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My Post Partum Preeclampsia Story
During pregnancy you read a lot of things and hear a lot of stories and the term “preeclampsia” comes up a lot. I knew they were screening my urine at my midwife appointments for this, but I never really put a lot of attention on it, or bothered to look up what it was. It was my philosophy during my pregnancy that I would not put any energy into negative things that *could* happen, because that would manifest it. So, I didn’t think twice and peed in the cup when I went without anymore thought.
By definition, preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal. Left untreated, preeclampsia can lead to serious — even fatal — complications for both mama and baby.
Every minute, somewhere in the world a woman dies in pregnancy or childbirth. This amounts to 1400 women dying each day – and more than 500,000 each year from pregnancy related causes.
If undetected, preeclampsia can lead to eclampsia which is one of the top five causes of maternal and infant illness and death, causing an estimated 13% of all maternal deaths worldwide, or literally a maternal death every 12 minutes.
Approximately 5 to 8 percent of pregnancies are affected by preeclampsia.
In the US preeclampsia is responsible for approximately 18% of all maternal deaths.
Preeclampsia causes 15% of premature births in industrialized countries and it is the number one reason doctors decide to deliver a baby prematurely.
All of that being said, preeclampsia usually presents itself during pregnancy but in very rare cases can develop up to 6 weeks after the baby is born. All of the pee tests, and never was preeclampsia ever brought up in any of my midwife visits. I had a healthy pregnancy, I did have GBS and was given penicillin during labor, but otherwise Winnie and I were healthy. She was born on December 17 which was a Tuesday, and per hospital rules for vaginal childbirth we were to stay the mandated two days, and we were discharged on Friday the 20th. I’ll get to her birth story one of these days, but by the end of my stay there was one nurse technician who I had consecutively had problems with. We got into a tiff during my last day, which elevated my blood pressure, and gave a pretty high BP reading. This was enough of a flag for my midwives to insist I follow up at the office on Monday the 23rd, but only for a quick blood pressure check and then I could go home. Let’s remember this is December 23, 2 days before Christmas, I had been in the hospital from Monday-Friday already being induced and giving birth, and two weeks before that had 3 trips to the hospital and one hospital stay. So, going to the doctors office for a quick BP check seemed like a breeze. EVEN THOUGH I was adamant that it was a false flag because that nurse tech was just super annoying and we got into an argument before she checked my blood pressure. Duh I had high blood pressure. I was just fighting. But, it was this confidence that there was nothing wrong that drove me to the office right off of York Road in Towson, on Christmas Eve Eve without hesitations.
My blood pressure was 142/100. So, for anyone who doesn’t know, because I certainly didn’t, that is high blood pressure. Normal is anything below 120/80. They checked my BP 5 times, because I was still insisting it was wrong. Finally, they had to call the doctor in. “Do you have a headache” Well of course I do. Breastfeeding sucks the life out of you… “Do you have any upper abdominal pain?” Well of course I do. I *just* gave birth to a baby. They asked me to go across the street to the hospital to do further testing. They wanted to put me on a heart rate monitor for an hour, to see what happened. These things that I thought were of course normal, were in fact not, and in addition to the hypertension and proteins in my urine...there was no denying it
I don’t have any idea what I was thinking, but in my head this wasn't a big deal. In hindsight, being escalated to the hospital *should* have been a big deal, but I was so blind sided with being unhappy about the inconvenience of going to yet another place on Christmas Eve Eve when my husband and my newborn baby were at home waiting for me, that my health and concern for it never really dawned on me. So because I didn't know how long I would be we all loaded up, and went to St. Joe’s Labor and Delivery department, for the umpteemth time. Everyone knew us there at this point. So one of the nurses who helped deliver Winnie hooked me up to a heart rate monitor, and I expressed my distaste for being there to her. She agreed with me that it must be a fluke and she took my BP over...and over...and over again. After an hour, my blood pressure had not lowered, in fact it got higher. At the highest, it was 200/something, and I was completely in denial. They kept telling me I had to stay, I had to stay. But I only had a headache...and I didn’t *feel* like I was dying….
It took my midwife Julia, a Doctor who had helped deliver Winnie, a nurse tech, and Josh to convince me to stay for a magnesium treatment, and only after they said the words “you could die” did I even consider it. They literally told me I could die and the only thing I could think about was getting my brand new family home for Christmas. Stroke. Seizures. Organ failure. All of these were real things being thrown at me and I just was not processing it. A magnesium treatment was the only solution, and it had to be administered at a therapeutic level for 24 hours. 24 hours. That meant Christmas Eve, I thought in my head. Not, ‘what is magnesium?’, not ‘how will this make me feel?’ - crazy, I know. I concocted a master plan. Since I hadn’t planned on checking in to hotel de la saint joes, I *had* to go home and take a shower and change my clothes. They all fought against that, so I signed an AMA - against medical advice - form, and I went home to “shower”. Full disclosure: I did not shower. Josh and I had battle royale about whether or not I was going back to the hospital. Clearly, he won. And let me tell you, he was fuuuuuurious when he found out we only left the hospital as part of a poorly constructed plan on my part. At this point we had gleaned quite a bit of hospital packing experience and we loaded pillows and blankets, and what we thought was enough of everything for Winnie Poo. We packed Christmas cookies I had manically baked the day or two before, and Sorry! to pass the time. We were going to make the best of it, as a family.
