High BP, Induction and Big Headed Baby

OurNewEngland · April 2014

Hi all, I'm a FTM and have had a rough second half of pregnancy. I've been on bed rest for the past two months due to high BP. It's been gradually rising since I got pregnant (pre-pregnancy was avg 110/65) and is now consistently in the high 130s-150's/90s, even when I take a reading when I first wake up in the morning. If I get up to make a sandwich or walk up the stairs my diastolic jumps over 100. So far I don't have pre-e but I get checked each appointment.

Because of this my doctor wants to induce me on May 1 at 39 weeks. My baby's head has also measured at 99.99% since 26 weeks so that's another concern of whether or not he'll physically be able to descend through my pelvis. My DH has a huge head also and was unable to descend so after 36 hours of labor his mother wound up with an emergency c-section.

So now I'm really starting to weigh my options. I'm nervous about being induced having not progressed at all thus far (I'm 37w4d). I also know they're most likely going to want me on an epidural right away to keep my blood pressure lower. Both of these things will most likely lead to a long, exhausting labor that might wind up ending in emergency surgery.

My concern is the trauma baby and I could both be subject to, given what's stacked against us, if an emergency c-section is necessary ... when compared with a controlled, safe and scheduled c-section. I know high BP is nothing to mess around with and pain/exhaustion/labor etc could cause that to sky rocket. For STMs who have been there, or FTMs facing the same decision ... would you speak to your doctor about considering a scheduled c-section instead of induction? I'm really driving myself crazy with all the what ifs that could happen during labor with our circumstances and I just want what's safest for both me and my baby.

Any advice to help ease my nerves, etc would be very appreciated. TIA. Sorry this is so long.

IBackBevo · April 2014

Well, first, if my old OB or MFM were seeing you, that bp would not be high enough to warrant an induction. My BP was that high or higher from about 24 weeks with my DS. I did develop severe pre-e, though. However, OBs seem to vary drastically on these sort of things and mine during my last pregnancy was not cautious enough because my "pre-e" was not discovered until I was really far along even though I had every symptom imaginable and by then my baby was growth restricted and my pree was "severe." They did not induce me because my LO also had IUGR and started having decels. I had to go straight to a c-section.

I don't know on the head size thing. My LO now has a head in the 99th-100th percentile, but he was only in about the 50th when he was born...the rest of his body was in like the 3rd which is typical of assymetrical IUGR. You do have to remember that ultrasounds can be off, though, and I think that the head measurement is the more difficult one to take because it can be affected by position. Still, don't really know what to tell you.

My gut would be to at least try an induction because a c-section recovery is rough. But if the odds of success are super low and you are going to end up in a c-section anyway then no point in tiring yourself out. Recovery from a c-section with a newborn is tough. Still, I think I would be inclined to at least try...

OurNewEngland · April 2014

From what I've heard from friends and read about, the recovery from a long labor and emergency c-section is far worse than that of a scheduled c-section, which is what concerns me. I'm really hoping things will just get going on their own so I can avoid an induction all together, as that seems to start the cycle of interventions. Sigh.

IBackBevo · April 2014

OurNewEngland said:

From what I've heard from friends and read about, the recovery from a long labor and emergency c-section is far worse than that of a scheduled c-section, which is what concerns me. I'm really hoping things will just get going on their own so I can avoid an induction all together, as that seems to start the cycle of interventions. Sigh.

I have no experience with the former to compare, but my recovery from a planned c-section still sucked and I didn't labor ahead of time. My general view is to avoid a c-section if at all possible, but you may get a completely different view from those who have birthed babies with huge heads and torn badly.

sthomas1222 · April 2014

I personally would not do a c/s unless my Bishop score was absolutely abysmal. Even then I would probably still try an induction just b/c I will do anything to avoid a c/s personally. There are benefits to a vaginal birth and it is typically the easier recovery in general. There will always be those who loved their c/s, hated their vaginal, hated their c/s, loved their vaginal. There's just no way to know ahead of time what you're going to be like unfortunately. Discuss with your doctor your Bishop score at 39w, it gives you a pretty good estimate on whether an induction will be successful and the chance of a c/s occurring. Discuss when he would call the need for the c/s and if he would even want the epidural right away. From the births I've attended for high BP induction they do tend to be overly cautious and limit mom's movement to keep the BP from spiking. Also, if they do Mag to keep your BP down they most likely won't allow you out of bed at all due to the fall risk. There's a lot of factors at play and you'll want to know your OBs game plan and your chances before deciding anything.

SMM1986 · April 2014

I don't think it will hurt at all to mention your concerns to your OB. Maybe hearing why they are preferring induction over c section will ease your concerns.
I personally would want to try a vaginal delivery first, but that is definitely something for you and your doctor to decide.
Good luck!

OurNewEngland · April 2014

Thanks, everyone. That's exactly what I needed to read. It's so easy to work yourself up into hysterics with so many unknowns .. and so easy to doubt yourself, your decisions and your body's abilities. It doesn't help that I'm creeping up on the part of pregnancy I've always dreaded ... the part where the baby actually comes out!

Junebug060609 · April 2014

My DS had à 97% head. I was induced for mild pre e with him.

