Hi! I have both chronic and white coat hypertension..what a combo!
Hi everyone,
Been lurking for a while and finally decided to chime in. Sorry, this may be long. I'm 32/2 weeks and at about 24 weeks, my blood pressure started to become a problem but it really became an issue at 28 weeks when I was sent to triage because my BP was quite high (both numbers were in the 100's).
Since then, I am seeing an MFM every Monday to monitor baby girl (who is doing PERFECT) and doing an NST with follow-up OB every Thursday. I have been monitoring my blood pressure at home and it is ALWAYS under 140/90; I am lucky to have the summer off due to my teaching job, so much of my day is spent relaxing anyway. So everything has been under control.
Until yesterday.
I have my routine NST but since no OB's were available at the time, a nurse practitioner was overseeing my appointment. So I'm hooked up to the machine and baby girl is going crazy, moving my stomach, and being extremely hyper. The tech comes in a few times and says it looks good and everything is in range. She takes my BP and it is quite high, but I am expecting that because I know I have the white coat syndrome and I had a decent number at home before I left for the appointment (128/79). I have shown my numbers to my doctors at each appointment to let them know that I only have these elevated BP's at the doctor's and they are quite good at home.
So, I'm hooked up to the NST machine for an hour and 15 minutes (no joke), and I'm beginning to get stressed, antsy, uncomfortable, and the baby seems to have fallen asleep at this point. The nurse practitioner FINALLY comes in and furrows her eyebrows at the NST results, says they look odd, says my BP is too high after taking it again (I tried explaining to her my results at home and how the doctors usually seem pleased at my normal BP), but alas, she sends me to L&D. Second time there within a month. Yay!
I am crying of course in triage because how stressful is this situation again. My husband and mom (who works in L&D) show up and I begin to relax. Basically, the doctor on staff looks at my NST results that are being conducted there and says he is very pleased with the reaction she is showing, I have still no protein in my urine or swelling, and he understands my white coat syndrome. I have previously seen him and he agrees that the numbers at home are what are most important and to keep recording them because they are a huge help. My liver blood test came back a TAD high, but he doesn't seem concerned and that it could be completely unrelated to pregnancy. We'll just keep an eye on it.
My mom (thank God I have her) expresses her unhappiness with my seeing a nurse practitioner when I am considered high risk. The doctor agrees and says she most likely sent me to triage because she wasn't comfortable with what she saw and she normally deals with the "normal" and low-risk patients. Which I totally get, but she couldn't grab an OB on staff with her for back-up before sending me to the hospital? The doctor said at 32 weeks, my NST will not show the huge peaks that the nurse may be used to seeing with patients who are normally farther along than me.
I'm sent home within 2 hours and I'm pretty frustrated with how things were handled at my doctor's visit. I am wondering if the whole ordeal would have been avoided if I saw a regular OB OR if she would have simply asked an OB on staff for some guidance.
Thanks for letting me vent! Does anyone else experience the white coat hypertension?
Re: Hi! I have both chronic and white coat hypertension..what a combo!
I did/do on both accounts. With DD I had severe white coat syndrome. I never had an issue my whole life with blood pressure and around 28 weeks I started spiking and they would send me to L&D, I was swelling (but that's apparently normal now for me in pregnancy)...I would walk in with HUGE numbers, they would have to admit me and as soon as I got an IV and relaxed I was fine. I also had untreated chronic hypertension (like I said never had a problem till 28 weeks) -- so after I delivered I was sent to a cardiologist. Needless to say all the stress gave me PTL and PROM and I delivered her at 33 weeks. This pregnancy, I've been on bp meds which have controlled it and knowing it's controlled has helped me control my white coat syndrome -- I actually don't get flustered about it anymore. I used to "just know" and it was a huge issue. This pregnancy I've been able to be controlled (minus outrageous swelling) and have gone to term. Best of luck!
Oh -- and the NP at my practice won't see me, because I'm high risk, it's the policy.
It should have been this way with me as well, but I didn't really know better to say anything until my mom brought it up at the hospital. The nurse did not have the greatest bedside manner either with the way she was furrowing her eyebrows and humming and hawing at my NST results and that basically sent my BP into overdrive.
I'm on labatelol (200 mg twice a day) and that seems to pretty much control it along with my limited activity but GAH! I just need to practice some breathing techniques in the waiting room.