Wednesday, April 21, 2010

Thank goodness for the Labor Progress Handbook!

I'm still waiting on my home birth client to go into labor, and she may end up not being my first doula birth after all. One of my other clients has been dealing with high blood pressure for several weeks and may have to be induced. Needless to say I have been finding out as much as I can about hypertension, pre-eclampsia, induction and laboring with these conditions.

She is currently being tested for protein in her urine to see if she may have pre-eclampsia in addition to her hypertension. Pre-eclampsia is
a condition that typically starts after the 20th week of pregnancy and is related to increased blood pressure and protein in the mother's urine (as a result of kidney problems). Preeclampsia affects the placenta, and it can affect the mother's kidney, liver, and brain. When preeclampsia causes seizures, the condition is known as eclampsia--the second leading cause of maternal death in the U.S. Preeclampsia is also a leading cause of fetal complications, which include low birth weight, premature birth, and stillbirth. 
An increase in BP in late pregnancy is fairly common, and does not always become pre-eclampsia. There is no proven way to prevent pre-eclampsia, and the only way to treat it is to have good medical care. The only "cure" is to deliver the baby.

This is why, if the doctor finds she may have pre-e, she will most likely be induced as soon as possible. I have made several suggestions over the past couple weeks for lowering her blood pressure, and she has told me that she has tried relaxing more. Unfortunately her BP is still high, though I don't know how high. I am worried about her being induced, because that is what she had to go through last time for being "late" and she definitely did not have an easy time of it. If she does not have pre-e her doctor still wants to try to get her going as soon as possible, and has said she will be stripping her membranes next week.

For those who do not know what stripping membranes is:
Stripping the membranes is where a health care provider will separate your bag of water from the cervix, it is not intended to break your water, however, it may. It may also cause infection, and may be painful for some. The reason that we tell people that we are stripping their membranes is to "get things going" in regards to labor. This little technique is usually done during a vaginal exam at the end of pregnancy, with or without the knowledge or consent of the woman. Stripping the membranes, we are told, is supposed to stimulate production of prostiglandins in the cervix and bring on contractions. I have heard doctors tell my clients after stripping their membranes they will have the baby in two days. While this may appear to work for some, at term it's all a guessing game. There is no scientific work to date that can back up the routine procedure of stripping membranes. (from Childbirth.org)
Needless to say I am now preparing for the possibility of her being induced very soon, and for the probability of her being told to labor in bed for her hypertension.

And this brings us to the title of my post: Thank goodness for The Labor Progress Handbook!
In my panic of "yikes my first birth might be a hospital birth medical induction stuck in bed omg how do I support a woman in this situation I'm freaking out!" I found exactly the information I needed in Penny Simkin's wonderful doula/care provider labor guide:

- Many caregivers restrict the woman with pregnancy-induced hypertension to bed in labor (and late pregnancy) because blood pressure is usually lowered while a woman lies on her left side. The book states that whether such treatment has resulted in improved outcomes or less progression of pre-eclampsia is not known.

- While caring for a woman who is restricted to the bed with PIH, explain why left-sided bedrest is being asked of her, help her focus on comfort measures that she can use in bed, such as relaxation, breathing patterns, vocalization, guided imagery and visualizations, other attention-focusing measures, massage of back and feet. If some walking is acceptable, have her walk to the bathroom and to the shower or tub. Water therapy frequently lower high blood pressure.

- Assess her emotional state. Raise spirits by having her wash her face, brush her hair, play upbeat music, have a new visitor come chat with her optimistically. She may benefit from a good cry. Acknowledge her frustration and giver her a pep talk.

- Women restricted to bed may still be able to use position changes to improve labor progress (and coping). If the mother does not have any indicators of malposition it is appropriate to try to "rollover." The bed-ridden woman spends 20-30 minutes in each of the following positions: semi-sitting, left-side-lying, left semi-prone, hands and knees lean, right semi-prone, right side-lying, and back around again.


Panic over  :]

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