A Crash Course in Preeclampsia

I’ve had a lot of questions in the past several days, so I thought I’d try to give a brief summary of preeclampsia for those who are interested.

Preeclampsia has two major diagnostic criterion – high blood pressure combined with protein in the urine after 20 weeks of pregnancy. For a diagnosis of preeclampsia, there need to be two measurements of blood pressure at least four hours apart where either the top (systolic) or bottom (diastolic) numbers are greater than 140/90. There are several other warning signs that preeclampsia might be on its way or present (large weight gains in the course of a day or week, lots of swelling in legs, intractable headaches, visual disturbances, severe pain in the upper right side of the belly) but those are not diagnostic like blood pressure and urine protein.

When I went for my prenatal appointment this past week, I wanted to talk with my doctor about preeclampsia because my morning blood pressures had been rising and because I had some of those other warning signs – I was gaining 2-6 lbs of fluid daily (although mostly losing it overnight), had developed pretty severe carpal tunnel (caused by fluid retention in my wrists), and was having painful swelling in my legs and feet as each day progressed.

In light of this, we did labs (including a test for urine protein) despite my blood pressure falling under the 140/90 threshold for a diagnosis of preeclampsia. I had protein spilling into my urine – and, at my appointment the next day, my blood pressure was over the line. This is when we arranged for me to have 24 hours of monitoring in hospital. Note that I didn’t yet have an official diagnosis of preeclampsia because I hadn’t had two blood pressures (taken at least four hours apart) “over the line”.

While hospitalized, I received a couple of steroid shots that will help mature baby’s lungs in case early delivery is required. Otherwise, I sat or laid around in bed between blood pressure checks, which occurred every 2 hours.

Of the 18 blood pressure checks I had in the hospital, five were at or above the 140/90 line that fits the diagnostic criterion for preeclampsia – the rest were in what, in non-pregnant folks, we call the pre-hypertensive range (top number between 120 and 140, bottom number between 80 and 90.) Prehypertensive blood pressures aren’t normal or healthy – they’re a sign to start taking care – but they’re not a sign of imminent danger either. If you showed up at your doctor’s office routinely with pre-hypertensive blood pressures, your doctor probably wouldn’t start you on medicine, but they might schedule you an appointment with a dietitian who can help you develop eating habits that are known to be helpful with managing blood pressure (both the Dash diet and the Mediterranean-style diet have good evidence for blood pressure control). Your doctor would likely also encourage regular physical activity and, if indicated, weight loss.

Given that my blood pressures were right there on the line during my hospitalization, I returned home yesterday afternoon. I will continue at home with outpatient monitoring at present.

As far as monitoring goes, there are three main potential indicators that I need to head back to the hospital and/or have the baby right away.

First, baby could stop growing or be in distress because of what’s going on with me. To make sure this isn’t the case, we will do weekly biophysical profiles which use ultrasound to measure baby’s growth, activity, and amniotic fluid.

Second, my blood pressure could rise to severe levels – greater than 160/110. I will continue to monitor my blood pressure at home at least once daily and I will go into the doctor twice a week to have in-office monitoring. (Louis had to be delivered at 34 weeks, 3 days when my blood pressure rose persistently into the severe range.)

Finally, other organs in my body could be affected (additional kidney problems, liver problems, blood cell abnormalities) which would be an indication for delivery – Tirzah Mae was born at 32 weeks, 1 day when my liver enzymes and blood cells indicated multiple organ involvement. I will have weekly labs to monitor for this last potential indication for delivery.

But, unlike during my pregnancies with Tirzah Mae or Louis, we have caught the preeclampsia while the majority of my blood pressures are NOT in the preeclamptic range. This makes outpatient monitoring a possibility and makes our likelihood of delaying delivery until the c-section we were otherwise planning for 36-37 weeks much higher than it was with either of our first two children.

So we are feeling fairly optimistic about the prospect of staying pregnant longer and maybe even avoiding a NICU stay this time around.

We do appreciate your ongoing prayers – we know things can still change pretty rapidly in this game and that we need to be ready for anything. We also want our children to be able to enjoy as normal a life as possible while we wait for the new baby to arrive while at the same time not hastening baby’s arrival – so we will need lots of wisdom as to what I should and should not be doing and how to truly love and wisely parent all five of our little ones as we wait.

