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ObGyn/Pregnancy issues/Hypotension/epidural issues

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Hi Cheryl,

I recently gave birth and had an unpleasant experience, and after obtaining my medical records, I'm terrified. I'd like any advice/information/opinions you may be able to give due to your experience with labor and delivery. I had a pretty smooth labor up until I received an epidural top-up. Unbeknownst to me, my blood pressure dropped to 83/37, and wasn't taken again until 12 minutes later and read 98/44. During this 13  minutes, my daughter's heart rate remained stable. In the next few minutes, the nurses noticed the episode and came in to hang a new IV bag. My pressures went up for about 20 minutes to 112/45, 120/50, but then back down again to 108/45 and 98/55. Another 20 minutes went by before that last pressure was noticed, and a nurse came in to administer an IV bolus (according to records, but time on the charting is incorrect, so may have been a nurse error or she may not have delivered the bolus at that time). My blood pressure wasn't checked again for an hour after that, at which time it was normal (112/70). During this two-hour period, my contractions stopped picking up due to the IUPC falling out during cervical check, so many of the decelerations can't be compared to contractions, but there was a consistent pattern of very small decelerations for a long period of time. Variability of the fetal heart strip also began to decrease over this time, and by the time the normal BP was read, was almost minimal, but did eventually become moderate again. At the time, I did not know how low my bps were and didn't know this was an issue with epidurals, I knew none of what I do now. I'm very worried that my daughter may have suffered some damage from the blood pressures. I don't feel that the nurses were paying attention and don't trust the care I received. I'm confused as to how serious these bps are, and how serious the late decels (which were hard to detect, the decels were only 5bpm at a time)were.

Answer
It is typical for epidurals to lower your BP, typically in the last trimester the BP drops significantly on it's own. Meds like Stadol and that of an epidural increase the likelihood for lower blood pressure. As for the delayed decels, 5 BPM is fairly normal. Decels are somewhat normal in small intervals. They typically become concerned once the FHR (Fetal Heart Rate) drops below 100-120 BPM. An IV bolus can certainly increase your BP, as can laying you on your left side or putting you into a reverse trandelenburg position. Reverse trendelenburg is obviously not an ideal position for childbirth, so they tend to opt for an IV bolus, IV meds to elevate the BP or position. I do not believe, based on my previous experience, that this would pose a threat to your child at all. Please always consult an MD with your concerns, as they have a multitude of experience and education to help give you the best answer based on your history. I hope this has helped ease your mind and wish you well. Congratulations on your sweet bundle of joy!

ObGyn/Pregnancy issues

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Cheryl Hatcher

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I can answer any questions concerning any and all pregnancy related concerns including: High risk pregnancies, Gestational Diabetes, multiple birth, premature birth, complications, concerns/worries, placenta previa, toxemia/pre-ecclampsia and more. I prefer not to answer questions that are not related to a diagnosed pregnancy. Please note: You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter, you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition, you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice or discontinue medical treatment because of information on this website.

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I have an astute knowledge of the obstetrical field.

Education/Credentials

I worked in Labor and Delivery at a hospital.

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