Pregnancy Questions. Need Help!

[Gemma]

Hi everyone! I am 5 month pregnant and trying to get more information about pregnancy and labor with dysautonomia.

If anyone who went thru pregnancy can recommend any useful info.

What kind of anesthesia are we able to get if needed C-section?

How about epidural, are we allowed to get that?

Is vaginal labor better for us or C-section?

I was told we are not considered high risk, was anyone told differently?

Do I need to let any important info to my doctor?

What might go wrong?

Also, how everyone was feeling during pregnancy? I am so so, fatigue better, but have occasional presyncope flares. Also, has this weird pressure inside my head which makes me totally spaced out and foggy and goes away when I lay down. Is this a POTS symptom or pregnancy? I didnt really have it much before.

Thank you all!

[SarahA33]

Hi Gemma!

I Missed the pregnancy announcement..my congrats though!

Be kind to yourself! Who are you are you working with now?

Sarah

[Gemma]

Hi Sarah. What do you mean who I am working with? Did you mean the doctor?

[SarahA33]

yes

[Gemma]

Ohh, no one for POTS. Just my primary as needed and obgyn for pregnancy. None of the POTS/OI docs were helpful so i just stopped looking for one. 2 years of trying to find a good doctor was enough!

[Gemma]

Is this post appearing on the forum at all? I wonder why nobody answers? I am pretty sure lots of women here went thru labor and delivery and I would really appreciate some recommendations. Thank you all.

[MomtoGiuliana]

Hi Gemma--I think everyone's experience is different. Many POTS patients have pregnancies without significant problems. I think it is good to be under the care of a high risk ob-gyn not b.c you are high risk but that you might need to take meds for POTS during pregnancy or might need special considerations during labor. High risk Ob-gyns are more knowledgeable about interventions/meds, etc.

The feeling in your head that you describe is common for both POTS and pregnancy, I think. It can be hard to tease apart what is a POTS and what is a pregnancy symptom. For some women pregnancy exacerbates POTS but others actually feel better during pregnancy.

[Gemma]

Hi, thanks for a reply. I am actually under the care of high risk doctor. But I only saw him 2 times and he said if needed he will see me again if any complications. I asked him if he can recommend wether vaginal or c-section is better but he said it doesnt matter for POTS. He knows of this condition well, but no real recommendations from him as to labor and delivery.

This is the reason why I posted here in hopes to get some answers. I did hear before that we can not get certain anesthesia and the epidural needs to be administered special way, but I don't have exact details. If anyone is familiar with this information please let me know.

As to head pressure, its so weird that I feel it when I sit or stand but it goes away after 5 minutes when I lay down. I googled it online and something like CSF leakage come up. Well hopefully it just goes away, because being pregnant and having some leakage is no fun .

Thank you.

[MomtoGiuliana]

I had POTS but was not diagnosed until after pregnancy. So I can't answer as to how it was managed in my case, bc it wasn't managed at all! Perhaps post another topic w a specific question about anesthesia and maybe you will get more responses, if you don't get more responses in this topic.

I do know people have had both vaginal and C-section deliveries on this forum.

A sensation in your head that is relieved by lying down does suggest POTS. I would talk to your dr about it.

[sideofsalt]

Congratulations Gemma! I am deciding whether pregnancy is a possibility for me as I developed POTS about a year after I stopped nursing my son. I had an uneventful delivery and POTS was not discovered then so I don't have any experience to share with you. I feel it is frustrating to not have more answers going into it, but my doctors have told me that we just don't know how our bodies will react until we are actually there.

The more I consider pregnancy, I wonder about the realities, such as how to really get off my medication. Can you share how you stopped your medication prior to pregnancy or did you just quit when you learned you were pregnant? And how symptomatic (and what types symptoms) were you just prior to pregnancy? Many thanks and best of luck with your pregnancy! I hope your symptoms resolve soon.

[corina]

Congratulations on your pregnancy Gemma!

[jackiemxoxo]

Like someone else mentioned, everyone's experience is different. To me, vaginal birth was preferred because c-section is major surgery and I didn't think I would be able to handle anesthesia well but be prepared for anything. While I was pushing, my heart rate would jump all over the place but luckily my OB understood and let me guide what I could handle. I got an epidural which my pots doctor said was fine but I had it titrated because I am hypersensitive to medication. It made my blood pressure drop and they had to give me ephedrine and that made my blood pressure shoot up right away. I am more hyperpots though and my blood pressure was raising during the last month of pregnancy so I was induced. I felt really potsy after birth for about 2-3 weeks but after that things improved. I think pregnancy was miserable during first trimester but was really good during second. I felt better than then when not pregnant. This is just my experience, I hope your pregnancy and delivery go smoothly!

