Blog Posts

#3 High Blood Pressure in Pregnancy

When you’re pregnant, your blood pressure will be checked on your prenatal visits, but it’s important for you to monitor your blood pressure at home. In fact, it’s a good idea to know what your blood pressure is before you get pregnant so you have a baseline to refer to as you track your blood pressure during pregnancy. Blood pressure is relative. What is normal for you may be high for someone who starts their pregnancy at a lower blood pressure than is normal for you.

I strongly recommend you purchase a wrist blood pressure cuff and keep it handy during your pregnancy. Take your blood pressure about the same time at least once a day. These wrist cuffs may not be as accurate as a cuff that wraps around your upper arm, but they are accurate enough to watch the increases and decreases in your blood pressure. You can even take your blood pressure cuff to your prenatal visit and check how closely the readings are to your doctor’s blood pressure cuff.

Blood pressure normally goes up and down during the length of your pregnancy. Your blood pressure usually drops in the first trimester, stays low in the second trimester, and then gradually increases in the third trimester.

Elevated blood pressure is often the first sign of pre-eclampsia. If you have high blood pressure, try to get it under control before becoming pregnant.

In pregnancy, blood pressure hardly ever rises precipitously. It almost always rises slowly and predictably. In my experience, it is far better to treat increasing blood pressure in its early stages.

It is also important to monitor your blood pressure even after your baby is delivered. Often, people assume that the possibility of eclampsia subsides one your baby is born, but it doesn’t work that way. Sometimes, the postpartum period is the worst time for blood pressure elevations. Continue to take your blood pressure after you are home. If it goes up, call your doctor.

#2 Managing Morning Sickness with Diet

Pregnancy comes with so many surprises and bodily changes that the small things sometimes get overlooked. For many pregnant women, morning sickness is tolerable because it doesn’t last long or it isn’t really bad. But for those women who really suffer from nausea when pregnant, let me tell you what I learned by listening to my patients. You need a balanced diet of carbs, protein, and fat to maintain blood sugar levels high enough to avoid nausea. Eat like a diabetic with three big meals and three or four small meals in between big meals.

In your first trimester, your body has to increase its blood volume by several liters. This increase in blood volume leads to your having low blood sugar part of the time. In addition, your baby will get the blood sugar it needs first, possibly leaving you dizzy and unable to eat.

I recommend trying to manage morning sickness without medications if at all possible. Keep a snack of fruit juice and crackers beside your bed. When you wake up in the morning, eat the snack and lay back down in bed for five or ten minutes before getting up. This will allow your blood sugar to stabilize a bit before you get out of bed.
When you get up, don’t run to the shower. Get yourself to the kitchen and have a good old fashioned breakfast of bacon, eggs, and toast. You need fat, protein, and carbohydrates. This is not the time to avoid carbs in your diet. I recommended a little breakfast before your big breakfast, another snack mid morning about 10 o’clock, and another snack in the afternoon about 3 o’clock and at bed time. Do not skip meals.

If you really can’t look at a breakfast of bacon and eggs in the morning, try oatmeal with some butter and sugar and for protein, a small piece of cheese. This is the time to avoid the cold cereal breakfast even if it’s easy and fast. You are trying to get your blood sugar stabilized.
Often time is short in the morning, especially if you are working. It seems there is a need to leave enough time between breakfast and driving to avoid car sickness. I recommend at least half an hour between eating and driving. Above all, do not eat when you are driving.
In my experience with my patients, most morning sickness can be controlled with diet.

Give it a try!

#1 Pregnant and Afraid?

You were really looking forward to being pregnant. Now that you are, congratulations! But wait a minute. Now this life-changing event is beginning to cause you to doubt yourself, possibly even doubt your ability to move forward with the safe pregnancy and delivery you envision.

Too often, women find that the healthcare they receive comes with a lack of clear communication, too little information about their bodies or conditions, and a lack of a personal relationship with their obstetrician. Many women don’t know the kinds of information they need to make good decisions about their pregnancy in cooperation with their doctors. Knowing what questions to ask will have a positive and meaningful impact on the choices women make to create the kind of pregnancy they want.

I encourage you to ask questions of those charged with working with you through your pregnancy and delivery. It’s all about empowering yourself to create the pregnancy and delivery outcomes you want. I hope the answers to the following common questions about pregnancy help you let go of some of your fears so you can enjoy this life-changing event.

