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Gestational Hypertension

I’ve had my first “traumatic” experience.  One of the clients I worked with was having difficulty managing her blood pressure and it of course spiked into dangerous territory. I knew this was a possibility, I knew it happened to some women.  But until recently, I never personally knew anyone it had happened to.

Before nursing school, I sort of understood blood pressure was a measure of overall health. I didn’t really know what it meant or why it was important.  I just knew if it wasn’t good you would be told to stop adding salt to your food.

Some would say nursing school has made me “fearful” of high blood pressure (hypertension) because I now understand this is something to be avoided. I want the families I work with to maintain healthy blood pressures, and honestly this should be manageable for most people. But it isn’t always easy to eat right and exercise (the two key factors to maintaining a healthy blood pressure). I also know if people understood the damage hypertension does to their bodies they might be more inclined to find time for that exercise and to eat right.

But I don’t understand gestational hypertension.  I don’t understand why one woman’s body responds to pregnancy this way.  I don’t know why, even with excellent nutrition and exercise, some women simply cannot maintain a healthy blood pressure during pregnancy.  And I cannot even begin to guess why some women can have gestational hypertension and return to normal after pregnancy with no ill effects while other women get progressively worse overall leading to placental problems and preeclampsia.

I guess that is why gestational hypertension seems so scary to many practitioners. It is something you cannot predict, often cannot control and can become dangerous very fast.

My questions today are about my responsibility to the families I work with.  At what point does providing information about diet and exercise become pushy and demeaning? At what point does my responsibility to educate meet their responsibility for their own health? I ask this because I know my role as a midwife is limited – decisions are not always in my hands when a woman develops gestational hypertension.  So if I am going to help her, I need to do my best to ensure she does not develop gestational hypertension. But I cannot chose what she eats, I cannot chose how she exercises, and she can do everything right and still respond with gestational hypertension.

I’ve always thought I was comfortable with the uncontrollable nature of pregnancy and labor.  But right now, I don’t feel comfortable with gestational hypertension.  I’m sure I’ll learn to understand the subtle signs mothers exhibit that will tell me if they are in danger or if they will be OK, but for right now it just feels overwhelming.

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Jennifer Vanderlaan CNM MPH is the author of the BirthingNaturally.net website. She has been working with expectant families since 2000, training doulas, childbirth educators, and midwives. She has worked with midwives in Central America and Sub-Saharan Africa. Her interest in public health grew in 2010, and she is now a PhD student learning to become a producer of knowledge.

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