Pregnancy And Pots

[sonshine456]

I know there's a lot of old discussions on pregnancy and pots but I would really like to talk to others who have gone through this. I'm about 8 months pregnant. It's been going really well but now there's discussion going on between dr's as to what to do about delivery. For those of you who have had babies with pots I would appreciate chatting with you a bit. I have a number of questions but I'll start out with asking what kind of delivery you had...natural, epidural, c-section, general anesthesia?

Thank you!

[MomtoGiuliana]

I had POTS but was undiagnosed until after pregnancy (it was all in my head until I saw an electrophysiologist when my daughter was 4 months old.) I had an induced labor b/c I was late and my bp had started rising. Unfortunately during the induced labor I had placental abruption and had to have an emergency c-section with huge loss of blood--I had to have a blood transfusion. I was debilitated for months b/c of the combination of this highly traumatic event and having POTS. If I were to have another pregnancy my ob-gyn (new one, I am seeing a different dr now) said she would recommend a planned c-section at 37 weeks.

Many POTS patients on here have had normal vaginal deliveries. I don't think POTS necessarily requires any interventions during labor and delivery. It depends on your individual situation.

Best of luck and congratulations!

Katherine

[Rachel]

Hi sonshine456. Congratulations on your upcoming arrival!

I'll share some about my labor and delivery. I wanted to do everything as naturally as possible because I don't often react well to meds and I heal very slowly, so I wasn't sure what interventions would do to me. I went to a midwife, but we did the delivery at the hospital just incase. I wasn't sure if I'd have the strength to make it through delivery (I'm very weak - in a wheelchair because of fatigue and muscle weakness as much as orthostatic intolerance), so we wanted to be in a hospital incase a c-section was necessary. But that was only an absolute last resort because of my slow healing.

I went into labor naturally at 41 weeks. Labor started at midnight and I hadn't gone to bed yet. So I started everything on 0 sleep. That wasn't good! But I made it until the next afternoon. Labor was progressing, but I was no longer holding out well. I was way beyond tired. I had nothing left. It got to the point that I either had to get some sleep or I'd have to have general anesthesia and have a c-section.

Due to my history with insufficient healing, we went the epidural route. The midwife also added some petocin to speed things up for me because my uterus wasn't contracting as strongly as it should have been. Everything went very well with the epidural and petocin. The epidural took the pain away so that I could get some much needed sleep. I slept for about an hour and then it was time to deliver. It was hard work, but thankfully I'd gotten some sleep. Plus, by then adrenalin kicked in. So that helped me to get through. I rested sometimes too instead of pushing and that helped as well. And eventually my baby boy arrived healthy as could be.

If I had to do it all over again I would just choose the petocin and epidural from the beginning. It would have enabled me to sleep so that I was more rested going into that first week with a baby. Labor takes a lot out of you. We just didn't want to do the epidural due to my history of med reactions. Plus an epidural can lower bp, so that is something to take into consideration. My bp stayed normal, though, and we had no problems.

If you have any more questions, just ask. I hope that everything goes well for you. Do you have help lined up for after delivery?

Take care,

Rachel

[trisharose]

Hello fellow pregnant Pots friend! My name is Trish! I am pregnant also. I am not due till december though. I was diagnosed with POTS after the birth of my sescond child. This is my third child I am pregnant with now and my first POTS pregnancy. I asked my dr. about all your worries and they told me that the natural the delivery the better. They said if I need meds and etc it is possible but its easier on me and easier for me to recover due to POTS if I try to have the baby as natural as possible.

With that said after My diagnosis I had several surguries and was under anesthia and etc numerous times. It did not affect my POTS at all. I even was on alot of pain killers fro pain and they did not affect me at all. So i would said go with your gut and research as much as you can.

If like you said and your not really having problems now I wouldnt sweat it. Soon you will have a precious baby in your arms and nothing else will matter!!

off the stubject. Your the first person I have met with POTS and pregnant at the same time. Was it hard in the begining of pregnancy?? My dr. took me off all my meds already for POTS to protect the baby and im super dizzy and just need to lay low for awhile and cant do much. Does it get better the farther along in pregnancy you are?? Im only 3 months so i got a long time to deal with pregnancy and POTS symptoms all at the same time!! I would love your opinoin!

