Defensive at the OB's office....

SamsMom91

Hi all.  I am 27 weeks pregnant with DS #2.  DS #1 was born at 35 weeks due to severe pre-e and HELLP Syndrome.  I am obese, but managed to lose 40 pounds off my pre-pregnancy weight with DS #1 before becoming pregnant again.  This pregnancy was not planned, but we're overjoyed at the idea of bringing another baby into our family.

My problem is this.  I learned so much about pre-e and HELLP Syndrome after DS #1 was born and I'm determined to get the best care possible from my OB.  I just don't feel like people take me seriously or listen to me.  I'm not being unreasonable or even crazy pregnant woman; I just KNOW my body.  My requests are very simple.  For instance, I know that small blood pressure cuffs on my larger arms make my pressures read high.  Same goes for when they hold my arm out straight and take my pressure.  High blood pressures = panic mode from OB.  I also know that I tend to have small amounts of protein in my urine in the morning.  Also = panic mode from OB.  While I would normally just say forget it and switch OB's offices, I think the problem goes deeper than that.  I've had these problems at my primary care as well.  It's like if I don't have a degree in some part of the medical field, I'm not qualified to speak on behalf of my own body. 

Does anyone else have this problem?  I feel like I'm constantly defending my normal at-home blood pressure readings and constantly asking for a larger cuff and to be allowed to hold my arm down when they take the reading (which they did today--and surprise, surprise, it was 120/80).  Any suggestions?  Thanks!      

Meg1031

As a nurse- I will always advocate for the patient.  It is important to use the right size blood pressure cuff- to have erroneously high BP readings due to a small cuff can subject mom and baby to unneeded interventions.  Just as conerning as if a thinner mom consistently had her BP checked by a too big cuff, and they missed higher BP readings.  Not good.

As far as the arm out to your side- this is actually preferential to having your arm hanging down.  If you consistently get better readings with your arm down, then keep doing it that way so if there is a change, it will be reflected.  They shiould not elevate arm above level of your heart though.  Having your arm hang down usually results in higher readings.  It would be better if you could rest your arm on a table at rest.  By having your arm at heart level it can actually give a very accurate reading.  I do think it goes back to how the nurses were taught.  Also- if they do it manual- request they always do it that way.  If they use an electronic BP machine- have them always use that.  There can be a discrepancy between the 2 methods at times.

I always remind them to use the bigger cuff on me if they forget.  And I am borderline between the 2 cuffs.  

If a mom has really large arms, (or any patient for that matter)- it is generally accepted to use a cuff that fits the forearm instead of using the upper arm.  The tubing needs to rest at the radial pulse site at the wrist.   

mrsjrmiller

I can sympathize with you because my situation is similar. I went to a reg OB for the first part of my second pregnancy, and although they were not doing anything "wrong" (they used the proper size cuffs, etc) they seemed to dismiss me and what I had since learned about pre-e from pregnancy #1. More of my situation was I was seeing a repeat of high BP, headaches, nose bleeds, and it was worrying me and my OB was dismissing it as chronic hypertension (I got severe pre-e and had DS at 27 weeks) and not taking any drastic measures, which I felt were necessary. My pattern was following exactly where I was with preg #1.

I was transferred to a high risk OB/MFM office. My reg OB was out and his partner did the transfer, my reg OB also called me and the high risk office and said there was no reason for me to be there - (I had history of pre-e, history of IUGR, single vessel cord andfetal pyelectasis) what made it worse is my OB is my sister's neighbor, a client of my husband and a friend of the family). I very uncomfortably had to tell him I was not coming back to his office.....

The good thing is, your office is being overly cautious but I agree with pp, if you know you are getting inaccurate readings then they are putting you through unnecessary measures and stress. I think you need to be at a high risk office/MFM - even though things appear to be going well, I think they will be more in tune to your situation. Sometimes I also thought there was a weird enjoyment at my non-high risk office about seeing me cause I was out of their norm too... at the HR office, we are all HR so if they can get through a patient without an issue, I think they love that!!!

Is there any chance you can switch?  If not, maybe you could even bring your own BP monitor in and do it yourself and show them the readongs you get at home. 

I am sorry you are dealing with this.... Congrats on baby #2 and best of luck!!!!

 

courtz00

I am having some similiar situations.  I monitor my bp at home and it is fine, there is an occassional borderline reading but generally it is fine.  At the office it is consistantly high.  I have taken my cuff in and checked and it was accurate.  My ob finally decided that she will look at my bp chart I have been keeping and see what she thinks, but I am being treated at a special PIH clinic and the ob there I really don't like. I feel like he lectures me and blames me and accuses me of lying to him. He told me that I must have had hypertension before I got pregnant simply because I am overweight.  I offered to go online and show him my medical records proving that I did not and he didn't want to see them.  I don't have any suggestions.  But I know how you are feeling. 

jen5-03

Honestly I feel like a lot of doctors think that fat = stupid. I think it's important to find a doctor that respects you and listens to you. Is it the OB that is the problem or just the nurses at the OB's office? If it's just a problem with the nurses I would mention something about the BP cuff size to the OB and ask him to note it on my chart which one they should use. If it's the OB, I'd switch.