Daniel could also use additional prayer as much of the added burden of parenting, meal preparation, and homemaking falls on him – and all this in the midst of a fairly busy season at his day job.

I got to looking at my old blood pressures to give an idea of the differences between my first twenty four hours of hospitalization with each case of preeclampsia.

Tirzah Mae LouisNow
Gestation (weeks,days)29w,6d33w,6d33w,1d
Total BP readings423618
Normal BP readings (<120/80) 0 (0%)0 (0%)1 (6%)
Pre-hypertensive BP readings (120-139/80-89)12 (29%)5 (14%)12 (67%)
Preeclampsia BP readings (140-159/90-109)20 (48%)29 (81%)4 (22%)
Severe preeclampsia BP readings (>160/110)10 (24%)2 (6%)1 (6%)

A few notes: I had a lot more blood pressures taken with the first two pregnancies because each high blood pressure generally triggered a follow up after I’d had a chance to sit quietly for a while, in hopes that it would come down a little with extra rest. With Tirzah Mae, I was on IV magnesium sulfate for the first 24 hours of hospitalization to prevent seizures and lower blood pressure. Even with this intervention and no movement whatsoever, my blood pressure was still above the line (orange or red) 70% of the time. Contrast this with this pregnancy, where I received no medication and had no enforced restrictions (although I did mostly sit or lie down when I wasn’t getting up to use the restroom) and had blood pressures below the line (yellow or green) >70% of the time. The one “severe” blood pressure this time around was from when I was telling an animated story while my blood pressure was being taken (that’s a no-no – you’re not supposed to talk while your blood pressure is being taken.) A second pressure taken 5 minutes later when I wasn’t talking was at the low end of the hypertensive range.

Of course, I should add the caveat that I am not a medical doctor and cannot diagnose or treat any disease. I speak as a mother who has experienced preeclampsia three times, twice with severe features necessitating preterm delivery. If you have or suspect that you have preeclampsia, please contact your maternity provider so an individualized treatment plan can be made that takes into account your unique medical considerations.

Pain and the Presence of God

“We specialize in pregnancy complications,” I tell the nurse with a laugh. And, truly, it often feels we do. Preeclampsia, transverse presentation, preemies, post-dates, prolapse, miscarriage, shoulder dystocia. We’ve done them all.

And with this pregnancy, we have complete previa and now preeclampsia again.

Yes, that’s right. I am back in the hospital at 33 weeks and a day, nursing a sore bottom from the corticosteroid shot meant to mature baby’s lungs in case we need to deliver in the next couple of weeks. Lord willing, no severe features of the preeclampsia will reveal themselves and I’ll head home after my second shot tomorrow.

Lord willing.

It can be such a glib phrase. Or it can be a profound one. I probably use it glibly plenty – but not when it comes to having babies.

If there’s anything specializing in pregnancy complications has taught me, it’s that God gives and takes away, he chooses and he chooses best. And he is present every step of the way.

He is present when sperm meets egg, when embryo implants, when placenta forms. He is present and working when preeclampsia is written into the vasculature of the developing placenta. Or when the placenta develops right on top of the cervix.

God was present and working when I started bleeding and our fourth baby was lost just five weeks after conception – and God was present and working when I started bleeding early on with this pregnancy and our baby survived.

God was present and working and willing when we discovered complete previa on the “routine” 20ish week ultrasound I’d declined with all my other pregnancies (providential, wouldn’t you say, that I chose not to decline this time, when it matters so much that I not go into labor or deliver vaginally?)

God was present and working and willing each time that the external signs made clear the preeclampsia that had been latent from the beginning.

None of this has ever been hidden from his sight. None of this has been outside his hand.

Lord willing.

Someone recently pointed out to Daniel that this is a part of Adam’s curse, this perpetual pain in childbirth. And so it is. But it is also God’s blessing on us fallen creatures.

