High blood pressure during pregnancy is a serious condition not to be messed around with. Although it is entirely possible to have an otherwise healthy pregnancy and delivery, getting diagnosed with hypertension is usually just the beginning of a cascade of interventions for most births, whether or not there are any other issues involved. If you happen to have some other factor that is considered high-risk, such as a high BMI or gestational diabetes, birthing in a hospital under the watchful gaze of doctors and nurses is pretty much a guarantee.
Now granted, that is probably a wise choice, but unfortunately in my time as a medical assistant, where I essentially took blood pressure for a living, all too often I saw people getting diagnosed with hypertension who never should have been. Not to mention all of the women I saw under a Nurse Midwife getting the pre-eclampsia stamp without any other symptoms of the condition.
During my first pregnancy, I had actually become a bit phobic about the idea of having my BP checked at all. Since I was unfortunate enough to be placed under scrutiny at prenatals because I am overweight and I do have a family history of gestational diabetes, I was determined to not get that hypertension label that would have risked me out of a homebirth unless I really earned it.
Learning how to take BP accurately was something I actually had to do on my own time by researching the American Heart Association and other heart disease related groups that would distribute this information to healthcare professionals. Since I now know how incomplete college training can be across the board for every healthcare professional, I’ve compiled this information for you here so you can make sure you never get wrongly diagnosed, particularly during pregnancy when this diagnosis is so critical.
These are tips, not tricks! You can not create a false low reading. These are simply meant to make sure your BP is not being falsely raised or measured inaccurately. You may not necessarily need to follow all of these guidelines as slight variations are usually not a concern. However, if you do find your BP starting to get up there, I would be certain to follow every single one to ensure total accuracy.
1) The most important factor is using the correct cuff! If it’s too small, BP will read high. If it’s too large, BP will read low. Check your arm circumference on a regular basis, in both inches and centimeters. Remember those numbers! Not all BP cuffs are rated the same. Not only can they be rated differently by several inches, but some are rated only in centimeters.
When you go in for a check-up, ask your care provider to double check the cuff rating for accuracy. If your request is refused, or they don’t have the right size cuff available, I would decline to have it taken. I have actually been threatened in the past and told I must have it taken. Remember: You have a legal right to decline any and all medical tests and procedures! You also have a right to not be harassed for your decisions. If someone harasses you or attempts to force you to do anything, report them to the office manager, your insurance company, or the head of whatever medical group they work for.
If you fall outside of the “normal” range for cuff sizes, you should bring up this issue with your care providers before you go into labor. Getting a false reading in the middle of labor can lead to unnecessary interventions.
2) Along the same vein, do not let your BP be taken on any other body part except your upper arm. In the average clinical setting, there is absolutely no reason not to do it on the upper arm. Just like how your temperature reads differently when it’s taken in different spots, the same goes for BP. The problem is that the standards for BP are set using the upper arm measurement.
3) Stay calm. If you have what’s known as white coat hypertension, this is easier said than done. Sit calmly for a few minutes and try to clear your mind. You can even request to be left totally alone and meditate. Sometimes it’s better to wait until the end of an appointment to have it taken as seeing the doctor and getting the health discussions out of the way puts patients at ease. Do not ever be afraid to ask for whatever you need to do to feel more relaxed.
4) Don’t do anything else during or just before having your BP read. Talking, reading, walking, or being prodded at raises BP. Again, don’t be afraid to ask for what you need. If someone is talking to you, ask for silence, and clear your mind of the conversation. If you just walked in from the lobby and 2 seconds after sitting down you’ve already got the cuff strapped on, ask for a few minutes to rest. Don’t have your temperature or pulse taken at the same time, and definitely don’t reach for that cell phone!
5) Get comfortable. Any aches or pains will raise BP. If you’re experiencing an unavoidable pain, request that it be noted in your file as an explanation for a higher reading. If you’re hurting because of an uncomfortable position or chair, request to be moved. Sit and breathe a few minutes to let your body return to normal. This is a little bit more difficult in pregnancy, which is why BP tends to slowly creep up toward the end.
6) Completely relax your muscles. You should never have to hold up your arm during a BP reading. Whoever is taking it should position and hold your totally relaxed arm at about chest level.
7) Make sure the cuff isn’t being overinflated. There is absolutely no reason to pump a cuff up past 160 unless there is a history of hypertension already established. If the cuff is so tight it cuts off circulation and your arm goes numb, it’s overinflated. Not only does this cause pain, but simply pumping it too high in itself can cause elevated pressure.
8) Do not cross your legs or put your body into any other awkward position. Sit upright with your feet firmly on the floor.
9) If you catch the person taking your BP placing a thumb over the top of the stethoscope, ask him/her to move it. The thumb has a beat in it, which can transfer through the stethoscope and be heard over your own beat, skewing your reading.
9) If you need to have it retaken, make sure it is being done on the opposite arm and request you be given a few minutes to relax again. This is especially important if it needs to be retaken because you did get a high reading.
Blood pressure may be a numerical measurement, but there are a lot of qualitative things that can affect the reading. Make sure you have them all under control!