(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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