GOOD LUCK and congrats on the baby!!!!!!!!!

[MomtoGiuliana]

Most women with POTS seem to feel better as the pregnancy progresses. I was the opposite.

Katherine

[doctorguest]

Congratulations on your pregnancy! There have been several case reports published on the topic of pregnancy and labor and delivery in women with POTS. Most involve either an elective C-section or some type of intervention during the labor. These reports are just isolated cases and by no means represent the standard of care or practice. However, these do raise awareness as to the special precautions and considerations that should be made for women with POTS who is ready to deliver.

I know that spinal block, which is the type of anesthesia typically used for C-section, can have various side effects because it induces a block of all of the outflow information - sensory, motor and autonomic - below the upper thoracic level, whereas the epidural block has much less consequences because it blocks sensation at the lumbar level. I am also aware that in certain cases, a C-section can be done under epidural rather than spinal anesthesia, but this should be discussed in details with the OB and an anesthesiologist who will be performing the procedure, if this is elected as an option.

I think the choice ultimately depends on your POTS status now and immediately before pregnancy, as well as the general pregnancy status, size of the fetus, number of prior pregnancies/deliveries, etc. Additionally, as you get closer to the due date, things may also change to influence whether vaginal delivery or C-section is indicated. One other thing that I want to add is that natural birth without analgesia may not be the best choice for POTS patients, in my opinion, since pain is a very strong stimulus that normally causes BP and HR changes in a healthy person. However, for a woman with an autonomic dysfunction, it may create an even bigger problem during the labor and delivery. Good luck with the rest of your pregnancy, and I hope your labor and delivery goes smoothly.

[sonshine456]

wow, thank you all for your responses.

This is my first pregnancy and I was diagnosed beforehand with pots and have it under control with Mestinon. They wanted me to stay on Mestinon throughout the pregnancy-they weren't concerned with me being on it. Things have been pretty good so far. Just the typical ups and downs of pots. I also have to factor in the fact that I have a very small chiari malformation (i've been told it's not a cause of concern) which is I believe the biggest issue for my anesthesiologist at the moment and he wants to play it safe and do gen. anesth. but my perinatologist doesn't want me to have a c-section because of POTS. So that's where I'm sitting. I have concerns about both options. I've done ok with gen anesthesia for procedures but i've had it for svt ablations so of course my bp is going to be screwed up after they've been messing with my heart so I don't know how I would do AFTERWARDS with that.

Katherine- is your dr recommending a c-section for your next one because of your placental abruption or because of your pots?

Rachel-I'm definitely most concerned with being too weak to push. If I should happen to have a bad bp drop, most times I barely have the strength to lift my hand up. And I'm also terrified of meds because I seem to be hypersensitive to them which makes me worry about the epidural. I know I've been ok with gen. anesthesia before because I've had svt ablations. That was comforting to hear that you have the same problem with medication sensitivity and were fine with it...even though I know it's going to vary from person to person..that was good to hear. My perinatologist initially said it would be best to have an epidural and let my body "labor down" and let my body do as much as it can on it's own without me pushing. The goal would be to just push as little as possible. Did you have problems with your bp when you were pushing and how many times did you have to push? How long did it take you once you got to the pushing? And also, how did they do the epidural with you? Did they spread the dosing out carefully to lower your risk of your bp dropping?

trish-congratulations to you! as I just stated above, I was also told a vaginal with an epidural would be best. I'm going to try to get some more specifics about what the difference might be between recovering from a natural delivery and recovering from a c-section when it comes to a pots patient. I did have more problems in the beginning but I feel that my body just needed some time to get used to this change going on in my body. Around 29 weeks though I had a week or two of feeling amazing. I felt awake and I had energy and then about a week later I started having some of the bp problems. I think it was just a short phase and I feel like it's getting a little better now. I was told that later in the 3rd trimester is when the blood volume is highest so I'm still holding out hope to have those days again with energy and feeling awake. You can email me if you'd like and we can chat thoughout the pregnancy. It's sonshine456@yahoo.com.

doctorguest-what type of interventions are you referring to in the case reports..out of curiousity? Thank you for that info on the spinal block...I can be prepared to ask questions about that now. I'm expecting a call from my anesthesiologist this week so I appreciate that info. I was also running through my mind that if an epidural wasn't going to be a good choice and obviously general anesthesia isn't what I'd like than maybe I should consider just forgoing medications and try it naturally. At the same time though I was wondering with the whole pain response thing if that would make things worse. I really appreciate your opinion on that. What you said is kind of what I figured. I just have the wheels turning with the possible different options :-) You covered a couple questions I wanted to ask without having to ask...thank you!