[abbyw]

Hi and congratulations.

I had a baby a year and a half ago with POTS. My POTS is pretty controlled with an SSRI, so I was on that throughout the pregnancy. I had a vaginal delivery. I warned the anesthesiologist about my POTS and they didn't seem to take me too seriously. When they did give it, I was in a faint within a few minutes. A little epinephrine and we were good to go.

Since then, I had a miscarriage around a month ago. For that, I was under general anesthesia. Again, I warned them. They took me more seriously and seemed a bit nervous, but everything went just fine.

I hope that makes you feel better about the whole thing!

As a side point, the pediatricians were more nervous about my SSRI. They had me stay an extra 24 hours so that she cold be under observation for her first 72 hours. (Even though that is protocol for 80mg of Prozac, and I take 20, but I was happy to be on the safe side for that one.) Baby was fine too!

I hope things go well for you too!

Abby

[Rachel]

Hi Gemma,

Congratulations! I'm so happy for you. I hope that everything goes well for you with labor, delivery, and motherhood.

I have had two full-term pregnancies, and everything went very well. I didn't have any complications with POTS even though I'm fairly disabled from dysautonomia.

First pregnancy and delivery:

I didn't take any medications during this pregnancy. I did wear compression hose during pregnancy, plus drank lots of water.

My son was born in a hospital with a midwife attending the birth. I hadn't planned on having a midwife, but she worked at the OBGYNs office, and I liked her so much that I kept going to her. There was a high risk OB at the practice, but they didn't see a need for me to go to her. The midwife was comfortable having me as a patient, especially since the OBs were on call should there be a complication or need for a c-section.

I wanted to go through labor as naturally as possible because I didn't know how my body would react to pain meds or an epidural. I did end up needing an epidural toward the end, and I didn't have any problems or complications with that. I had gone into labor just before midnight (and had never fallen asleep that night at all). As the day went on I became so sleepy and fatigued. By 5:00 in the afternoon I was REALLY in need of rest and sleep. At that point I chose to have epidural so that the pain would go away and I would be able to sleep. Once the pain went away, I slept for half an hour. It was a much needed nap! Soon after that it was time to deliver. Delivery went smoothly. There weren't any complications for the baby or for me.

Second pregnancy and delivery:

This time around I went to an OBGYN. I would have gone to the midwife who had delivered my son, but she was in Alaska, and I was living in Kentucky. So I went to an OBGYNs office that was recommended by friends. They did refer me to a high risk OB for a consultation, but the high risk OB didn't have any reason for concern, and she said I could return to the regular OBGYN office.

The second time around I planned to be induced in the late morning. I didn't want another experience of 48 hours with almost no sleep. My health deteriorates quickly without sufficient sleep. I also planned on getting an epidural once I got too tired and was in need of pain relief so that I could take a nap.

But all of those plans changed two days before my scheduled induction. An ultrasound showed that my daughter was really big, and we decided it was too risky to try inducing and delivering naturally. I had a c-section instead. I had an epidural for the c-section, and that went well. Delivery went well, and my daughter was big, but healthy.

There are pros and cons for both. If I had to do it again, I'm not even sure which one I would choose!

It was more fun doing a natural delivery. Recovery was also quicker and less painful. But I was so absolutely worn out after the marathon of labor, and 36 hours without sleep was especially difficult.

The c-section was quick and didn't result in any sleep loss. There was very little pain involved with the c-section during prep and delivery. But the c-section is a more painful recovery. Even now, 5 years later, there is still a spot on my abdomen that is extra tender.

I hope this helps, and I hope that everything goes well for you.

Rachel

[Rachel]

I forgot to mention that I did take medications during my last pregnancy. I took midodrine, doxylamine succinate, and omeprazole, plus all of my normal vitamins and supplements. All of this was under the supervision of my OBGYN.

[Gemma]

Wow. Thank you all for replying. I greatly appreciate it. Its very scary not to know what to expect, especially that lots of obgyns do not know much about POTS. My high risk also told me that I do not need to be seen by him, unless I will need some meds. So i am basicly seen by regular obgyn.

