has hibiscus flowers, chamomile, Hawthorne berries, red raspberry leaf, nettle leaf, cinnamon chips and lavender. I have seen amazing results in people who have been willing to drink several cups of this tea a day combined with other lifestyle and diet changes. If you want to purchase this tea from me then send me a message! Otherwise you could mix up your own blend.
  • Hawthorne Berry Tincture – Hawthorne is very helpful in stabilizing blood pressure. However, it needs to be taken consistently for at least 6 weeks to see results. I highly recommend this tincture to my clients earlier in their pregnancy before hypertension has become an issue. If you are having elevated readings at lets say 36 weeks this tincture won’t really help you. I also make this tincture and sell it. Send me a message if you’re interested.
  • Calcium Magnesium Supplement – If you’re not already taking a good cal/mag supplement then this would be a good one to add. The one I really like is called CALM and you can find it at most supplement stores like Super Supplements, or follow the link to find it on Amazon.
  • Cayenne Pepper can help lower the diastolic (the bottom number) reading. It works by dilating the blood vessels which is the same thing that exercise does. You can take it in capsules with meals but be careful to not take it on an empty stomach or it might burn your stomach and/or cause acid reflux.

Diet Changes

  • Do an inventory of your diet. I recommend that clients download some sort of app where they can track what they are eating in a normal day and see where there is room for improvement. A healthy diet should include at least 80G of protein, complex carbohydrates, healthy fats, plenty of fresh fruits and vegetables and be very low in simple carbs and refined sugars. Oh and did I mention 80g of protein?? 😉 Make sure you are getting enough protein in your diet! It can be surprising how much 80g actually is but it is so essential to find a way to get that into your diet.
  • Make sure you are drinking plenty of water. Usually two liters per day. You can replace a portion of this with herbal pregnancy tea which I highly recommend.
  • Salt your food to taste! This is so important. In the past it was thought that salt caused high blood pressure and that still has many pregnant women worried about their salt intake. Your body actually does need the salt for normal blood pressure. So, don’t overdo it but DO salt your food.
  • Include plenty of raw onions and garlic in your diet.
  • Cucumber and watermelon are both known for their ability to lower blood pressure.

There it is folks! There is so much more that can be said about high blood pressure regarding the types and it causes but this is just a basic overview of what I usually go over in prenatal care with my clients.

I hope you all have a lovely weekend and may your blood pressure be stable!

 

Rebekah Alice, LM

 

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To Water Birth or Not to Water Birth

To Water Birth or Not to Water Birth

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Hello Friends!

Rebekah Alice here, Licensed Midwife sharing with you some thoughts about water birth. Now, this post is especially helpful if you are my client or are thinking about becoming my client because every midwife is a little different in how they choose to manage births and in this post I will share a bit on my own personal convictions surrounding birth and water birth. So, please don’t think I speak for all midwifery practices or midwives, to the contrary, I am speaking only on behalf of Lilac City Midwifery.

First of all let me start off by saying that I am definitely an advocate of home water birth. I have birth pools that I rent out to my clients who are desiring to labor and/or deliver in the water and I have seen water birth be an absolutely beautiful experience. I have also experienced having to contend with the extra element of having a mom or baby in the water when they need help.

When it comes to water birth I am a huge advocate of not doing it just to do it. Lets be honest! There is an ideal surrounding home water birth. There are the gorgeous photos you see of a mother in the blue birth pool, rose petals floating in the water, surrounded by soft candle light while her hunky partner lovingly strokes her alabaster brow. We all want that kind of delivery, right?! I know I do!

I actually witnessed a birth in which the mother was so absolutely determined to deliver in the water that she got up from a side lying position on the bed while her baby was crowning and waddled over to the birth pool while holding her baby’s head in with her hand, got in the pool and gave birth to her baby who had the cord wrapped around his neck five times. I guarantee you that baby would have had a more peaceful entrance into this world had his midwife and birth assistant not been splashing around trying to unravel his cord while keeping his head above water. Was everything fine? YES! Absolutely. But occasionally I remember that birth and just remind myself that sometimes things unfold just as they should without us projecting our ideals upon the situation.

