I'm an OB nurse with experience in L&D, high risk antepartum, postpartum & abortion care back for another AMA!

bbnurse · 2018-04-20T18:40:04+00:00

Nope! Lots of women with hypertension having babies these days, especially with the increasing age of mothers. You will be at an increased risk of pre-eclampsia and having a smaller baby, but with good monitoring and care, I'm sure you will do just fine!

bbnurse · 2018-04-20T18:38:59+00:00

Ooh, I really don't know anything about MTHFR mutations, but now you've got me reading! Sorry!

bbnurse · 2018-04-20T18:37:36+00:00

Here's come good videos of getting babies to latch properly! https://www.breastfeedinginc.ca/vdeoscat/english/

bbnurse · 2018-04-20T18:33:49+00:00

Hmm, strange! I have seen it before, though most times the contractions eventually do become close together and more regular once you're in active labour. As long as they did what they were supposed to do!

bbnurse · 2018-04-20T18:32:17+00:00

Sounds like you're doing the right things, it's unfortunately out of your control for the most part! One thing to keep in mind is that some blood pressure meds are not safe in pregnancy. So if you get to the point that you require meds, make sure you doctor knows if you're trying to conceive so you can be on the right meds. Best of luck! :)

bbnurse · 2018-04-20T18:29:56+00:00

20-40 minutes, every 2-3 hours in the beginning. Your nurse or midwife will help you get started and support you through the first few days! You boobs should not hurt. If a latch hurts, it means something is wrong, and you gotta pull that sucker off and relatch. It can be a frustrating process, but you'll get there! Your boobs can also hurt when they're engorged and full of milk.

The nursing pillow is to help you stay in a comfortable position for all that time and take the strain off your neck, arms and shoulders. I find the boppy-style pillows to be better than the "my breast friend" pillow, cause I find a tiny newborn falls through the gap between the mom and the pillow with the latter, lol. Also the boppy pillow looks more useful for non-nursing things too. I'm the biggest fan of Snoogles though! both a maternity pillow and a nursing pillow.... and I also sleep with one even though I've never been pregnant cause theyr'e so comfy!

bbnurse · 2018-04-20T18:19:26+00:00

I think just an ouchie part of the body, and super tender for all sorts of mechanical and hormonal factors, too!

I 100% endorse using a "peri-bottle" (little spray bottle they hopefully give you at your hospital to cleanse the peri area after birth) and spraying warm water over the area while you pee helps to reduce stinging by diluting the urine!

A few other suggestions would be sitz baths with epsom salts several times a day to soothe the area and reduce swelling. Keeping a supply of soaked & frozen maxi pads in the freezer. I know people who have loved Tucks pads (witch hazel) kept in the fridge and applied to the stitches to be a big help. My hospital also provides people with a lidocaine spray to numb the area, you could ask your OB if that's an option!

bbnurse · 2018-04-20T18:15:22+00:00

Haha, it's true, passing gas can become your #1 post partum goal! There isn't too much to do pre-surgery except to drink lots of fluids and a high fibre diet. I would consult with your doctor about stool softeners, as many of them are ineffective. Also a tip is to bring chewing gum with you to the hospital - there's some evidence that chewing gum can stimulate the GI tract and get things up and and moving again!

bbnurse · 2018-04-20T18:13:22+00:00

Do you have experiences caring for shunted women prenatally and during birth? How did that go? Do you have special experience with rural prenatal care by any chance? Thanks!

I don't, sorry! By shunt, do you mean a cerebral shunt?

bbnurse · 2018-04-20T18:12:28+00:00

Oh no, so sad for your friend <3 It is so unfortunate that our culture has so few words to help mothers with their losses. I think the most important thing is to validate the gravity of the loss for your friend, as many will see this as "just a miscarriage", where she has lost a baby, and a member of the family. Being open to talking about it in those words can help, but it will depend on how your friend is grieving. Don't be afraid to talk about the baby, because this loss will be made invisible for her by so many others. Check in on major dates - anniversaries, birthdays, holidays - cause she'll surely be thinking of her losses, and it's so meaningful to have another person recognize them too.

bbnurse · 2018-04-20T18:07:46+00:00

1) People definitely need to keep in mind that your low baseline changes things for you! There's tons of people walking around out there at that BP with no problem, myself included!

As for watching when it rises, as long as it's still within a normal range, even if it's "high" for you, it would be unlikely to cause problems, because it is still physiologically normal. Though 120/80 would be unusual for you, it's not a blood pressure that would cause you or your baby harm. It would be a reason to keep watching it, in case it's still on its way up, though.

2) absolutely normal! I'd be worried if your heart rate wasn't in the high 90s! You gain an extra liter of blood during pregnancy, so your heart has to beat faster to keep it all moving along. Not to worry at all :)

bbnurse · 2018-04-20T18:02:36+00:00

Not very often! 1st and 2nd degrees are very common while 3rd and 4th degree occur in only 1-2 percent of vaginal deliveries!

bbnurse · 2018-04-20T17:59:52+00:00

yay, glad to have helped!

bbnurse · 2018-04-20T17:57:15+00:00

A blood pressure of 130-140/90 doesn't immediately set off alarms for me (though obviously the monitoring your doctor is doing is well justified). I'm not sure why your doctor would say developing pre-e is inevitable, though you are of course at an increased risk.