His head size was à non-issue. Vag delivery.

Jennyinheaven · April 2014

I'm going to play devil's advocate here and say after what happened to me during my failed induction and subsequent emergency c section I think I would have had a much easier recovery if I just went with a scheduled c section. either way I would suggest further discussion with your doctor and your husband make sure you're making a decision that you're comfortable with and feel that you have all the information up front. Good luck let us know what you decide either way.

chknma · April 2014

I was induced with DD, no cervical progress @ 39 weeks due to complications from GD/low fluid. DD's head was >99% and She weighed almost 9 lbs. I pushed her out without any issues or tears. My MW even told me today that most times it has more to do with the baby's position during delivery then head size.

Also, never had a c/s but most would say a vaginal recovery is much easier then c/s. also depending on if you plan to have more children, a c/s can limit your options in the future (repeat c/s vs VBAC options)

cnbean · April 2014

I had a long labor and an emergency c-section. My DS had gotten in the pelvis wonky and wouldn't fit. Nothing to do with head size. But with all that said I would still opt for an induction over a scheduled c-section. My recovery was more difficult than it would have been otherwise, but it still was pretty easy. Since there isn't any way to really know for sure that your baby won't fit through your pelvis I would go for the induction. And as others have said, its hard to get accurate measurements with ultrasounds, they can be off.

Just thought I'd tell you that while I didn't bounce right back from my c-section, it wasn't that bad either. I was home after 5 days and pretty well able to do what I needed to.

EmilyGolden1 · April 2014

Would you consider getting a second opinion from a different OB?

kat8805 · April 2014

I can't weigh in on the induction leading upto a CS, but since someone mentioned laboring before a CS, I can speak to that. I had an ECS scheduled for 40w last time, and went into labor naturally at 38w1d. They didn't seem to take my labor seriously at lunchtime when I went in for a check, so I went home and labored there, until my water broke 12 hours later. We went to the hospital, were admitted, hooked up, and ready for surgery within a couple hours. My CS went smoothly, and my recovery was fantastic. I was on my feet the same day, and released 2.5 days after admission. I was off all pain medication within a week, and moving fairly normally soon there after. I'll be having RCS, and am hopeful for a similar recovery given my age, the previous techniques used, and the procedure my Dr plans to use this time, which we discussed today.

My cousin just delivered vis CS due to her son's head measuring in the 98th percentile, and her own anatomy not allowing proper progression. Every situation is different though, and I'd agree that maybe a second medical opinion would be most helpful. Either way, best of luck!

jenb_99 · April 2014

I had somewhat mild PIH at the end of my first pregnancy (consistenly 140/90, no bed rest). DS's head measured 3 weeks ahead and never engaged; therefore, I never dilated, not even with 3 prostaglandin treatments, Cytotec, and pitocin. But I had my heart set on a vaginal birth and insisted that my OB induce me and allow me to labor. DS didn't respond well to the contrax. His heart rate crashed after every one and he released meconium very early. I ended up having a c-section anyway, and DS ended up in the NICU, which set us up for breastfeeding failure, which triggered PPD for me.

I will always wish I'd just gone along with the c-section in the first place. I loved it and had a very easy recovery. I was such a fan that I didn't even briefly consider VBAC this time around, even though my OB allows it.

Go with your gut and your body! There are no trophies handed out in the delivery room. The goal should be a healthy baby (and mother), not the ideal birth story.

bcnoelle · April 2014

My SIL had a planned c-section with a rough recovery whereas I labored awhile and had an emergency c-section (due to being sunny side up, big head, failure to descend) with a relatively easy recovery. So you never know. If it were me and my first, I would try for the vaginal birth, especially if you want to have multiple children in the future.

JKTTC1 · April 2014

My mother had 3 csections due to having a small pelvis. With DS my water broke at 38 weeks. 12 hours later I was ready to finally start pushing, but he wasn't born for another 3 hours.

He had head trauma and a very distorted skull from being in the bc for so long. His APGAR acore was low and had to have oxygen hood for several hours. I had a full episiotomy and the vac was used.

I've talked to my new doctor about all our concerns and he said there are several different types of pelvis' and if I don't progress it's very possible if have a csection this time after such a difficult delivery last time but we will shoot for a vaginal delivery! My recovery from it was VERY tough and lasted weeks...like 9-12!!!

OurNewEngland · April 2014

Thank you so much for all your stories, it really helps to weigh options. My doctor hasn't pushed me into a c-section at all, but is highly recommending induction at 39 weeks (May 1). He's actually on vacation this week and I'm meeting with his female partner tomorrow. She'll be checking me for progress and we can possibly schedule a membrane sweep to get things going on its own before an induction. But I am curious to hear her thoughts on the safest scenario. It's hard to play this out in my mind with so many possible outcomes. I'm no hero and not looking for a proud moment in the delivery room, but definitely want what's safest for my boy. Good to know about head size and positioning as well! I'm pretty confident in the size estimation as he's always been in good position for imaging (we get an U/S at every appointment since week 5), and my DH's head was and still is freakishly huge.

My OB seems confident that my pelvis has adjusted enough to accommodate him, but with the induction looming I'm getting so anxious about how it will all play out.

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