Lets talk about why I love water birth, two words friends: PAIN RELIEF

I have seen that pool of warm water make the difference between a hospital transfer and a successful home birth. Especially for moms who are experiencing labor and delivery for the first time, I think having a pool there and available is a must. That first labor can be longer and more intense than you think and having a way to mediate the pain is so invaluable. This being said, I don’t always think it’s the best option to actually deliver in the birth pool. This is a concept that sometimes people are surprised by when I talk to them about having a pool at their birth. You can have the pool at your birth and just labor in it!

A few more reasons I love water birth…

Studies have shown water birth to reduce both the need for pain relief and the length of labor as well as maternal transfers to the hospital. Cha-ching! That’s what I’m talking abut ladies. Why wouldn’t we want all those things?

Studies have also shown water birth to increase the incidence of hands off delivery, maternal satisfaction and upright birth positioning.

Now, lets talk a bit about the circumstances that would make me question if a water birth were the best option and would prompt some informed decision making between my client, her partner and I.

  • Concerning fetal heart rate pattern – Throughout labor I am keeping a close ear on baby’s heart rate via doppler. This is totally something that can be done in the water with a waterproof doppler. The baby’s heart rate is what lets me know how he/she is doing. While it is absolutely normal for the heart rate to drop a bit right before birth as the baby’s head is being squeezed, if the baby’s heart rate would not return to normal or if I would detect some other concerning heart rate pattern then that would be an indicator to me that we need to try some position changes to see if we can correct it; or if the baby is going to be born within the next couple of contractions it could be a possibility that the baby would need a little help with breathing which is something that is not uncommon or scary, but it can be difficult to give the baby the help he/she needs quickly and effectively if both mom and baby are in the water.
  • Bleeding – If a momma has some bleeding while pushing then I want to know what is causing it and where it is coming from; also, I want to be able to accurately estimate how much bleeding there is. Both of those assessments are very difficult to make when the momma is in the water. A little bleeding could be normal but there isn’t a completely accurate way to measure blood loss that is happening in the water. It is for that same reason that I usually have my clients get out of the water for the delivery of the placenta if there is bleeding after the baby is born.
  • Meconium stained amniotic fluid – Sometimes when a baby has a period of distress in the uterus they poop into the amniotic fluid, that poop is called meconium. It’s thick and sticky and can make a little bit of a mess of things. There are several variations of meconium stained fluid. If I see it I can know if the period of distress was recent or if it happened some time ago, maybe not even during labor. The thing is that if that sticky tar like substance is aspirated into the baby’s lungs that can cause the baby’s lungs to not fully inflate because of how sticky it is and it can also cause an infection. Additionally, as I said before, it is a sign the baby has been stressed out and although the baby could come out crying and pink, we want anticipate his/her needs and be ready to help him/her get started with breathing ASAP, if needed. I am not saying that if the bay was born out of the water that there is a guarantee that the baby would not aspirate the meconium stained amniotic fluid. Rather, if the baby were born out of the water he/she would in a better position to receive help with breathing if needed.

There are also some situations where a previous history will be a good indicator of whether or not a water birth will be the best option. Examples of that would be if you hemorrhaged after your last delivery, or if your baby seems like he or she on the bigger side and you have a smaller build which could give us an idea that the baby might need a little assistance from the midwife getting his/her shoulders out after the head is born.

When I attend births my goal is to have a safe and peaceful delivery. What I have experienced first hand is that when a complication which could be quickly and peacefully managed out of the water, happens in the water then there can be an element of disruption and sometimes fear that is introduced into the situation which could have been avoided had the client, her partner and midwife made the collective decision to not use the pool for delivery. Now honestly, I debated whether or not to even publish such potentially inflammatory words against the character of water births because I do not want anyone thinking I don’t support water birth or would discourage my clients from giving birth in the water on the basis that some crazy unprecedented complication “might” happen. That’s definitely not true! I have attended countless water births and definitely support my clients in choosing a water birth. However, I also fully support informed decision making and understanding the benefits and risks of each step of pregnancy, labor and delivery.

One thing I love to do as an alternative to delivering in the water is to have mom and baby get into an herb bath in the pool after the placenta is delivered and bleeding is stabilized. It can be such a beautiful and peaceful moment and makes absolutely stunning photos.

There it is my friends! This midwife’s opinion on water birth.

Feel free to contact with with any questions regarding water birth , I would love to discuss further.

Much love,

Rebekah Alice, LM

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