[MomtoGiuliana]

I doubt I will have another one, however she recommended a scheduled c-section due to the placental abruption, not due to POTS. The cause of the abruption, according to my previous ob-gyn, was due to the fact that the placenta was partially attached to a fibroid (benign uterine tumor)--which she discovered at the c-section. I believe that my problems with high blood pressure that suddenly came up in the last days of my pregnancy, combined with an induced labor that brought on extremely strong contractions, combined with POTS (e.g., I believe, as the doctor states, that my response to pain brought my bp even higher) caused it.

BTW, I had to have general anaesthesia b/c it was an emergency. I did fine with that--it was the loss of blood that I think put me into a worse situation with POTS postpartum. Unfortunately, as I said, I was not even diagnosed at the time. My doctor told me I was depressed when I could barely get out of bed or out of the house for the first months after birth.

Katherine

[sonshine456]

katherine, I went through the same thing with being told I was depressed or had anxiety for a few years before I got my diagnosis. I think that's a common story for most of us here. I didn't feel like I had those issues but after being told that for so long I started wondering if I was just in denial. It's been a few years now since I've gotten established with a really great cardiologist and primary care dr. We've found the cause of all the weird symptoms I was having and they've been fixed by svt ablations and by the medication I take now for POTS so I KNOW for sure looking back with absolute certainty I was right with my gut feeling that it wasn't depression or anxiety..there was something else going on. I get really angry thinking back to those other dr's. They were the one's who made up their minds right away. ANYWAY...can you tell I have bitter feelings about that whole thing? :-)

So how high did your bp get? Did that happen from the abruption or from your POTS being out of whack?

[Rachel]

Hello Sonshine,

I was very concerned wtih being too weak to push too, but I made it through. How? Hmmm...maybe adrenalin? The support of my husband? Divine intervention? Sheer determination? All of the above?!!! Somehow I made it through. I wanted to do all I could to avoid a c-section. Healthy people have a more difficult time recovering from that, so I knew it would be even harder for me.

I had to push for an hour and fifteen minutes. I don't know how many pushes it was total. Plus, I didn't push through every contraction. I rested for a few. An hour and fifteen minutes sounds long, but actually in some ways it was the easiest part. I think because finally I was doing something. The end was near! It was exausting, but it was good to be able to do something too. And once the baby is born you forget the pain and fatigue. You're just thrilled to have your baby.

One thing that I think really helped me to keep my strength up for delivery was eating during labor. I know that most doctors don't allow that, but some do. Midwives are more likely to allow it. The hospital I delivered at only allowed clear liquids (broth, jello, tea, juice). But I knew there was no way I'd be able to make it through labor without food, so I brought my own Gatorade, fruit, cheese and crackers, granola bars, etc. If I was hungry then I ate (as long as the nurse wasn't around!). It was kind of a don't ask, don't tell situation. I didn't have a problem with nausea or vomiting. But everyone is different. I'm not saying you should bring food. It's a decision for you and your doctor to make.

My midwife had also mentioned getting an epidural so that I could just rest and let my body do everything until I absolutely had to push. I chose not to do that, though, because of my med sensitivity. But looking back, that's what I'd choose to do!

Eventually when I had to have an epidural and keep trying (vs. having general anesthesia for a c-section), everything went fine. I kept the dose as low as possible. They gave me a button to push if I needed to up the dose. I upped the dose a few times, but only when I had to. It was set up, though, so that I couldn't push the button more than once in a 15 minute time period. That way I wouldn't have too much. I think the dosing is controlled like that in all hospitals. When you have an epidural they constantly monitor your bp. They will also have a belt around your middle to monitor your contractions and the baby's heart rate. So if vital signs change, they'll know right away and can intervene.

