preeclampsia

Categories Pregnancy

Will you do it for us?

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Last year, recognizing that while we were at low risk for death or serious illness from COVID-19 you might not be, our family masked up, socially distanced, and got our vaccines.

My children have masked every time they’ve been in public since the CDC started recommending it (which means Daniel and I have also masked whenever our children have been in public, even during the brief period that CDC dropped the recommendation for masking for vaccinated individuals). My children missed a year of Sunday school (their primary interaction with other children) so their mother could continue to teach Sunday school without putting others at risk.

We did this not because we are particularly vulnerable to COVID but because the grandparents of my Sunday school students, the person who stands behind me at the grocery store, and the fellow taking my money at the McDonald’s drive-through might be.

This year, though, as Delta ramps up, filling our local hospitals once again and as lowered mitigation practices have started “respiratory season” months early (really months late since we basically skipped it last fall and winter), I feel particularly vulnerable.

Because this year, my family is at risk.

While preeclampsia is the immediate concern for me and baby, preeclampsia isn’t the only thing going on. I have complete placenta previa, which means that baby’s placenta completely covers my cervix. If my cervix starts to dilate and the placenta begins to detach early, baby could die. I could bleed out. It’s not a pretty possibility. This is why we’ll be delivering early, via c-section, no matter what happens with the preeclampsia.

But even if there’s no cervical dilation, no placental detatchment prior to our c-section, we’re not out of the woods yet. We are grateful that ultrasounds show no evidence of accreta – abnormal embedding of the placenta into my uterus. But even without any ultrasound evidence, there is still a significant risk, given my history of two prior sections and the presence of complete previa, that the placenta won’t detach cleanly and I’ll need an emergency hysterectomy and lots of transfused blood.

This year, given placenta previa and the risk of accreta, it matters to my family that our hospital is adequately staffed and equipped to handle desperate situations. We might well be that desperate situation.

But say God graciously grants us reprieve from early labor, from accreta, from hemorrhage. We’re still having a preemie. No ifs, ands, or buts about it. This baby will be born before term. We’re going to try to get as close to term as safely possible, but “safely possible” is no later than 37 weeks, 5 days.

And, as we know from past experience, preemies are particularly susceptible to respiratory viruses. In fact, we were strongly encouraged to distance our preemies by keeping them away from all crowds (including grocery stores and church) and all other children until they were a year of age because of their risk for rehospitalization if infected by RSV (the “respiratory season” currently going on that we skipped last year is largely RSV).

But our baby won’t be able to stay away from all other children – he’s blessed with four big siblings. Instead, our children will likely have to spend a second year in a row isolated from other people – last year, to protect those others, this year to protect their baby brother or sister.

And should baby end up getting sick and ending up back in the hospital? It matters to our family that the hospital be adequately staffed and equipped to handle that situation.

Which means that this year, it matters to us personally that we as a society get COVID under control.

Maybe it doesn’t matter to you personally. You consider the risk to yourself to be fairly low. But if you get COVID and spread it and community levels stay high, my children face another year of isolation. If you get it and spread it and our hospitals stay full, I and our new baby may be unable to get the care we might need.

So please, even if you won’t do it for you, will you do it for us? Will you consider laying down some of your rights to help us? Get vaccinated if you haven’t already been. Wear a mask when you’re around other people, especially if you’re unvaccinated or your community has high levels of transmission. Choose not to go out at all if you’re sick.

Will you do it for us?

Categories Pregnancy

A Crash Course in Preeclampsia

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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.

Categories Pregnancy

Only one patient

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Childbirth stories never fail to pique my interest. Birth has been a passion of mine since I was young, reading my mom’s copy of Rahimah Baldwin’s Special Delivery. But since I’ve become a mother, my interest in childbirth stories has only increased.

So when the headline “Focus On Infants During Childbirth Leaves U.S. Moms In Danger” showed up in my newsreader, I clicked through to NPR’s report. And when I finally got the time to read the whole thing (it took several sittings because, hello, newly pregnant mother of a toddler and an infant), the story hit home in a way I wish it hadn’t.

The statistics are nothing new for me. The United States does a terrible job of keeping pregnant and postpartum women alive when compared to the rest of the developed world. I knew that. But this is a story with a face. The face of a woman with preeclampsia, with HELLP syndrome – a woman with what I had. A woman who died, leaving her baby behind.

There were warning signs. Signs that weren’t heeded. There were lots of opportunities to save her life. But when she or her husband suggested that preeclampsia might be the problem, they were pooh-poohed. And she died.

The text of the article hinted at rather than driving home the point the headline made: “Focus on Infants during Childbirth Leaves U.S. Moms in Danger” – but I couldn’t help but relive my own experiences.

When I think back to my hospitalizations with Tirzah Mae and Louis, one of the hardest things for me to deal with was how the focus shifted from me to the babies the moment they were born. Before they were born, I was the patient. The nurses checked on me hourly. Every care was taken to keep my blood pressure low and to keep the baby inside me healthy.

But once they were born, it was as if a switch was flipped. Never mind that I had the exact same (life-threatening) condition I’d had before the babies were born (now with major abdominal surgery added on top of it). I was no longer carrying a baby, so I would be just fine. My baby was the important one. It was as if only one of us could be the patient. My turn was over and it was the baby’s turn.

Thankfully, with Tirzah Mae, I started improving after her birth and continued to improve.

With Louis, a medical error – a resident forgetting to prescribe me my blood pressure meds when he discharged me on a Friday afternoon four days postpartum – could have meant my death. By the grace of God, I took my blood pressure that Saturday afternoon just as I had every day of my pregnancy since my morning blood pressures had started to rise near the beginning of the third trimester. My blood pressure was at critical levels.

Rather than going to the hospital to hold and feed my baby on his fifth day on the outside, I traveled to the hospital for another purpose – to live to hold and feed my baby again. I spent hours in the ER getting one dose after another after another of IV labatelol. It took five doses to get my blood pressure back down.

I’m not angry with the nurses, with the doctors, not even with the resident who failed to prescribe me a blood pressure med on discharge. But I am angry with a system that only considers a woman’s health important inasmuch as the baby is kept healthy. Why can there only be one patient?

Is it not just as important that these babies we rightly fight to keep alive and well in our NICUs have mothers who are alive to care for and love them?

Why must there only be one patient?