abbyw Posted January 7, 2013 Report Share Posted January 7, 2013 Hi,I have just found out that I am expecting a baby. I have quite a long while to go, but one of the first things I thought of was the use of epidural anesthesia. I know that for my last baby, pre-POTS, my BP dropped pretty low immediately after getting the epidural. I would like to come with some sort of instructions in hand for the anesthesiologist, just in case. Thanks,Abby Quote Link to comment Share on other sites More sharing options...
jackiemxoxo Posted January 7, 2013 Report Share Posted January 7, 2013 Hello, congrats on expecting! I don't have any instructions but wanted to offer my experience. I just had my little one (12/20/2012) and my bp dropped with the epidural as well and they gave me ephedrine and it went right back up. I even met with an anesthesiologist beforehand to discuss dysautonomia and what could happen. They recommended slowly titrating the dose instead of giving a large bolus dose (which is normal) to see how I'd react. I think this is a good way to approach it but it can still cause a drop in bp. Most anesthesiologists will meet with you during pregnancy if you ask your OB for a referral and then you could see what they could offer. Quote Link to comment Share on other sites More sharing options...
HopeSprings Posted January 7, 2013 Report Share Posted January 7, 2013 How exciting - congratulations! If you google "anesthetic management POTS" a few articles pop up. This was my experience: I asked my POTS Dr. at the time to write a letter on my behalf (still have the letter) and he wrote "There are no specific recommendations for pregnancy in the literature although volume loading if often helpful. From an anesthetic point of view BP can also be sustained with phenylephrine if not otherwise contraindicated. Between volume loading and phenylephrine things should be quite manageable." I also spoke with the anesthesiologist beforehand and discussed my concerns. He said he was going to look into it for himself, so I assume he came prepared. Anyway, it all turned out fine. I had the epidural and am not aware of anything negative happening. As far as I know, my body did fine with it and no intervention was needed. Definitely let the Doctors involved know about the dysautonomia so they can devise a plan for you. Good luck with everything! Quote Link to comment Share on other sites More sharing options...
abbyw Posted January 7, 2013 Author Report Share Posted January 7, 2013 Thanks for the congrats, we really are very excited, and funny enough, you guys on Dinet are the first to know! Thank you so much for both of your experiences. I live in Israel, where medicine is socialized. I do have the option of hiring a doctor privately should I want to. I have done this in the past for other pregnancy complications. I have heard that people have hired anesthesiologists privately as well. It is really expensive (like $1,500 - 2,000), but I may do it for my peace of mind. That way, I can meet with them in advance, bring them some of the research, and feel better than walking in during labor and handing whoever is on call a bunch of papers and say "read quickly and decide what to do". I have read old posts from Dani, who also mentioned that they titrated the dose up slowly, and that seemed to work.I got a little crazed reading some people's horror stories and some studies which recommend c-sections to avoid any pain or pushing for a Potsie, and that some others docs said no epidurals - so au natural! So much conflicting and contradictory information. I have done half of my kids with epidurals, and half without, and I would like to know that I have my options open, if need be, Quote Link to comment Share on other sites More sharing options...
Altruism Posted January 7, 2013 Report Share Posted January 7, 2013 I did not know I had POTS while I was giving birth to my son 2 months ago, so no precautions were taken. However, after the epidural, my blood pressure and heart rate were sky high - 160/110 and pulse 150-170. The nurse kept telling me it's normal, but I knew it wasn't. Just wanted to let you know that there are POTS mommies whose vitals go up instead of down with epidurals. Quote Link to comment Share on other sites More sharing options...
abbyw Posted January 7, 2013 Author Report Share Posted January 7, 2013 HI,I guess I will never know if my previous labor issued were do do POTS stuff in my system before I knew it, but as I said in my original post, my BP went really low and they were not happy with the baby's heart rate. They kept losing it. There were lots of nurses coming in and out and rearranging the monitor. I kept asking if there was a problem and it was "no, no, everything is fine." Then ,they called the head nurse who called the doctor and lots of people were running around. They kept telling me everything was perfect. Then, the midwife said "You have an epidural, right?, let's get this baby out " and - sorry for the graphics - but manually stretched me from 6 to 10 and said "now push". She was born 2 minutes later, a little purplish bluish, but otherwise perfect.There is no way of knowing now, of course, but I wonder if some of that was related to my very low BP.I would like to avoid that kind of excitement this time around. Exciting enough to hear boy or girl.Thanks again,Abby Quote Link to comment Share on other sites More sharing options...
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