Advice Wanted - Trying to avoid PE and have a VBA2C.

[mummachelle]

Hi just wanted to ask anyone if they had any advice they could give me regarding avoiding pre eclampsia during a 3rd pregnancy? and also the best way I can facilitate a vba2c? I live in Bunbury, WA and would love any information offered regarding a vba2c friendly ob or really really interested in a homebirth/waterbirth this time.

I am currently not pg but am planning ttc starting in october this year. I had PIH in my 1st pregnancy and many visits in and out or hospital resulting in an advised cs at 38wks. 2nd Pregnancy I developed full blown PE and ended up with another cs at 38wks. Both of my babies were born 11months apart and healthy, but I feel like I am missing something that my body as meant to do in birthing my babies vaginally.

I was severely obese with my first two pregnancies and births so I am currently working on losing weight and have lost 14kg in about 15 wks.

Thanks to anyone that might have any suggestions on achieving these goals.

[charlis_mum]

I had it with both my pregnancies. With DD I was booked in for a c-section, but she came early, and then DS was induced at 36weeks due to PE. He was starting to ge bad - placenta was failing and he was blue (very glad it was a 2hr labour) and my liver was starting to not function properly.

I went to see my GP about it a few months ago, as we are starting to think about TTC #3. He also suggested loosing a bit of weight (i was just in the overweight BMI) as with all organs, the liver will retain fat if you are over weight, and not be as healthy as they can be if they have excess fat. I read somewhere (can't remember where sorry) that a healthy liver before pregnancy can help reduce the chances of PE, so I am going to see a natruopath/homeopath about a liver detox type of thing. There are no guarentees, as it is only a theory, but i'd give anything a go. I have been told that olive leaf oil extract is another good thing for all over good health and your liver. I am also seeing a chiropractor to try & make sure everything is aligned properly before we TTC and will continue to see her whilst pregnant. It won't necessarily stop it, but it may hlep my body deal with it better, and be able to cook my baby for longer without danger of the placenta failing again.

I am also trying to be a bit more healthy all round - no alcohol leading up to TTC, trying to exercise more etc etc, just in the hope that a healthier body will be able to handle things better.

As for wanting to birth your next baby vaginally - is it something you could also bring up with your care-provider? I expressed in no uncertain terms to my OB that if we could avoid a c-section and have me & bubs healthy, then that's what i wanted. So he did the stretch & sweep, which IMO contributed to DD being early. He still booked me in for the c-section but when i went into labour he told the midwives to let me labour until morning (it was 11pm when my waters broke), monitering my BP the whole time and nil by mouth,as if things didn't progress well he wanted a c-section in the morning. As it turned out, my body reacted well to labour and my BP was perfect for the duration (went up again as soon as DD was out!!) And i had a 7hr labour - not bad for a first timer. When things went pear shaped with DS's pregnancy, c-section wasn't mentioned - he went straight for the steroids, and internal, and asked how i felt about being induced in 24hrs. I only had ARM for that birth too - contractions started strongly 10mins after that, and there was no need for the drip. I do think I am lucky that my body reacts well in birth, and not all cases are like this. But it might be something worth exploring next time. A trial labour, with monitoring and if you or bubs start to suffer, then opt for the c-section, but not use it as the first option. If you are told about the dangers of your scar rupturing with a VBAC - i am sure there are some lovely doulas on here that can give you advise on the real chances of that happening, and not the scare tactics sometimes used by other care providers. Good Luck with it!!

[mummachelle]

Thanks for the info, unfortunately my ob with the first did an internal and my cervix was unfavourable not softened apparently and that my son was not engaged so no hope of an induction working so was told c-sec and after being in and out of hospital and the scares being given I just placed my trust in him/them and now really regret that action because was told after by next ob that I didn't really have PE just PIHT grrrrr. With my daughter they transferred me through to a different hospital 2hours away just three weeks before the birth because of weight and PE. Didn't know options, doctors, nothing and they were not forth coming when I asked about vbac (if I went into labour before c-sec date might be able to try). SO another c-sec at 38 wks.

I am not ungrateful for two beautiful children but I would really really love to at least attempt a vbac next time. I have joined a womens gym with an eating plan and that is helping immensely with the weight loss and increased fitness.

Hope you have a safe and healthy pregnancy :)

[sweetperfectchild]

I was just thinking about writing up about this for people ttc because there is some reasonable evidence that there are simple things you can do to reduce the risk of PE.

This is the best news:
http://www.medscape.com/viewarticle/573914

Yes! Eating good quality chocolate reduces your risk. Hurrah. So I'm having about 50g a day of Lindt 70%.

