To thine own self…

20 Feb

(Note: This is a description of my experiences. My experiences are no way meant to be used as a substitute for appropriate dialogue with a medical professional or for substitution of medical treatment..)

Last week I got my first taste of what it means to be a woman of ‘advanced maternal age’ (the term the doctors use in my file) on the verge of childbirth.Yes, I admit that I have gestational diabetes, but I have been very conscientious about observing my dietary restrictions, working out and taking care of myself. Both my overall weight gain and Alex’s weight are healthy and normal and I am truly aware of the issues that I face given my age and genetics. But, I also know that I am a healthy person in general who, pre-pregnancy, watched out for what I ate, avoided additives in my food, used all natural cleaners and body soaps. Awareness has been the key to my life — my whole life. I’ve been aware of how I should eat, exercise and take care of myself since I was little.

This, though, was put to the test the other day.

I have always known that I have a lot of anxiety about going to the doctor’s. When I was little I often had my blood drawn. Not with the small disposable needles, but with huge horse needles. In fact, my mom remembers me being strapped down to a table when I was 18 months old and having blood taken from my neck. Not a great way to instill trust in someone with a white coat, if you ask me. I also remember a nurse chasing me with a needle when I got my mumps vaccine. She was truly scary. I ran under a chair and hid. My mom had no idea what to do, and obviously this nurse had no bedside manner.

These are memories that are ingrained in my subconscious.

Until I got pregnant I so seldom went to the doctor that my anxiety wasn’t an issue. In fact, up until 3 weeks ago, it only manifested in my slightly elevated glucose levels the morning of my doctor’s appointments. Now that I have to see the doctor once or twice a week, though, I’ve gotten worse.It first began the visit after my first pelvic exam. The doctor came in all excited and worried asking me if I had a host of symptoms for preclampsia. Knowing that I didn’t and that my blood pressure is generally really good, I said no. Even so, there was a frenzy of activity. A few minutes later my blood pressure was checked again and it was fine.

Unfortunately, a pattern had been established.

This has happened every visit since then. Last week it precipitated a visit to the hospital with talks of emergency induction.I went to the hospital knowing full well that my BP would be lower soon (even saying this to the doctor). While our hospital is really nice and comfortable, it did mean lying on my side in a truly uncomfortable position, watching bad TV, not having anything to drink (on a day that was over 80 degrees) or eat (shooting off my glucose levels), and not being able to properly elevate my feet (to allow the heat & gravity-induced edema to go down).

I was glad to go for a trial run, but since the doctor couldn’t be paged for a good 3 hours, it wound up being more trouble than it was worth to me. And, of course, my BP was normal.

The day after this I got to thinking. I know that my doctor is just doing her job and being cautious, but can’t she see the pattern? Do they not discuss white coat hypertension in medical school? Is it not obvious that my BP goes down after my exam?No, instead she focuses on my initial BP readings, saying that they are dangerously high. Well, being anxious will make anyone’s BP spike. The key is whether or not it falls back to more normal levels.

I then had to go back on Friday. I was so upset about being packed off unnecessarily to the hospital again. The first visit was great as a trial run, but it took me two days to recover from the experience of almost being forced into induction, missing my oh-too-few and precious calories and trying to get my glucose levels back on track. Deep within myself I knew that another visit to the hospital unnecessarily would do nothing for me or for the kiddo.I then started to do some research and found out a lot of interesting information about white coat hypertension.

One study in JAMA talks about how white coat hypertensives tend to have more surgical births. Another source I found describes how it may be more prevalent in pregnant women than most doctors think. Not surprising given the personal nature of the examinations we go through.

So, on Friday I refused to go to the hospital.

Instead the day before I bought a BP monitor and started monitoring my BP along with my glucose. I noticed that right after my doctor’s visit my BP was little high, but within 24 hours, it was fine. My labwork all along has been fine — a strong indication to me that my levels reflect my inner fear of doctors more than my true BP.

The doctor wasn’t happy with my decision and I get the feeling that no one ever challenges her. That few people out there are aware of white coat hypertension and will instead allow the doctor to induce unnecessarily. The JAMA article talks about how 42% of the women with white coat hypertension wind up with surgical births. I wonder how many of those surgeries were truly necessary and how many were done simply because there was no awareness on both the part of the patient and doctor that some women experience acute anxiety during doctor’s visits at this point in their pregnancies?

Both Doug and I are aware of our decision, but it was a decision we made after much research and discussion. We know that if Alex’s health is an issue that there will be a possibility of induction and/or surgical birth, but we’d rather enter into such a situation educated, aware and accepting of it instead of from a place of fear and lack of understanding. But there are a few questions that I keep asking myself…

How can my doctor not see the pattern of my BP values?

Why doesn’t she ask me what’s going on emotionally to trigger this and make note of it in my file? (I always have to repeat that I have had this condition since I was little…)

How many other women go through this without question and wind up on the operating table?

How come there isn’t more information about how this condition affects pregnant women?

The other day I stayed true to my ideals. But, it was draining… I just don’t know if I’ll still have the energy to do so with my next visit. Precious energy that should be funneled into preparing emotionally, psychologically, spiritually and physically for Alex’s entrance into this world.

