High Blood Pressure before Birth

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.

7 thoughts on “High Blood Pressure before Birth

  1. I have had two women in one week calling me that their doctor got blood tests results back showing signs of pre-eclampsia, with the blood pressure checked only once since or not at all but both were booked for induction for the next day!
    What is the rush? As I understand pre-eclampsia more testing/monitoring as well as nutrition and risks consulting of the mother should be done.
    It’s interesting to know that both of them were 39 + 4 wg.

  2. I wrote a paper on PE for midwives….. and I’ve seen a couple of true cases in the last 10 years or so. Many midwives do not understand the physiological changes of BP in pregnancy and that makes it pretty hard to accurately asses what’s going on. I like when we all get chatty about it! You want to see hemodilution with that 28 weekish drop in BP that slowly rises again toward term. That is *normal*. And you cannot accurately assess protein in the urine by dipstick. A 24 hour urine collection is the only way to really see how much protein a mother is dumping.

  3. Twice I had ” mamas” who were experiencing high blood pressure, swelling in the face, hands and feet. I had read that carrot , beet and cucumber juice was excellent for bringing blood pressure down . It worked really well , drinking from 2 to 4 cups a day as well as raspberry, nettles ( to support kidney function )tea.
    And also pointing the importance of high quality protein every few hours.

  4. Shouldn’t another question be, how quickly did the blood pressure go up, and perhaps also how far along is she?

    When I was 38 weeks, my blood pressure *spiked*. It had been borderline before I got pg (135-140/80 range) but dropped once I was into the pregnancy (115-120/70). I was monitoring at home regularly because there’s a family history of HBP (non-lifestyle-related) and HBP is considered a “risk factor” for midwife care in the Ontario health care system. It stayed constantly at a healthy level until one day, I felt funny in my head, heavy and sort of dizzy, and when I checked my BP it was 150/90+.

    I called my mw, who called the ob. We watched it for 2 days, but it stayed up and even seemed to be edging higher.

    Baby was healthy, a good size for dates, an ultrasound (I know they’re unreliable but still) showed that she was likely at least 7 pounds and fully developed. Had this been earlier term, I’m sure things would have been done differently, but since she seemed at least mostly “cooked”, we opted to induce.

    Other than the actual induction and nurses yelling at me to lie down (which I ignored), she was born without interventions or complications. We were back home within hours after the birth and bfing went fine. She was perfectly healthy and is now a tall and strong and gifted 4yo.

    As soon as she was born, my BP went back down to 130/75 levels. Since then, it’s gone back to creeping up as my genetics kick in as I approach 40, so that now it’s 150-160/90-100 at all times, and I’ve started medication. This is in spite of a healthy lifestyle. The medication cannot be taken during pregnancy, so now I’m torn… if we want to have another, what would happen to me healthwise?

    I’ve never regretted the decision to induce, even though it meant losing our home waterbirth. There was no protein in the urine, but I just felt *wrong.*

    I guess the other thing that’s missing in this article is the answers to the questions listed. What are the “that’s normal levels, wait it out” answers, and what are the “oh, that’s too much, we need to do something” answers?

    • Heather, there might be other ways to keep your BP at a lower level.
      Late in my last pregnancy (I was 31) my blood pressure was borderline (?/80) and I also have a family history of HBP. I had swelling in my ankles and fingers as well. My midwife recommended an acupuncturist who I then had treatments with 2x week until my baby was born. I also took traditional Chinese herbs 3x day prescribed by the acupuncturist. My BP stayed at or below borderline and I was able to have a home birth. Also, on the days I received acupuncture the swelling of my ankles would go away and it felt so nice to not be puffy for awhile. My blood pressure went back to normal (?/70) but was has crept up again as I get older ( I am 42), particularly during stressful times. I drink a strong nettle tea and take motherwort tincture daily, which I read about in the New Menopausal Years the Wise Woman Way by Susun Weed. I took the herbs for help with perimenopause issues but they seemed to have got my BP back in the (sorry-I can never remember this # but I think it’s) 110/70’s.
      Best wishes to you!

  5. I would add to the diet question, where are her calcium and magnesium levels. I was diagnosed at 36 weeks 4 days with pre-e and induced at 37 weeks. My bp did not resolve after birth, in fact it kept climbing. They put me on medication, which brought it down but not to prepregnancy levels. I had a midwife mention in passing calcium and magnesium could affect bp. During pregnancy I had become lactose intolerant and struggled to get the proper amount of calcium. I started a calcium and magnesium supplement at 9 months post partum. The next day my bp was at my prepregnancy normal reading and has remained there.

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