For here, in the many pains of childbearing – pains we have felt most acutely – here we also experience his presence, his providence, his hand. Here we see that he is not content to let us lean on our own understanding, not willing to let us labor under delusions of our own control, not satisfied to let us remain in our fallen insistence on autonomy. Here, he calls us to rely on him, to trust him, to be conformed to his image.

For whatever God may will for the remainder of this pregnancy, I am confident in this: that God is willing and able to complete the good work that he started in us. He is present in this pain for that very purpose.

Got it!

Dose 2 of Pfizer is in my arm – a couple more weeks and I’ll be protected.

I’m thrilled that preliminary reports suggest that in addition to virtually eliminating the risk of severe COVID in vaccinated individuals, the currently available vaccines also reduce the risk of infection at all (and therefore spreading.)

Given that it doesn’t eliminate risk of infection, I’ll still be masking up when in the presence of potentially unvaccinated individuals – but this extra layer of protection is more than welcome and I look forward to the increased confidence it can give us in small groups of individuals whose health status/vaccination status is known. And, of course, I am hopeful that others will join the ranks of vaccinated so we can break the chain of transmission sufficiently to keep icky variants from gaining a foothold here in the US.

If you live or work in Sedgwick County, Kansas, the mass vaccination site at the old Central Library (so nice to visit my old digs again!) is very efficiently run and has had open appointments for anyone over 16 for a couple of weeks now. If you’re somewhere else, check with your local health department and get your vaccination scheduled – together, we can beat this!


This Moment

Sometimes, I just want to take a snapshot of this moment in time, so I can remember the ordinary not-so-noteworthy things that nevertheless make life as a parent of young children so delightful.

Like how Shiloh is taking her tentative first steps – three to five at a time, but only when she thinks no one is watching.

Like how Beth-Ellen gave me dozens of pretend gifts for my birthday and then carefully gathered together all the pretend wrapping paper and took it to papa to be shredded and composted.

Like how Louis has suddenly decided that drawing is a thing and is busily creating books full of animals, complete with captions, when only a week ago he didn’t even bother trying to be representational with his artwork.

Like how Tirzah Mae found a math workbook and raced through half of it in less than a day’s time.

Thank you, Lord, for these precious moments.

Oh. That’d be fine.

Louis requested to change which direction he lays on his bed. His argument was that the light gets in his eyes the way he sleeps now.

I tried to explain that if he faces the window (rather than having his pillow under the window as it is now), the light would be in his eyes even worse.

No, no. He was talking about the girls’ reading lamps, not about the sunlight through the window.

I lay on his bed in his proposed new orientation to explain how even the girls’ reading lamps were more likely to be in his eyes that way.

“Oh,” he replied, undaunted. “That’d be fine.”

New Passions

Long a fan of construction vehicles, Louis has lately shifted his interest to dinosaurs and mythical beasts.

So I am busy all day answering questions like: “Is an allosaurus bigger than a blue whale?” or “Does a stegasourus eat meat?” (Answer: “I’m not sure, son – I know very little about dinosaurs. How about you find your book and we can look it up.”)

Louis with his mouth (closed, thankfully) full of food

Frustrated with my lack of answers, he has started to just make up “facts” about imaginary dinosaurs. “The excavator dinosaur is as big as an orange shark, but still smaller than a blue whale.”

It’s a small step from imaginary dinosaurs to dragons – and Louis transforms into Sedonafee, a genuine fire-breathing dragon. Sedonafee is terribly proud of his little brother – HE breathes meatballs instead of fire. (Cooked meatballs. His mouth is like an oven that cooks them first.)

Love Comes Easily. Charity Does Not.

“Let all that you do be done in love.”

~I Corinthians 16:14 (ESV)

I’ve tried to make it a governing principle of my decision making as it concerns this pandemic. “How can I love my neighbor in this instance?”

Should I venture into public or stay home? Should I invite someone in or visit on the porch? Should I wear a mask or not? Should I comment on this post or not comment on this post?

Well, how can I love my neighbor in this instance?