Interview Your Obstetrician

On your first initial interview with your obstetrician, ask how manybabies he or she has delivered. Experience is especially important in obstetrics. A physician who has delivered 1000 babies will be more practiced in the art of medicine than a physician who has delivered 100 babies. It’s okay to accept care from the less-experienced doctor. However, just be sure you feel comfortable and trust this physician.

Who am I to be asking questions of my doctor?

Navigating the world of pregnancy and delivery will most certainly result in your having hundreds of questions. One of the most important decisions you will make is choosing the best obstetrician for you. Keep in mind that a good working relationship with your obstetrician is a critically important step to establishing your peace of mind. Unfortunately, many doctors see pregnant women as numbers, not individuals. That is why women must advocate for themselves and choose an obstetrician with whom they feel comfortable. I suggest interviewing several to find the right fit. Here are five questions I recommend asking before committing your pregnancy care to a doctor.

Five Questions to Ask Your Obstetrician

Will you be the one delivering my baby?

Often, the obstetrician you’re working with may not be the one to deliver your baby because many hospital obstetricians work on rotation in delivery rooms (called the doc on deck). Asking this question allows you to understand who will be with you during your delivery. After investing time in finding an obstetrician whom you feel comfortable with, you will want to make sure that physician will be at the delivery. If you like your obstetrician and he or she can’t guarantee being with you during delivery, consider asking to meet some of the other obstetricians who might be there so you will at least recognize familiar faces.

Will I be allowed to have my support team in the birthing room with me?

You will need an advocate, someone to represent you, your wishes, and your best interests. This is a relationship that begins with your pregnancy and lasts throughout your delivery and postpartum. Ask your obstetrician if he or she is willing to work with another professional in the delivery room such as a midwife or a doula.

If you want your partner or a doula in the birthing room with you, this is a crucial question to ask your doctor. Hospitals vary on who they will allow to be with a woman in labor. Obstetricians vary on who they will allow in the delivery room. The time to ask these questions is on your first visit to your obstetrician.

What is your C-section rate?

If you want to avoid delivering your baby by C-section (and I recommend you do), then you should ask your obstetrician on your initial interview how many C-sections he or she has performed. When I was a resident 40 years ago, the normal C-section rate for an obstetrician was 11 percent. Today a physician’s C-section rate should be around 15 percent. If it’s greater than this (especially if it hovers around 30 percent) you should consider interviewing other obstetricians if you want to avoid a C-section.

C-sections are the most common surgery in the U.S., and cost nearly twice as much as vaginal deliveries. Consumer Reports collects information about the rate of C-sections at various hospitals (these rates can vary considerably). Be sure to ask your prospective obstetrician about his or her personal rate of C-sections and the overall hospital rate for C-sections.

Have you had any maternal deaths?

Ask your doctor about his or her maternal mortality rates. Also, ask how many Caesarean-hysterectomies (c-hysters) he or she has performed to stop postpartum hemorrhage. There are a number of ways to control postpartum hemorrhage. In my practice and my consulting with other obstetricians, I performed over 1000 C-sections but I never had to do a c-hyster to stop hemorrhaging resulting from the C-section surgery.

Note: If you’re working with a midwife on a home birth, ask your midwife about his or her maternal mortality rate. Be aware that sometimes midwives send patients to the hospital because of complications. You should ask your midwife if he or she has a working relationship with an obstetrician at the hospital you would be going to if it becomes necessary for you to be admitted to the hospital. If your midwife makes the decision for you to go to the hospital, you do not want to show up in the emergency room and find the obstetrician on call may not like working with midwives.

Who will see me when I come in for a regularly scheduled prenatal
visit?

Ask you obstetrician who will see you on your prenatal visits. Sometimes nurse practitioners, physician assistants, or midwives do most of the prenatal visits, with the obstetrician sticking his or her head in the door briefly before moving on to the next patient. It’s important for the obstetrician to come into the room and sit down and answer your questions on each prenatal visit. Make that known on your first visit and see if what you want can be accommodated.

Steering Your Pregnancy

The best way to dispel any fears you may have about your pregnancy is to ask questions of your caregivers and advocates. With this information, you will be prepared to make decisions for a safe pregnancy. I like to call this steering your pregnancy, much like a pilot steering a plane.

Dr. Lindemann’s RuralDocAlan Etsy store offers printables about many pregnancy issues which you might find helpful.

DISCLAIMER: This post is not intended to be used as medical advice or diagnosis, or as a substitute for professional medical services. Dr. Alan Lindemann and ARL, Inc., make no representations or warranties regarding the content of this post and will not be held liable with respect to its accuracy, completeness, or usefulness. The information provided here is for your general knowledge and is not medical advice or a substitute for medical advice.