White Coat Syndrome in Pregnancy.

by Sophie Fletcher

One of my clients at the moment (I have permission to post this) is having a tough time of it and suffers badly from white coat syndrome. She is absolutely set on a homebirth, because she feels anxious in a hospital environment, but has been challenged every step of the way. Not overtly, as I’ve heard other mums being told – “it’s your first birth you can’t have a homebirth or “we’re too short staffed, you have to go into the hospital”. But her confidence is subtly being undermined by certain tests that will determine whether she is low or high risk and whether she will be ‘allowed’ to have a homebirth or not.  As she really wants a home birth these tests become a threat to her choice and consequently  the tests themselves cause anxiety, which can impact negatively on those test results.

This mum-to-be is excited about her baby’s arrival, has a wonderfully supportive husband, and is fully conscious of her connection with her little one. So it nearly broke my heart when she said last week,

“I guess I thought it would be a wonderful lovely experience and everyone working in that environment would be so full of love and positivity, its just taking me this long to realise that its just a job to most full of red tape, the ladies at Sainsburys checkout are happier and full of more love… what a shame.”

Ironically the stress being created by her treatment is probably causing more problems than if she were being treated with honesty and compassion.  Did you know that there is such a thing called white coat syndrome, which is a associated with people becoming more stressed in a clinical environment. Commonly it’s also called white coat hypertension in people with high blood pressure. Very often if someone has to go into hospital or to the doctors to have their blood pressure taken it goes up, if they take the machine home, their blood pressure can go down and be perfectly normal. The NICE guidelines on Hypertension note:

“White Coat Syndrome is reported to occur in as many as 25% of the population, especially where their BP is close to the threshold for diagnosis. It is more common in pregnancy and with increasing age. Failing to identify WCH makes inappropriate treatment for hypertension in normotensive patients a possibility. Similarly, hypertensive individuals can also exhibit WCH and may receive inappropriate dose titrations or additional antihypertensive agents. Patients have historically been enrolled in trials using clinic BP values, and these trials will almost certainly have included a proportion of patients with WCH. It is unknown whether benefits of treatment differ substantially in those with or without WCH.”

This study puts white coat syndrome as high as 32% in pregnant women.

White coat syndrome can affect pregnancy in several ways. Common antenatal tests such as gestational hypertension and gestational diabetes can to respond to stress in a negative way, sometimes skewing potentially normal results and pushing women into the higher risk category and maybe unnecessary induction before baby is ready to be born (my client was told she would have to be induced at 38 weeks, despite perfectly normal readings at home and diet management).  Other conditions, especially skin conditions such the itching due to cholestasis can worsen in relation to stress. For those of you with eczema you’ll already know that stress can cause skin conditions to worsen. In addition, viruses are harder to fight off if stress levels are higher. As a hypnotherapist I work with many different types of skin conditions, which see massive improvements after reducing stress and anxiety.

Reducing stress is crucial in pregnancy to maintain the best possible health both emotionally and physically and to avoid the implications of white coat syndrome. Here are several ways to reduce stress:

1. Take time out every day for just you, whether it’s a bath, some relaxation, reading a book. Prioritise it for you and your baby and make sure that you don’t postpone it
2. Learn self-hypnosis and stress reduction techniques that you can use before going in for a hospital appointment. Many classes, including our Mindful Mamma class, teach this. I’ve heard of women actually being able to reduce their blood pressure when they switch into self-hypnosis and rapid relaxation techniques
3. Ask if you are able to do any monitoring tests at home yourself so that you get a better picture of the patterns of your reading (place, time of day etc)
4. Hire a doula, a caregiver, or a consultant or midwife you trust or feel comfortable with.  You can request a change in consultant or midwife.  You can also choose to have an independent midwife or even to have private antenatal and postnatal care with an independent midwife if you can’t afford to pay for a full package.
5. In the absence of other symptoms, if you know you are stressed in a clinical setting having tests, talk to your doctor or midwife about monitoring in a different way

Michel Odent on Gestational Diabetes

Heni Goer on Gestational Diabetes

False diagnosis of hypertension leads to increased rates of intervention

Impact of stress and link to diabetes