Questions to ask if a woman’s blood pressure (BP) is elevated before birth:
• What was the starting baseline BP in this pregnancy? How many w.g.a is she now?
• What is the BP now?
• Who’s taking the BP reading, and is the mother in the same position (sitting, side lying, standing) each time?
• Does the mother have a fat arm and is the cuff long enough for her?
• Is she on any medication right now?
• Is she spilling any protein in the urine?
• Does the baby seem to be growing appropriately – i.e., is it the right fundal height for dates or close to it?
• Are the BP readings done at the same time of day?
• Is the mother active, sedentary?
• What kind of diet does she eat?
It’s important for student midwives to learn to ask lots of questions. If a midwife phoned a doctor and said “I have a client whose BP is dangerously high” the doctor would (hopefully) ask the midwife every one of those questions before jumping to any conclusions. The thing to remember about high blood pressure is that the body is trying to protect the baby and the mother by sending the BP up. Why it does this we don’t know, but even the doctors don’t want to bring it down to “normal” 110/70 levels. They are happy if they get it down to 140/90 and they stop medicating there. Many obstetricians around the world will not treat any hypertension which does not include proteinuria (protein in the urine).
The treatments have dangerous side effects, especially to the liver, which is the organ that is having difficulty in the first place. If the client had a diastolic reading that was more than 15 higher than her initial BP, protein in the urine, and swelling in the face, hands and feet, this would be of great concern. If increasing her protein, high quality natural salt, and rest did not turn it around very quickly, I would want her to seek medical advice. Dr Thomas Brewer recommends intravenous serum albumin therapy. http://www.drbrewerpregnancydiet.com/index.html
I helped one woman who got into this scenario, and her baby was removed from her body by cesarean at 32 weeks gestation. The baby was small for dates. The woman did a fantastic job of persevering with breastfeeding against all odds, and her daughter is a big healthy girl now. In her second pregnancy her blood pressure was normal and she had a VBAC at home. That is one case in more than 1000 women I have worked with, so it should be a very rare occurrence.