I had 3 different clinics that i visited and it was so difficult to choose. Maybe someone can recommend what would be the best choice for my delivery. One doctor that i saw is very nice and she is the only one in the practice, which means she will be delivering the baby. But she is not familiar with POTS. Also, she is affiliated with the hospital thats closest to my house but I had a bad experience there with my POTS visits. Every time in ER they basically gave me anxiety diagnose instead of POTS. Also, none of the stuff in the hospital new what POTS was.

Another doctor, is with a different hospital which is like 5 minutes farther then the first one. I know her for the past 7 years that she has been my regular obgyn. She doesnt know about POTS either. She is very nice doctor and the only one in the practice also. However, In order for me to stay with her I have to see another risk doctor who is affiliated with that hospital, plus I have no cardiologist that affiliated with this hospital, just in case something goes wrong.

Now 3rd obgyn group has like 5 doctors, which is a negative because no personal care. Anyone of them can deliver the baby depending who is on call that day. However, most of docs there are familiar with POTS. Also, my risk doctor is affiliated with this hospital and also the first one that I mentioned above. Plus the hospital that they deliver at specializes in cardiology and also has the best neonatal care out of all 3 of them. I was also seen by electrophysiology cardiologist at this hospital as well. Few times that I was at ER there the staff new about POTS, even technicians. They always ran a mini tilt table test on me there. Also, the obgyn gave me numbers of anesthesiologist to call and meet with them before delivery. Also, she said during labor they bring in cardiologist on staff, just to see how I am doing and in case something goes wrong. So whats negative with this hospital is that its a teaching hospital they can have resident in the room during delivery and even sometimes checking my vitals and stuff. And another negative is 5 doctors so not much personal care.

Sorry I wrong so much. But whoever decides to respond can you recommend what you think will be the best and safest choice for me. My husband wants a 3 hospital because he says he will worry less for me and the baby this way. But I am thinking that with our condition they should be able to take care of me at any hospital. What do you think girls? The other hospitals are more homey style local hospitals. The 3rd one is like a teaching hospital. All 3 of them are pretty close to house, like 15-25 minutes, so time is not an issue.

Thank you all!!!

[Susan3]

Hi Gemma,

Congrats on your pregnancy!

Below are links to 2 articles you may want to review with your doctors.

I have delivered two healthy babies with no major complications. I was under the care of a high risk doctor at a teaching hospital, which if anything, made me feel secure that they were taking POTS seriously. I met in advance with the anesthesiologist to come up with a plan for how my delivery would be handled. A c-section is major surgery and they thought there was no reason to plan for that scenario in advance unless an emergency situation arose. Personally, i agree.

The anesthesia was handled very well, they strongly encouraged an epidural early so i wouldnt get too tired out and they could very slowly titrate levels up to see how i was responding. I also had loads of extra saline to keep me well hydrated.

Feel free to PM me if you have any specific questions.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894719/

http://www.ncbi.nlm.nih.gov/pubmed/19659618

[corina]

Thanks for the articles Susan!

[shan1212]

Hi there and congratulations!

I have hyper-POTS; looking back, I've had it since I was 14, but I wasn't diagnosed until my second pregnancy. It wasn't until my first daughter was a year old and I weaned her and got my cycle back that I started having POTS flare-ups. Then when I got pregnant with #2, POTS had me flat on my back for much of the first trimester, and that's when I was diagnosed. I did begin to feel better during the second trimester, though I was still tired, but at least functional.

My first delivery was a c-section that I believe was avoidable. With my second I decided I wanted a vaginal delivery, partly to avoid the anesthesia issue, and also the recovery from surgery. I went into labor naturally on my due date (was not aware of the early stages of labor, so it felt like I was just suddenly in active labor, ouch!). I got to the hospital at 8 cm. The contractions made me have adrenaline surges, so I got an epidural at nearly 10 cm. The nurse anesthetist knew about my "heart thing." I had fluids beforehand. The epidural did the trick and after a long pushing stage, I had my daughter vaginally. The recovery was much easier than a c-section. I had some tenderness and swelling on the second day, but by day 3 was pretty much back to normal. With the c-section, it took a week or two to feel like I had full use of my lower body. And just personally, POTS or no POTS, the vaginal delivery was a better experience because I got to hold my daughter immediately. With the c-section, they took her to the nursery and I was barely with her for the first two hours (they've since changed their protocols at that hospital and don't separate newborns and mothers without reason any more). If it were me I would try for the vaginal delivery and take it from there.