Keep talking things over with your doctors, read books, gather advice, and make sure you're well informed of all the options. Weigh everything carefully and you'll be able to make a good birthing plan. You know your body, how it handles stress, pain, etc. You've got to plan for what you think is best. But remember that if plans have to change, that's okay. The goal is a healthy mom and baby, whatever the route to the goal must be.

I wish you all the best. Please let us know how everything turns out for you! And feel free to keep asking questions.

Rachel

[MomtoGiuliana]

I am assuming the high bp was pregnancy-induced hypertension. I did not have preeclampsia, but the high bp started 3 days before my daughter was born--and then continued for about 8 weeks after. I remember it went as high as 170/90. But it fluctuated a lot. It went even higher postpartum. My ob-gyn said it would go away on its own and didn't put me on any meds for it. The really high bp did go away after 2 months or so, but the POTS symptoms did not.

Katherine

[sonshine456]

thank you rachel for telling me your experience. It helps to hear what you did and what you would do differently. I see my dr again on tues so hopefully they'll be able to tell me what they're thinking so I can prepare mentally for it. I'm sure I'll have more questions after that appointment. Thank you sooo much for taking the time to chat with me about this. It's just always good (well not good but i'm sure you know I mean) to hear that someone else had the same problems and concerns and how it ended up.

[ethansmom]

I have had two natural, drug-free labors and two healthy babies since being diagnosed with POTS prior to my first pregnancy 4 years ago. I was one of the lucky ones who did better during pregnancy, the only complication I had was high blood pressure at the end of the first pregnancy. The second one was seamless and both labors were fairly easy and progressed nicely. I did get some serious palpitations when pushing out baby #2, but they abated as soon as he was born. Pushing was my biggest concern because of the likelihood of passing out and/or having palpitations from bearing down so hard for so long. I was lucky and each baby came out within 2-3 pushes, thankfully because I don't know what could have happened otherwise.

I chose midwives for both but the first labor was in a hospital with a CNM and the second labor was a home birth. I was able to eat and drink throughout and I do believe that helped a lot to keep up strength. My recoveries were fast with each and I did well postpartum.

Now I know that I have Lyme disease and that is responsible for my POTS symptoms, and that would have changed a lot but I didn't know I had it at the time. I don't know if I will have any more kids because we know that Lyme can be passed in utero and I am too exhausted with two active boys to even think about it...but motherhood is the greatest joy & blessing I have ever known, because every day I have to get up and out of bed and be a good mom to my boys. I don't have time to think about being depressed or feeling sorry for myself. I just feel good that I am able to give them a nice life and a loving home- I go to bed at night feeling productive and proud where I once felt empty and alone. It's the best feeling ever!!

Best of luck to you with your baby!!! Things have a way of working out for the best.

[Rachel]

I just wanted to add that I didn't do the really lo-oooong pushes where you hold your breath. For most of my pushes I slowly breathed out (hard to do, but you can practice ahead of time). I think that helped me to not get too faint from holding my breath. Once the push was done I could breath back in right away. And since I didn't push for a super long time I would rest for a moment in the contraction and then push again. All of that probably wasn't as productive as good long pushes, but it was what I could do. And it still worked.

[sonshine456]

looks like the eating and drinking is something that I need to talk to my dr about OR be sneaky about

Rachel, I'll definitely give the breathing out slowly thing a try...thanks for mentioning that.

If anyone else has any good suggestions for pushing that may be helpful in controlling the bp please throw them out there. I'm going to write everything down that I possibly can because I'm sure once i'm there my mind will go blank.

ethansmom-i'm REALLY hoping to only have to push a few times too. There's a history of fast deliveries on my moms side so hopefully that will continue on with me. Having had two svt ablations the heart palpitations are of real concern to me too. I can't imagine what pushing will do to my heart. Hopefully if it does get screwed up it's only for a short time. Were you hooked up to a heart monitor during the labor?

[JenniferInOhio]

I wasn't diagnosed until after my second child. However, I think I had mild POTS before having children. With my first labor, I was hooked up to heart monitors for a few hours because of my palpitations - they intensified during labor. At this time, no one knew I had POTS and my doctor told the nurses to take the monitor off of me because I didn't need it (she seemed dismissive and made me think I was being ridiculous). I think what I was having at the time were PVC's. I pushed for 1.5 hours. I had an epidural. The palpitations went away right after the birth and even with hemorraghing, I recovered quickly.

