16 weeks – different opinions

This pregnancy has been a rollercoaster since the start, so by now I shouldn’t be surprised when I encounter a fall again after a high point. I expect this will continue.

16 weeks

Last week when I went to the twins clinic, as a follow up from a week’s worth of almost daily blood pressure checks at the day assessment unit (DAU), I saw a lovely doctor. He listened to me, as well as looked through all my results, both in and out of hospital, on their machine and mine. His conclusion was that they’d stressed me out with repeated hospital trips for BP monitoring, and that while we can’t completely ignore high results, he was happy that my mean readings at home with the hospital 24-hour monitor were fine and that I just have white coat hypertension – BP that shoots up in a clinical setting. He trusted that I was happy and capable of monitoring myself, and would say if I spotted a change. I also have no risk factors apart from twins, an excellent gestational history, my blood and urine tests for BP complications have always come back normal, and the echocardiogram I had whilst in hospital on a drip for dehydration showed that my heart was working well. All good.

Since then I’ve been feeling very positive. Dare I say it, for the first time I saw a glimmer of enjoyment in this pregnancy. My vomiting has got less frequent, and although the nausea is still there all the time, it’s much more bearable without so much vomiting. I finally felt like I could start getting involved in twin-related groups on Facebook, and I even started looking at sling options. Again, all good. The only thing that concerned me slightly was that I was experiencing some dizziness even on the lowest dose of the drug to lower my BP, and my home monitor was showing very low (for me) numbers at these times. It wasn’t good having to do the school run and look after Joel whilst feeling light headed.

On Wednesday night though, I couldn’t sleep very well. I knew the next day I had to go back for another appointment, this time a kidney scan – they wanted to check that my acute high BP wasn’t affecting my kidneys, an extra test on top of all the blood tests I’ve had that show kidney function to be normal. I thought that the DAU had also booked me for a babies scan, but actually it turned out they hadn’t (as usual, less than optimal communication between departments and to the patient). It doesn’t feel like I’ll ever get over the anxiety of a scan since the one where they found no heartbeat. So I felt this was what was causing my tossing and turning.

After dropping Joel at nursery on Thursday lunchtime, I headed to the hospital and arrived 5 minutes before my kidney scan time. An hour later I was still sitting in the waiting room. The act of sitting around waiting in a hospital is something in itself that causes me stress. I can physically feel it – I get hot and sweaty, red in the face, I can feel my heart beating faster and harder. After the hour I asked the receptionist when I would be seen, as I had to go and pick up my son from school soon. She said 5 minutes. 10 minutes later I went in for the kidney scan. Unsurprisingly all was fine, with no signs of any damage or malfunction. Eventually I got my notes back with this written in them.

By this time I thought I wouldn’t be able to stay for the other scan and as it was I was already going to be late for Andrew. Thankfully Tom was able to drop what he was doing at work and run (literally!) to school, albeit not on time. The university can hand the bill for his absence to the NHS. So I went to the antenatal clinic as planned. However, as I said, when I got there I found there was no scan booked, but the receptionist said that I should see a doctor anyway being as I was there. Cue another wait in the waiting room, though not as long.

The twins midwife whom I saw before called me in for a BP and urine check. Unsurprisingly BP was high, though actually it’s been higher and given how long I’d been there already and how stressed I was about Andrew wondering where we were, I didn’t think the numbers were too bad. Everything is relative!¬†¬†Also I really wish the staff wouldn’t talk to me during the BP test, even if they think it’ll help calm me down, as it doesn’t help and talking can increase the readings. I’ve taken to ignoring them or smiling, they probably think I’m rude. At least my urine was fine, as it always has been.