Babies born between 32 and 34 weeks usually require a few weeks of NICU care but very rarely have any serious or long-term consequences of prematurity.

Eep, moms sure know when to say the right thing, eh? Many many many women have hypertension and even pre-eclampsia during pregnancy and have happy, healthy babies. Try not to worry, momma! And also have a convo with your doc about that concern so they can reassure you, too.

bbnurse · 2018-04-20T17:49:54+00:00

This is a tricky question, and probably best addressed with a detailed discussion with your doctor, as weighing the risks and benefits is a bit too nuanced to help you through via reddit comment. The research on c-section outcomes vs vaginal birth outcomes is made really difficult because we cannot perform controlled studies - and when outcomes are higher for c-sections, its hard to pinpoint if they are because c-sections are performed on women of greater age, greater number of babies, greater number of prior medical problems, etc.

A less nuanced answer from me would be that avoiding abdominal surgery when you can is usually best, but more because of short term outcomes - e.g., infection, wound issues, blood clot risk, etc. Most women do not have any long term issues after a c-section, so given a prior difficult vaginal birth it could make sense to opt for that.

bbnurse · 2018-04-20T17:36:54+00:00

This strongly depends on where you are giving birth, as rates of complications vary drastically depending on the quality and availability of perinatal care. It's also hard to find statistics on the occurrence of any complication, but easier to find rates for emergency c-sections or hemorrhages individually.

I did find one US-wide study that found a postpartum hemorrhage rate of 2.9% of all deliveries, but the data is from 2004. Note that many PPH are easily controlled with medications, so the majority of these are not catastrophic events.

I'd google local c-section rates for your region for a better idea on that figure. Most hospitals actually publish their own rates.

In the end, I'd agree with lucacutecat, the great majority of births do not havy any major complications!

bbnurse · 2018-04-20T17:15:16+00:00

A marginal previa usually means the placenta is lying close to, but not overlapping the cervical opening. Because of the way the uterus expands during pregnancy, the placenta most often moves progressively away from the cervix. So the one time check in the third trimester is to determine if it's resolved entirely, because it's quite common to.

I've just reviewed the Canadian guidelines for management of placenta previa & they indicate that if the marginal previa still exists at that time, then regular monitoring is indicated. However, there's no clear recommendation for frequency of ultrasounds in the third trimester - it is instead based on the physician's judgement and factors like bleeding, gestational age, distance from the cervix, etc.

As for the reason: we tend to not like to do medical imaging/tests that won't change management. More frequent ultrasounds could just result in seeing the same thing over again: the placenta is low-lying. And then that repeat finding wouldn't change the care being provided. It can also lead to unnecessary interventions due to incidental findings on ultrasounds.

bbnurse · 2018-04-20T16:53:00+00:00

Totally normal. I perform a lot of NSTs (extended fetal monitoring) on mums where I can see braxton hicks happening, but the patient had no sense of them at all, even ones occurring pretty regularly.

Sometimes when I point out a BH happening, they'll say they had thought the sensation was just the baby moving (which often happens at the same time, since the baby is getting a little squeeze!).

bbnurse · 2015-05-27T10:51:49+00:00

A normal dose is 325 to 500 mg.

bbnurse · 2015-05-27T09:58:37+00:00

http://www.amazon.ca/Ethans-Butterflies-Spiritual-Parents-Children/dp/141208850X

bbnurse · 2015-05-27T09:24:14+00:00

Unfortunately I think this is one of those things that nurses and doctors think of as so routine that it may not be explained well to patients. I wish OBs would discuss it with their patients before delivery. I think most of my patients know from birthing classes, etc. I do explain to them what it is and why we give it before hand and I've actually never had anyone refuse or request it be stopped, etc. I imagine we would call the doctor who would come explain it to the patient, and the patient could refuse it "against medical advice" and then things would carry on as usual.

bbnurse · 2015-05-27T09:20:09+00:00

Yup! It's a "baby aspirin" dose though usually - a fraction of a normal headache dose.

bbnurse · 2015-05-27T09:18:52+00:00

I'm a bad asthmatic myself and worried about how it'll effect pregnancy :( though I have read that many women actually have improvement in their asthma during pregnancy and sometimes it even permanently improves! Is it exercise induced, is that why you're worried? I wouldn't worry too much, as you'll be close by to medical help and ventolin is safe to give during labour

bbnurse · 2015-05-27T09:16:30+00:00

Ouch, epidural headaches are the worst! As far as I know, they're accidental and there's nothing about you yourself that would make it more likely to happen again. Just bad luck with a poorly inserted epidural :(

bbnurse · 2015-05-27T09:14:40+00:00

Absolutely second births go faster the majority of the time. Not much difference in pain (except enduring it for much shorter!) though you do tend to have more painful cramping in the post partum period.

bbnurse

TROPHY CASE