It has mostly come easily for me, thinking this way. Perhaps because I have relatively little fear of this virus for myself or my immediate nuclear family (and because we live far from our extended families, meaning that physical contact with them always requires advance planning and careful decision making.) Perhaps because I also have what I consider to be a healthy fear of infectious diseases from a population standpoint. Perhaps because I remember what it was like to have a baby the medical world wanted me to bubble wrap – NICU staff didn’t want me to take my first two even to church for their first year of life. When I took my preemies into public, I was relying on the conscientiousness of others to protect my vulnerable and not-yet-fully-vaccinated little ones from diseases that regularly put children in their situation back in the NICU and even kill them.

So loving my neighbors by taking COVID precautions has mostly felt pretty straightforward.

Love comes easily. Charity?

Not so much.

You see, charity would have me be patient with those who are (in my opinion) unnecessarily fearful regarding COVID – and patient with those who are (in my opinion) unnecessarily reckless regarding COVID. Charity would have me think kind thoughts and speak kind words about those people with whom I disagree regarding COVID.

Charity would not boast to my husband about how much smarter and more loving I am than all those other people out there who aren’t making the same decisions I am. Charity would not arrogantly assume that her perspective on COVID is the only one worth having. Charity would not be rude (even just internally) to those stupid people who… (do you see how easily my thoughts turn to rudeness?)

Charity would not be irritable toward or resentful of those who misinterpret my attempts at loving as fearfulness for self. Charity would not rejoice when someone “gets what they’ve been asking for” and finds out that COVID isn’t a joke after all.

Charity would bear the misunderstanding. Charity would believe the best of others’ motives. Charity would hope that even the reckless not be hurt or hurt others. Charity would endure the misinformed Facebook posts without having to tirade to her husband about those ALL CAPS EXCLAMATION POINT DOINKS who have no understanding whatsoever of science or immunity or how masks are supposed to work.

I am not charity. Not even close.

“Love is patient and kind; love does not envy or boast; it is not arrogant or rude. It does not insist on its own way; it is not irritable or resentful; it does not rejoice at wrongdoing, but rejoices with the truth. Love bears all things, believes all things, hopes all things, endures all things.”

~I Corinthians 13:4-7 (ESV)

I have to repent daily for the uncharitable thoughts I think as I read the news or scroll through Facebook. I have to repent daily of the uncharitable words I speak when I complain to my husband about the latest ridiculousness that has me up in arms.

Lest I grow puffed up because of how well I have prioritized loving others during this pandemic, I must remember how poorly I have prioritized charity.

And I must fall upon the mercy of the God who is love, who in His charity reached down and redeemed me – impatient, unkind, envious, boastful, arrogant, rude, selfish, irritable, resentful, short-tempered, unbelieving, cynical me.

“But when the goodness and loving kindness of God our Savior appeared, he saved us, not because of works done by us in righteousness, but according to his own mercy, by the washing of regeneration and renewal of the Holy Spirit, whom he poured out on us richly through Jesus Christ our Savior, so that being justified by his grace we might become heirs according to the hope of eternal life.”

~Titus 3:4-7 (ESV)

Love makes us do strange things

This past year has been full of strange things. Stay-at-home orders. Face masks. Cancelled events. Working from home. Foster care relicensure via Zoom. Court via Zoom.

It’s been hard to make decisions in a world cowed by COVID. Even harder when everyone has a different perspective on both the problem and the solution.

For us, we’ve tried to keep one thought at the forefront of our decision making process. We’ve tried to keep love at the center.

“Let all that you do be done in love.”

~I Corinthians 16:14 (ESV)

So when lockdowns were first implemented and our foster daughter could no longer have visits with her mother? We arranged to have daily video chats (as difficult as those are when the “chatter” is not yet 2 years old and there are four other little chatterers in the house.) And when it became evident that restrictions would be prolonged? We insisted on taking on the personal risk so that in-person visits could resume – which meant that we also took on personal restrictions so as not to pass that risk on to others. Our foster daughter’s contact with her mother became the only contact our family had with people outside our family. Because we wanted to love our daughter and her mother by giving them the opportunity to bond instead of letting the fragile bond that was just starting to be established to become a casualty of COVID.

When the time came to decide whether to travel to see our families at Thanksgiving, we opted to stay at home and to instead plan to see them for Christmas, when we had the time to isolate before and after. Because we wanted to love both our families and our community.

