Pre-Eclampsia: A frequent reason Mamas are prescribed bed rest
August 25th, 2010Pre-Eclampsia-Definition and Background
Pre-Eclampsia is a medical condition that only affects women during pregnancy and post partum. It is characterized by 
high blood pressure and protein in the urine, subsequently creating a toxic physical environment for both mother and baby. It is frequently the reason a pregnant woman is prescribed bed rest. While it can occur anytime during pregnancy, it typically occurs after 20 weeks of pregnancy, in the late second or third trimester. Pre-Eclampsia occurs in 5-8% of all pregnancies globally and is the cause of some 76,000 maternal deaths and 500,000 infants annually.
Pre-Eclampsia can rapidly become a serious or even fatal medical condition. Women should know the signs and symptoms of pre-eclampsia and report any signs or symptoms they have to their health care provider immediately.
Major Signs and Symptoms of Pre-Eclampsia
None – The problem with Pre-Eclampsia, much like other hypertensive disorders, is that it often has no symptoms.
Hypertension is known as “the silent killer” and pre-eclampsia is no different. Bed rest has been shown to reduce blood pressure and frequently reduces the signs, symptoms and complications that may arise as a result of pre-eclampsia. Even though bed rest is inconvenient at best and quite uncomfortable and physically challenging at its worst, if your health care provider prescribes bed rest for pre-eclampsia, Please follow his or her directions, even if you feel fine.
Hypertension – Hypertension or high blood pressure is defined as two blood pressure readings over 140/90 at two different times at least six hours apart. However, pregnant women with normally low blood pressure, such as 110/65, may be diagnosed with pre-eclampsia prenatally or in the post partum period when their blood pressure rises to 135/80 and/or they develop signs and symptoms of pre-eclampsia.
In 1990 the National Institutes of Health, National High Blood Pressure Education Program: Working Group Report on High Blood Pressure in Pregnancy issued the following research guidelines:
In the past it has been recommended that an increase of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure be used as a diagnostic criterion, even when absolute values are below 140/90 mm Hg. This definition has not been included in our criteria because the only available evidence shows that women in this group are not likely to suffer increased adverse outcomes. Nonetheless, it is the collective clinical opinion of this panel that women who have a rise of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure warrant close observation, especially if proteinuria and hyperuricemia (uric acid [UA] greater than or equal to 6 mg/dL) are also present.
For this reason, it is extremely important that women know what their baseline blood pressure readings are and at each prenatal visit they ask their providers what their blood pressure is. In this way, both health care provider and patient can be on the look out for blood pressure abnormalities and address them as soon as possible.
Swelling (Edema) – Swelling can be an insidious symptom of pre-eclampsia because so many women experience swelling of their hands and/or feet or even their faces when they are pregnant. However, when the swelling is significant enough to change your facial features, you should notify your health care provider immediately, advising them that you believe the swelling has become excessive. You may need to show them a photo of you prior to pregnancy, your driver’s license for example, to prove your point. In any event, if swelling concerns you, make sure it becomes a concern of your health care providers and that it is addressed.
Proteinuria – Proteinuria occurs when proteins, usually filtered by the kidneys and retained in the blood stream, leak into the urine because the small blood vessels in the kidneys have become damaged allowing the proteins to pass through. (This is usually due to your elevated blood pressure. Remember, pre-eclampsia creates a toxic physical environment to both mother and baby!)
Other Common Signs and Symptoms of Pre-Eclampsia
Sudden Weight Gain – Since weight gain is a hallmark of pregnancy, it’s often hard to discern between regular pregnancy weight gain and weight gain associated with Pre-Eclampsia. The rule of thumb is that if you start gaining more than 2 lbs per week or more than 6 lbs in a month, you should consult with your health care provider as this could be an indication of pre-eclampsia.
Headache – Severe, migraine-like headaches which are often one sided and dull and throbbing could be a warning that your blood pressure is dangerously high. Contact your health care provider immediately for evaluation.
Nausea or Vomiting – While nausea and/or vomiting is common in the first trimester, it usually abates during the second and third trimesters. If you have sudden onset of nausea and/or vomiting in the second or third trimester, contact your health care provider immediately for evaluation.
Changes in Vision – If you experience any sudden blurred vision, double vision, flashing spots, or sudden light sensitivity, this is another warning that your blood pressure may be dangerously high. Contact your health care provider immediately for evaluation.
Racing pulse, mental confusion, heightened anxiety, trouble catching your breath – While all of these symptoms can occur in pregnant women, when they suddenly occur from out of the blue and especially if they occur together, this is cause for concern. Contact your health care provider immediately.