With my second child, I only had to push for 10 minutes. Labor did not cause any palpitations this time. I had an epidural. I recovered quickly.

I hope all goes well for you and you recover quickly.

[Aprilmarie52]

Congrats on the pregnancy! I am pregnant with baby #2 and am due August 1st. I had my first daughter after I was diagnosed with POTS, but my cardiologist had me stay on the florinef throughout the pregnancy because of the outcomes whe he had tried to wean me off in the past. I have a happy healthy 2 1/2 year old. I went into labor naturally 5 days before my due date. I was in labor for about 7 hours. I didnt have an epidural because I was 9 1/2 cm dialated when we got to the hospital. I had a natural vaginal birth and plan to do the same with this one. I had a very hard time at the beginning of both of my pregnancies because I threw up so much that it was hard to stay hydrated. I must say that it is much harder being pregnant in the summer then it is in the winter (1st was a January baby). It is so hot which makes it hard to breath and I dont want to do much of anything because I am so miserable from the heat. I hope that you are feeling well! The best advice that I can give you is listen to your body and dont be afraid to speak up.

[goldicedance]

I do not think eatting is a good idea when there is always the possibility of a C-section and the possible need for general anesthesia. Sneaking it in was not a wise move. Glad that there were no problems.

Goodluck on your pregnancies, ladies!

Lois

[Rachel]

I apologize. I wasn't as clear as I should have been. For brevity's sake I didn't go into a lot of details, but I probably should have.

I did not go into labor uninformed. I read many books and talked with many nurses, midwives, and doctors. After my research and speaking with medical professionals (some of whom do advocate meals for moms in labor if they want it), we decided it would be best if I was allowed some food. I spoke with my midwife during a prenatal visit about this as we made a birthing plan together.

Thankfully things have changed a lot since the days that only ice chips were allowed during labor. The hospital I delivered at brought meals to the moms in labor. The meals included broth, tea, jello, juice, and something else that I can't remember right now. But because of my health I knew that I would not have enough strength with only the food provided by the hospital, so we had to bring some snacks of our own. I didn't bring in anything like a hamburger and fries. That would have been way too much. But I did bring nuts (just a handful of almonds are a great source of protein), fruit, Gatorade, and some crackers.

At the beginning of labor I asked my nurse if I could have some fruit. She didn't want to give me any, so I asked her to speak with my midwife about it. My midwife said that it was fine, so the nurse found a banana for me. The banana was so green it was crunchy, so there was no way I could eat it. And my nurse was so grumpy, that I didn't ask her for any more help. I simply waited for her to leave the room and then I found some snacks that I had brought. I didn't eat as much as I do when I'm not in labor. It was just some snacks to supplement the food already provided by the hospital. Primarily I drank Gatorade. It is a clear liquid, but not one that the hospital provides.

I hoped this has helped to clarify things. I do not think that every woman should eat lots of food during labor. But some food does help. And it is a decision for each mom and her doctor/midwife to make. Sometimes standard hospital procedure can be changed if the doctor sees fit. For me, being allowed to eat during labor (along with the epidural in the late afternoon) made the difference between having to have a c-section and being able to make it all night and all day, and then deliver on my own.

[MomtoGiuliana]

I do agree with Lois. Rachel that is great that you had a midwife who was confident it was fine for you to eat and that you didn't need any interventions (and as I said before, it does'nt appear that POTS pregnancies require any more interventions than non-POTS pregnancies based on the experience of others on this board). However, each of us is different, and each should get individualized medical advice from professionals (I know you were not giving advice, Rachel )

I also felt, as Rachel states, that I would be too weak to manage labor without eating. However, I am very glad that I did not eat once labor started b/c 3 hours into labor I had to have an emergency c-section and general anesthesia. It's important to follow your doctor's advice.

Katherine

[doctorguest]

A better option to provide calories during labor is getting dextrose solution IV which can provide the needed energy supply. That way if a vaginal labor should be converted to a C-section for whatever reason, there is no risk of aspiration of food from the stomach to the lungs as would be the case with taking in food orally.