When Sunday school reopened this year after a spike of COVID hospitalizations in November closed it temporarily, we opted that I would continue to teach but our children would not attend. In doing so, we hope to reduce our family exposure sufficiently that I can stay well enough to not be regularly leaving my Sunday school team in the lurch when I (the lead teacher for our class) can’t attend due to illness. We want to love my Sunday school students and my fellow teachers.

And when the Southwest Power Pool, which regulates power across the plains, experiences unprecedented demand combined with record low temperatures literally “freezing” some types of energy production? We close our drapes (all day long) to prevent heat loss, turn the heat from 68 to 65, and keep both the lights and the computer off. The sourdough I’d planned to bake sits unbaked; I switch to disposable diapers so less laundry piles up while I’m eschewing the dryer; I handwash dishes instead of running the dishwasher. Because we want to love our neighbors – and if a dark, quiet, cold house for me means they don’t have to suffer from power outages? It’s worth it.

Because I want whatever I do to be done in love.

And love makes us do strange things.

Put ’em in the bathtub

You’d think by the time a woman was shepherding her sixth baby through early toddlerhood, she’d have no more tricks to learn.

But you’d be wrong.

It never fails to frustrate me that brand-new puller-uppers LOVE to play in the toilet. Keep them out of the toilet and they’ll be digging around in the bathroom trash.

The worst thing is, when one is busy in the bathroom, one doesn’t always have a lot of ability to keep a baby’s hands out of inappropriate places.

It won’t really do much good if I take my hands out of the toilet where I’m rinsing dirty diapers just to move her hand away from the ick. And if I’m washing my own hands and they’re all wet? That’s not really ideal either. I’m going to have to wash them again (along with the baby’s hands) anyway, but I don’t really want to get her outfit all wet…

It’s a conundrum. It has been a conundrum for the past five and a half years since Tirzah Mae started pulling up on things.

But I’ve finally discovered a hack so simple I can’t believe I didn’t think of it sooner.

Shiloh, in my bathtub while I dress for the day

Put her in the bathtub.

Of course.

Humans are the only mammals who…

If you’re going to start a sentence with “humans are the only mammals who,” I sure hope you’re planning to share a fun fact, not to make an argument (unless your argument is that humans are unique among mammals.)

Alas, when I hear “humans are the only mammals who,” I brace myself for one particular argument: milk drinking.

Should humans drink milk from other species?

Well, humans are the only mammals who drink milk after weaning.

Tirzah Mae and Beth-Ellen drinking cow's milk
Young humans drinking the milk of another species

Folks, this is not a scientific argument. Say I accept your premise that humans are the only mammals who drink milk from other species. Does it follow that humans ought not drink milk from other species? No, this merely means that humans are different from other mammals.

The reality is, this is only one of many significant ways in which humans are different from other mammals. Humans build fires to heat their homes and cook their food. Humans wear clothing. Humans use soap. Humans write blog posts. Humans use medications to treat and prevent illness. We are truly exceptional creatures.

If “humans are the only mammals who drink milk after weaning” is an argument against milk-drinking, why shouldn’t the same argument be used to say we should all run around naked and unwashed? Why shouldn’t we also argue that we should only eat raw food (or food that has just happened to be cooked by the sun, without human intervention)?

Furthermore, is the statement that “humans are the only mammals who drink milk after weaning” even true?

When I was growing up, we took regular trips to visit my grandparents in rural northeastern Nebraska. There was one particular farm along the way that kept their cows and their pigs in the same pen. My siblings and I were always fascinated (and a bit grossed-out, to be honest) to see the pigs suckling on the cows. Perhaps the only reason “humans are the only mammals who drink milk after weaning” is because few other mammals have opportunity? After all, I think humans might be the only mammals who express their milk and that of other animals to be consumed versus consuming it only directly from the breast/udder.

So, anyway, if you’re trying to make an argument that cow’s milk (or non-milk cow’s milk substitutes) is unnecessary for humans, please try another argument.

This rant brought to you in response to something I read from someone who should have known better. Since I actually agreed with her true underlying point (that a child who is allergic to cow’s milk doesn’t need an alternate milk source), I didn’t bother to try to straighten out her argument – but I did want to get my frustration with that argument off my chest.