Second bit of good news:
http://www.medscape.com/viewarticle/569585

So, extra, extra folic. I'm taking 1mg a day on top of my prenatal vitamin. Most pregnancy vitamins only contain the minimum of 250-500mcg, but up to 5mg is recommended for women at risk from neural tube defects, so an extra 1g is perfectly safe.

There is also evidence for calcium supplementation and vitamin D, but not C or E:
http://www.ams.ac.ir/AIM/0253/0253151.htm

Exercise also helps:
http://www.medscape.com/viewarticle/495537_5

And aspirin:
http://www.cochrane.org/reviews/en/ab004659.html

Maybe garlic:
http://www.cochrane.org/reviews/en/ab006065.html

So, there you go - there's loads you can do.

And finally, there's a Swedish studies that show women who perform fellatio and swallow have a lower risk of pre-eclampsia too;
http://www.scribd.com/doc/96076/Journal-of-Reproductive-Immunology
Yes, really, so even your partner can help. ;)

[sweetperfectchild]

"High Fiber in Pregnancy Cuts Risk of Preeclampsia — Women who consume a high amount of dietary fiber during early pregnancy have a reduced risk of subsequent preeclampsia compared with those who eat little, according to a new prospective study [1].

For those with the highest intake, there was a 70% reduction in preeclampsia compared with those who had the lowest fiber intake, Dr Chunfang Qiu (Swedish Medical Center, Seattle, Washington) and colleagues report online July 17, 2008 in the American Journal of Hypertension.
Their results also show that dietary fiber may attenuate pregnancy-associated dyslipidemia, an important clinical characteristic of preeclampsia. "To our knowledge, we are the first to examine the relationship between maternal plasma lipid concentrations and habitual fiber intake during pregnancy," they state. "These results suggest important health benefits of increased fiber consumption before and during early pregnancy."
Prior studies of fiber intake and preeclampsia inconsistent
Preeclampsia, a vascular disorder of pregnancy, is associated with potentially lethal complications, including placental abruption, disseminated intravascular coagulation, cerebral hemorrhage, hepatic failure, and acute renal failure, say Qiu et al. Established risk factors for preeclampsia include obesity, family history of type 2 diabetes and/or essential hypertension, and diets low in antioxidants, fruits, and vegetables—risk factors similar to those typically reported for cardiovascular disorders.
The researchers note that only three prior studies have directly evaluated preeclampsia risk in relation to maternal fiber intake and that the results from these have been inconsistent.
Using women participating in an ongoing prospective cohort study, Omega, they assessed maternal dietary fiber intake in early pregnancy and its association with subsequent preeclampsia risk. The 1538 pregnant women participating completed a 121-item food frequency questionnaire (FFQ).
The researchers also evaluated the influence of fiber on maternal plasma lipid and lipoprotein concentrations among the study population. This secondary objective was inspired by reports showing the benefits of dietary fiber on the plasma lipid profile in numerous studies of men and nonpregnant women, they note.
Fiber lowers triglycerides, boosts high-density lipoproteins
Fiber intake was associated with reduced preeclampsia risk. After adjustment, the relative risk of preeclampsia for women in the highest quartile (≥21.2-g fiber/day) vs the lowest quartile (<11.9 g/day) was 0.28.
Associations of similar magnitude were seen when they looked at highest vs lowest quartiles of water-soluble fiber (relative risk [RR] 0.30) and insoluble fiber (RR 0.35), respectively.
And mean triglyceride concentrations were lower (–11.9 mg/dL, p=0.02) and high-density lipoprotein (HDL) cholesterol concentrations higher (+2.63 mg/dL, p=0.09) for women in the highest quartile vs those in the lowest quartile of fiber intake.
"This prospective study provides additional evidence of reduced preeclampsia risk associated with higher maternal dietary fiber intake in early pregnancy," Qiu et al state. "Fiber intake was also inversely related with maternal triglycerides and positively related with HDL concentrations (although to a lesser degree) during early pregnancy.
"Taken together with previously published literature, [and] if confirmed by other studies, our findings may motivate increased efforts aimed at exploring lifestyle approaches, particularly dietary approaches, to lower the risk of preeclampsia," they conclude.

Source
Qui C, Coughlin KB, Frederick IO, et al. Dietary fiber intake in early pregnancy and risk of subsequent preeclampsia. Am J Hypertens 2008; DOI:10.1038/ajh.2008.209. Available at: http://www.nature.com/ajh (http://www.theheart.org/viewDocument.do?document=http%3A%2F%2Fwww.nature.c om%2Fajh)."