After another short wait I got called in by a doctor, and the midwife followed us in to the room too. The doctor looked at all my high BP results in the notes and asked how much of the drug I was taking to try and lower my “consistently high” BP. I explained all about my hospital anxiety, the results of the 24 hour monitor being normal, the fact that I’d been feeling dizzy at home even on the lowest dose of the drug and that my home monitor was showing very low (for me) BP at the dizzy times. I was hoping that they’d say to stop taking it because it was bringing my BP too low.

But even with all the info I tried to give her, she came to a conclusion that was totally contradictory to the opinion of the doctor I saw last week. She said that she didn’t think it was just white coat hypertension, that there was something else going on, and that the lowest dose of drug wasn’t controlling my “consistently high” BP. She wanted me to go back to taking a slightly higher dose per day. I expressed my concern over already feeling dizzy, and she basically said that’s tough, deal with it, she doesn’t think it’s low enough to cause growth issues with the babies, even though it feels very low for my normal BP. She thinks the risk to me of untreated hypertension is greater than my discomfort in looking after children whilst feeling dizzy. And she pointed out a few times that it’s twins so higher risk – yes I had actually got the news thanks, but it’s not like this automatically condemns me to every complication going.

The midwife also chipped in with her opinion, which was basically the same as the doctor, though she did express it in nicer words. I said I didn’t understand how they had completely the opposite opinion from the last doctor I saw. There wasn’t really an answer for that. The midwife then suggested that my community midwife could come and do some BP checks at home for me, in the hope that they will be lower than my hospital ones. I agreed to this. As I found before, they won’t accept my home monitor readings, even though it’s clinically validated, brand new, a respected brand, and reads about the same as the 24 hour monitor I had from the hospital. Just another brick wall to bang my head against.

I couldn’t see myself getting anywhere, the conversation was going round in circles, so I gave in and just said I’d take the higher dose of drug and put up with the low BP. Thankfully they don’t want to see me again until 20 weeks (as long as my community midwife doesn’t refer me back), so at least I can just try to forget the negativity and not stress about it. The doctor said I can always go back if I have concerns – no thanks, I’m staying away for as long as I can, you’ve all put me off! (I said this in my head of course!) Obviously I will continue to monitor myself, as I have been, and if I see evidence of it rising, I will go back, I understand the potential risks, I’m not stupid. Nor am I against medicalisation if it’s necessary, I just don’t understand how it is in this case at the moment.

Finally I got home after a long afternoon at the hospital, and tried to relax. I kept going over what had been said, wondering if I could have explained things better. Again I didn’t sleep so well. Surely this kind of stress isn’t helping anything. The next day I got a call from one of the community midwife team (I hadn’t met her before). She said she’d been asked to take my BP today and could she come round in about 45 minutes. I wasn’t expecting that so soon, so it did throw me as I was trying to rest from my sleep-disturbed nights. I didn’t feel at ease, particularly after waiting longer for her to come and stressing about probably being late for Andrew, again! It was quite high, though not as high as in hospital, but higher than my usual home readings. She was nice though, and chatted with me briefly (I had to dash out to school) about my anxiety. She wasn’t overly concerned and was satisfied that I understand my BP monitoring and signs of preeclampsia to look for, so I would say if I saw a change.

She also suggested learning some breathing and relaxation techniques. I did a pregnancy yoga class when I was pregnant with the boys, and learned some techniques there that I used in labour. So this gave me the idea to order a pregnancy yoga DVD, as I can’t face going out to an evening class at the moment, to refresh my memory from over 4 years ago. I also posted in a gentle parenting multiples Facebook group asking if anyone had had this anxiety out of the blue in a twin pregnancy – plenty of ladies replied that they had, and gave me some great tips on how I could try to minimise it, as well as recounting similarly frustrating experiences of doctors and clinics. Just feeling not alone in this has really lifted my mood.

I feel like this week was a slight knock back for me, but I’m determined to get back on track and feel more positive. Deep down I totally know my body can do this, I’m not afraid of birthing twins, it’s just a case of trying to overcome this physical fight-or-flight response that occurs when I feel under stress from others.

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