Stomach or Right Shoulder Pain – I want to be a bit more specific here. The pain you may be experiencing here is right upper quadrant abdominal pain, specifically, liver pain. The pain may be “radiating” or “referred” to the right shoulder, but its origin is in the liver. This pain requires immediate attention as it is an indication that the liver is under stress and you may be suffering from HELLP (Hemolysis-bursting of red blood cells, Elevated Liver enzymes levels, and Low Platelet count) as serious obstetrical complication. It is imperative that you be evaluated immediately if you have symptoms of HELLP to avoid more serious complications or even death.
Lower back pain - Low back pain is so common in pregnancy that it is difficult to distinguish between the typical low back pain of pregnancy and low back pain associated with pre-eclampsia. If you are unsure, certainly consult your health care provider. But consult with your health care provider immediately if the low back pain is present with right upper quadrant abdominal pain as this may be another sign of pre-eclampsia.
This is a cursory overview of Pre-Eclampsia and we will delve into the subject with more depth in coming blog posts. Just remember that pre-eclampsia can have serious medical consequences for both you and your baby including death, so if you are concerned about symptoms, consult with your health care provider and have an immediate evaluation.
This list of signs and symptoms is edited and reprinted from the list presented on The Pre-Eclampsia Foundation website. This website is a holds a wealth of information on pre-eclampsia; current research and resources for more information and to get more help and/or support.
Did you have pre-eclampsia during your pregnancy? Are you a Mama on Bedrest now for pre-eclampsia? Share your story in our comments section below.
Hypothetical question: Preemies & Maternty Leave?
August 24th, 2010
Libby283, A mama to be posted the following “hypothetical question” to the community on The Bump.
This is just a hypothetical question and wondering if any other ladies had it happen and how it was handled…
What happens with maternity leave if you have a preemie baby that will require a lengthy hospital stay. For instance I only get 6 weeks maternity leave with my employer. If I delivered tomorrow, at 30 weeks, the baby would be in the hospital for the duration of the maternity leave. Does your doctor & employer let you go back to work early and then use the remaining leave time for when the baby comes home?
Just curious, but I hope I don’t have to worry about it as a reality.
There were some conflicting responses to her question, and I thought it a really good question to respond to on Mamas on Bedrest & Beyond. We’ll also be posting a reply on The Bump.
First and foremost, Libby283 is entitled to 12 weeks of unpaid medical leave as stipulated in the United States Family Medical Leave Act (FMLA). This act states that eligible employees are entitled to up to 12 weeks of unpaid leave with guaranteed job protection each calendar year to,
- Deliver a baby,
- Bring home An adopted or foster child
- Care for a critically ill family member such as a spouse, child or parent
- Heal and recuperate from serious illness.
Here is the actual text of The Family Medical Leave Act as posted on the US Department of Labor Website:
The Family and Medical Leave Act (FMLA) provides an entitlement of up to 12 weeks of job-protected, unpaid leave during any 12-month period to eligible, covered employees for the following reasons: 1) birth and care of the eligible employee’s child, or placement for adoption or foster care of a child with the employee; 2) care of an immediate family member (spouse, child, parent) who has a serious health condition; or 3) care of the employee’s own serious health condition. It also requires that employee’s group health benefits be maintained during the leave. The FMLA is administered by the Employment Standards Administration’s Wage and Hour Division within the U.S. Department of Labor.
So Libby283 is actually covered by the law as well as her employer.
What gets sticky is when people try to combine two or more leave policies to get more time off. The scenarios play out very differently depending on your employer, your state laws and how you choose to use the federal law. Recently in Massachusetts, the courts ruled that the Massachusetts Maternity Leave Act entitled women to 8 weeks maximum for maternity leave (See Massachusetts Maternity Leave Act: No Help for Mamas on Bedrest). since that is only a state ruling, women could then attach an additional 12 weeks onto their leave as stipulated by the Family Medical Leave Act. What is allowed varies from state to state so women planning to become pregnant should find out what they are entitled to and to make provisions in the event of a complicated pregnancy (requiring bed rest) and/or a complicated delivery requiring an extended hospital stay for mama, baby or both.
What employers choose to do becomes another matter. Libby283’s employer can say, okay, you can have 6 weeks paid leave (not sure if she is being paid or not) but if you want the entire 12 weeks, the remaining 6 weeks is unpaid. In that way her employer has not violated FMLA and has not breached the company policies. Likewise, the company can say, you are entitled to the 12 weeks of unpaid leave as stipulated by FMLA, but we are not obligated to pay you. Or, if they are a really family friendly company, they may even offer 12 weeks of paid leave (haven’t seen this one in a while, but one could hope!)