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7 Responses to “To thine own self…”

  1. Em February 20, 2008 at 9:59 pm #

    Good for you for sticking to your guns (especially well-armed with medical research, too!). I hope that your birth experience is a positive, empowering one. Hope you and your little one are doing well.

  2. Sara R. February 20, 2008 at 11:37 pm #

    A few things to note about preeclampsia:
    1. Make sure that the doctor/nurse takes your blood pressure while you are sitting up, preferably with your feet on the floor. Taking blood pressure while lying down gives an artificially low measurement.
    2. White coat hypertension is real. You did the perfectly correct thing by documenting the effect of a doctor’s visit on your blood pressure. If your doctor isn’t willing to accept your findings, it’s her problem.
    3. That being said, preeclampsia can move extremely fast. High blood pressure is only an outward sign that there is a problem — by the time your blood pressure is elevated, there can already be bad things happening. It rises because the placenta is failing and not getting enough blood to the baby; your body thinks that raising the pressure will get more blood to the baby (it does, but at a cost).

    An overwhelming percentage of births go just fine, and don’t need any medical intervention. But no one wants to be in that tiny group where things go haywire, and so doctors may go overboard and intervene in cases where it’s not absolutely necessary. And as someone who has been a member of that tiny group, I feel that a little extra caution is not always a bad thing.

    You seem to be very in tune with your body, and are listening to its cues. I’m very hopeful that Alex’s birth will go as smoothly as possible, with no complications.

    p.s. I hope you don’t find this comment judgmental. I just wanted to try to provide another point of view for you.

  3. geckogrrl February 21, 2008 at 1:32 am #

    Thanks Em & Sara for the comments! It really means a lot!

    Sara, I totally agree with you and don’t find your comments judgmental in the least. Caution is key! Your point of view is actually really similar to mine because being aware of the things that can happen is really super important. I’m always concerned that I’ll be in that percentage of haywire birthing moms, perhaps because I was a haywire birth.

    And it’s great that my doc is cautious, it’s just not all that great when she says “You’re not dilated yet.” in a frustrated tone of voice that implies that it’s my fault Alex isn’t ready to come out (this has happened twice with the doc and once with a nurse…). I do get the feeling that she wants me off her docket which is sad because up until this started happening she was really supportive of many of my birth plan choices.

    At home I always take my BP sitting up and have a SIL who had preclampsia and so have been looking out for the symptoms from early on in my pregnancy just in case. Luckily I have been monitoring this on my own and realize that there is a psychosomatic emotional trigger (having to do with an inappropriate pelvic exam a few years ago) which in fact caused me to finally break down in tears in the doctor’s office today.

    For me the most important thing is that Alex is fine and that if I notice a higher reading for more than 2 readings, I know that it’s time to go to the hospital. It’s just really obvious that this is due to anxiety because twice I had a reading of 150/83 and then less than 10 minutes later it dropped down to 138/83. An hour after that, it’s down to normal.

    Doug and I have discussed the fact that we may have to have an induced birth at length and are open to the idea if it means that Alex will come out healthier. We just would like to wait until closer to the due date so as to ensure that my body is more ready.

    And, it’ll be fun to introduce Viv to a new playmate at SnB one of these days soon!

  4. Kate February 21, 2008 at 5:33 pm #

    As I’ve gone through the whole knee and allergy things this year, I’ve realized while doctors have their purpose, they don’t know everything. And often times they don’t think outside the box. Good for you for sticking with your beliefs and not being bullied into something you knew was an issue.

  5. Nora February 22, 2008 at 10:24 pm #

    I think standing up to a doctor when you are pregnant and think they are wrong is one of the toughest things to do. To me it felt like gambling with the baby and made me unsure, and not as easy to argue my point. In my case I was able to ask a second opinion, maybe that would be an avenue of pursuing if this comes up again. It sounds to me like you are being smart and have considered your condition and your options, I wish you all a happy birth.

  6. geckogrrl February 24, 2008 at 2:57 am #

    Thanks, Nora and Kate!

    I normally wouldn’t be so hard-nosed but because I have been monitoring myself and know that my BP spikes for a few minutes pre-pelvic exam and then drops down right away, going to the hospital all the time is not going to do any good. (Particularly since hospitals and doctors’ offices seem to make me worse…) Staying at home, relaxing, meditating and monitoring has worked wonders and my BP is normal when I’m at home.

    Sad to say, but I read that many women with white coat hypertension are put on BP meds unnecessarily during pregnancy which leads to more premature and surgical births.

  7. Laurie February 27, 2008 at 2:16 am #

    I can vividly remember my brother and I hiding underneath the pediatrician’s table. I acutely remember our mothers embarrassment when the nurses had to pull us out for our shots. I never knew there was such a condition but I’m sure I was close to having it as well.

    But I’ve had lots of medical care in the last 15 years – infertility led to many doctors as did 4 pgcys and births and pediatrician visits galore and then my MS diagnosis. Lots of drs, not a lot of fun. 😉

    I’m so glad that you stuck to your guns! I am truly sad when I see first-time-moms who feel they know something in their gut but won’t even discuss it with their drs. It’s as if our society equates drs with all-knowing gods. Good for you! 🙂

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