Tuesday, September 21, 2010

Three years later, we get some answers

You know those questions that linger in your mind for years and one day you come along to the answer? That happened to me the other day while reading Holistic Midwifery by Anne Frey.

In my first pregnancy, one of the most upsetting events was being inaccurately diagnosed with pregnancy induced hypertension. At a 34 week prenatal appointment, my blood pressure at the start of the appointment was 160/89. That is a higher reading than my normal which was closer to 140/70. It also just happened to be a particularly stressful day where I was having a hard time holding down food, was late to my appointment by a traffic jam on the freeway and parked a half mile from the clinic and walked/ran to get there as soon as possible, all after facilitating a class for 14 2 year olds for the morning.

In researching the clinical diagnosis standards of PIH (pregnancy induced hypertension), I found that its only diagnosable after two systolic (the bottom number) readings over 90. First, it wasn't over 90 and second, it didn't happen twice. But regardless that was enough for the midwives in the practice to tell me in no uncertain terms that I needed to go on bedrest immediately.

In trying to understand the statistical risks of increasing blood pressure in pregnancy, I couldn't get very clear information from my providers. Not on what causes it, what it means and what the chances were of a poor outcome to occur, or effective ways of lowering blood pressure, what my physical needs were at that point in pregnancy. My husband and I were both frustrated but decided that bedrest might not be a terrible thing since it would give me time to work on my masters degree before the baby was born. At the time, we figured that we were hedging our bets and being more safe than sorry.

The side effects of bedrest could be a whole other post, actually. But to what I learned about high blood pressure and what it had to do with my pregnancy.

Anne Frye taught me that it was pretty obvious that I was malnourished during my pregnancy.

"Liver-related demands increase as pregnancy advances. Maintaining lifer function at peak efficiency requires a well-balanced diet with enough protein, calories, vitamins, salt, other minerals and fluids to meet the demands of increased metabolic activity. The liver can only make albumin (maintains blood volume through attracting an appropriate amount of fluid into the bloodstream) from dietary protein. If the diet in inadequate in an essential nutrient, the pregnancy suffers. If calories are inadequately supplies in the mother's diet, she will burn protein for her energy needs. Malnutrition due to a lack of either calories or high quality proteins can result in many complications of pregnancy...[including toxemia or blood pressure issues]. (p, 195)."

Because of the increased blood volume of pregnancy (+50-60%!), the liver must work harder to meet the requirements of the baby and placenta. The kidneys respond when there is not adequate blood volume by reabsorbing larger amounts of water and salt as they filter the blood and/or by producing a substance called renin which constricts the blood vessels. When the blood volume is low and the blood vessels constrict around the available fluid, blood pressure is increased and it can be seen in blood pressure changes like what I experienced.

Its no surprise that day I was feeling terrible with dehydration and lack of food!

It wasn't just an isolated day that led up to it. Throughout my second and third trimesters, I was exhausted most of the time and really struggled eating enough. I would get home from work, eat a can of prepared soup and then take a 2-3 hour nap. I felt like I couldn't get enough protein no matter how hard I tried. Even carrying around snacks and eating often, I was either too busy working or too tired from working that I didn't have enough energy to prepare food for myself. I frequently skipped or did not have a good breakfast and then my insubstantial lunch.

With this information, I'm able to make sense of why I was so tired. Working while pregnant, though not a terrible decision, placed stress on me that I did not prepare or compensate for very well. There has been some research that shows that pregnant women working can predict high blood pressure and preeclampsia, which could also be its own post...

The bottom line is that I struggled to eat well during that pregnancy. I even remember a time that I was so weak and tired that I called a woman from my church who came and brought me food. Eventually it negatively affected my pregnancy.

Unfortunately, its pretty common for providers to not understand the physiology and connection between nutrition, blood volume and PIH. My husband also appreciates learning this because it finally filled in the missing information we wished we had and struggled to access at the time.

Anne Frey's calls this blindness in the medical community a political as well as feminist issue. It is very important to understand the cause of increased blood pressure in pregnancy instead of treating it after when it becomes preeclampsia and a woman is experiencing seizures.


TopHat said...

I'm glad you got an answer. It is amazing how much nutrition can affect pregnancy- and it is so hard to eat well when pregnant! Pregnant women need more info than "eat less sugar and more vegetables and protein" and they need people around them who'll take care of them like partners who'll pick up some of the chores/duties that are keeping mom too busy and tired.

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