According to a study published in the Journal of the American Medical Association, more than one third of pregnant women may undergo increased intervention and cesarean surgery as a result of "white coat hypertension." This is an elevation in blood pressure that only happens when they are around doctors.
When doctors saw the rise in blood pressure in the women, they began to treat it with medications, which can alter the effects of the body's natural contractions.
The study had 144 pregnant women in the final trimester who had high blood pressure. 42 of them suffered from "white coat hypertension." This was detected as the women wore blood pressure monitors for 24 hours to determine their normal blood pressures.
19 of the 42 women ultimately had a cesarean section for the birth of their babies (45%), a rate similar to the 42 women among the 102 women who had real high blood pressure (41%).
When they compared this to women who did not have high blood pressure, their cesarean rate was only 12% (13 women out of 103).
While this study shows a correlation to the use of medications to increased cesarean rates, other practitioners are concerned that it's a cascade of intervention from medications to control high blood pressure, unnecessary inductions, medications given in labor for blood pressure, etc.
"White coat hypertension" may be just a symptom of a greater problem. "In many cases it's lack of good rapport between the practitioner and their client," says one local midwife. "And it's not just with doctors. Midwives can see this as well."
Good communications can make or break any relationship. A birth plan is one form of communication to help express your desires for birth. Remember to write down your questions a head of time, and write down the answers. If you feel you're being rushed, call your practitioner on it. Ask for a few more minutes, or schedule a time specifically for questions if that moment is not the appropriate time.
If you have been diagnosed with high blood pressure in the final trimester and are concerned, some practitioners suggest the following steps:
- Take your blood pressure in the grocery or drug store.
- Request a 24 hour monitor.
- Have your blood pressure taken at home by a machine (inexpensive).
- Talk to your practitioner about your concerns.