Magnesium sulfate is a mineral that reduces seizure risks in women with preeclampsia, and is administered intravenously. My plan of care was magnesium sulfate treatment intravenously to prevent seizures, in addition to blood pressure medication intravenously to prevent a stroke.The main risk associated with the magnesium therapy was magnesium toxicity - at a therapeutic level it can prevent seizures, at a toxic level it can cause coma, heart attack, kidney failure and more. So they had to monitor the treatment and the magnesium levels in my blood very carefully. In addition, in order to ensure proper kidney function they have to monitor urine output. They wanted to insert a catheter, but I freaked out, so they agreed that if I could pee every hour, they wouldn't make me get a catheter. First of all, I was like, who pees every hour. Second of all, no one mentioned to me at this point that I was going to have to be on bed rest, and pee every hour, so I would be doing wine-drunk pee yoga in my bed while postpartum bleeding every hour. And third of all, this was literally the only time in life ever that I *actually* had to pee every hour. So, the universe was on my side for at least that one. OH, and did anyone bother to tell me before I got hooked up to the IV that I would be on a liquid only diet? Fuck me. Christmas cookies? Forget about it. 24 hours on the magnesium IV, intermittent pneumatic compression devices on both legs, constant BP monitoring, pulse-oxide monitor on a toe, hospital bed pee yoga, blood work every few hours, and a new born baby. ‘Twas so much fun. 9pm on Monday, December 23 until 9pm on Tuesday, December 24th. I could do that. I’d be home in time for Santa to come...totally aware that Winnie has no idea about anything to do with anything at this point, much less Santa, this was still my first thought.
In all of this I had been so caught up in what was happening I didn’t put much thought into the “after magnesium” | “before I go home” portion of time. They wanted to monitor me for 24 hours after the magnesium treatment to make sure that the blood pressure medicine was working and keeping my BP level at an acceptable place, in addition to monitoring my blood to make sure that the magnesium levels had returned to normal. I was so distraught. It was my first Christmas as a mother and as a wife. I had already spent so much time in the hospital. My hormones were raging. I was a hot ass mess, and another 24 hours there was just not in my plan of things I had ever envisioned myself doing on Christmas and Christmas Eve with my newborn baby and my new husband.
I had become very close with my midwives (yet another blog post I will publish sooner or later…), and it was my luck that during all of my pregnancy and postpartum experiences they were both (one or the other) at the hospital every time I was. KJ heard I was fighting the doctors and wanting to sign yet another AMA (this would have been my third…) to leave to be home in time for that midnight santa deadline I had made in my head. Once again, Josh was pissed. He was pissed that he had begged me to stay in the hospital for the sake of my health, for the sake of our daughter growing up with a mother, and for his own selfish sake for not wanting to live without me should something go wrong. The doctor began to give him instructions should I have a seizure at home, and I think that terrified him. What would he do with a seizing wife, and a screaming newborn? But KJ somehow convinced me to stay. I bartered, as only I do, and I agreed to stay for another 12 hours, and not 24 hours. Because being home at 9am on Christmas morning was way better than 9pm. So we hunkered down, for one last nights stay, we tuned in to comedy central for all of The Office Christmas episodes, and we spent our first christmas eve together, as a family.
My Blood Pressure lowered down to 150/88 which was still hypertensive, but had lowered enough and been stable on the BP medicine for long enough that they felt confident sending me home that morning, with a follow up on Monday. It was a real Christmas miracle. I was going to be okay, which I think at this point it finally started to dawn on me how serious all of that really had been, and I was going to go home with my family, again, for seemingly the first time all over again. I followed up at the office with a BP of 140/91 which was still improved, and acceptable for me. I was to safely stop taking the labetalol and my BP would return to normal. At last check, my BP was 122/59 so I am happy to report I am not carrying hypertension around permanently.
Wow. I wasn't planning on writing a four page doc about my experience, but it was truly traumatic, life threatening, and I was SO close to not even going to that follow up appointment. Because of the amazing staff at St. Joes I was able to escape the leading cause of maternal mortality. Had that high BP gone unnoticed and a follow up not scheduled, I would have carried on about my days with epigastric pain and killer headaches thinking it was my new normal, and honestly I could have died from a seizure or stroke. Listen to your loved ones, listen to your health care providers, and listen to your body.