As the law reads you are entitled to 12 weeks family medial leave total per calendar year. So Libby283 could in fact split her time off between when she actually delivers and is discharged and when her baby comes home. While this is good in theory, it is my experience that when a mama has a preemie, she is not back to work but in the NICU any chance she gets, so time off could still be an issue.
It’s clearly evident from Libby283’s question and the laws that this is a confusing issue. Mamas on Bedrest & Beyond is committed to working with other organizations to advocate for improved maternity privileges including extending maternity leave and having maternity leave be paid. Subscribe to our blog and e-newsletter to stay abreast of what is happening with maternity leave and how we are working to initiate change at local, state and national levels.
Why Most Women Can’t Afford to Go on Bed Rest
August 19th, 2010
I recently commented on a blog post by a fellow mom blogger CourtroomMama. I really appreciated her blog post, commenting on and explaining the appellant victory of Samantha Burton and the ACLU which overturned a court decision that had ordered Ms. Burton to go on prescribed bed rest for pregnancy complications.
In March of 2009 a Florida court ordered Samantha Burton to go on prescribed bed rest as her doctor recommended due to complications with her pregnancy. Burton, a single mother with two living children had refused to go on bed rest citing that she could not afford to be out of work, unpaid and not able to provide for her family for the estimated 15 remaining weeks of her pregnancy. The ruling implied the court didn’t care about her right to make her own health decisions or her current children, but sought to protect her unborn child. To add insult to injury, Burton was also ordered to submit to any and all “medically necessary” treatments including cesarean section. Sadly, Burton delivered a stillborn baby several days into her bed rest. In August of 2009, The ACLU filed an Amicus Brief, i.e. a court appeal, on Ms. Burton’s behalf. This August, 2010, Burton and the ACLU won their appeal. The ACLU cited that the previous ruling had misused the “Best Interest of the Child” standard, applying it to an unborn fetus when it is typically reserved for issues of juvenile court involving “living” children.
I really encourage every one reading this blog to take a look at CourtroomMama’s post. She has done a really nice job of making legal jargon understandable for us commoners and she raises some very interesting questions as “food for thought” that we all should be heartily considering when it comes to maternity leave.
What struck me most about this Florida ruling and other rulings and declarations that rule in favor of “protecting an unborn child” is how the mothers in all of these cases are essentially reduced to a gestational vessels-their lives, their interests and sometimes even their health is subjugated in favor of the unborn child. In the Florida case, Ms. Burton clearly stated that she could not afford to be out of work for 15 weeks as she would be unable to pay for and care for her two living children. That was not a persuasive enough argument. Nor was the fact that ordering her to submit to medical treatments against her will was a flagrant violation of her civil rights. The court and Ms. Burton’s OB implied via this case and its ruling,
“You are incapable of making decisions regarding the health and well being of you and your child, so we are taking your right to make your own medical decisions-and your right to make decisions regarding how you will care for yourself and your family-out of your hands.”
Unfortunately, this is not an isolated court case and nor an isolated situation in which a woman’s rights are trounced in favor of the rights of someone else. The fuel of the abortion argument as well as the controversy surrounding the usage of emergency birth control, is whether or not a woman has the right to decide when she will carry a pregnancy and hence control her health and her body. I was completely outraged when Republican Senate Candidate Sharron Angel (R-NV) stated that women should never be allowed to have an abortion, even in the case of rape. Within the course of with Alan Stock, Ms. Angle made her infamous statement that women should take these “lemon” situations and make “lemonade.”
Besides being one of the most insensitive and ignorant statements I have ever heard of, I’d like Ms. Angle and others opposed to abortion, morning after contraception, voluntary sterilization and other medical treatments available to women that allow them to control when they choose to become pregnant to consider the fact that while they are telling women to have the children that they did not intend to conceive, they offer no tangible ways for these women to support themselves through the pregnancy and birth process. While some men share the responsibility of unintended pregnancy with their partners, many more who get their partners pregnant simply walk away taking no responsibility for the well being of the woman or unborn child. So with this being the case, is it any wonder that women are making what many would deem “radical decisions” regarding their health and the health of their unborn children?
The United States makes few provisions for women, especially single women, to provide for themselves and their unborn children. Instead we choose to point fingers and make the case that women should not even have sex outside of marriage. At the core of Samantha’s Burton’s case is the fact that United States is one of few if not the only Western nation that offers no paid maternity leave, no professional home attendance after a woman gives birth and little to no assistance with childcare. (For more on how poorly the US compares to other countries, take a look at the THE WORK, FAMILY, AND EQUITY INDEX-WHERE DOES THE UNITED STATES STAND GLOBALLY? report)
Whether a woman is single or in a stable relationship, our workforce rules and regulations are antiquated. Back in the early to mid 1900’s when many of our workforce rules were put in place, the majority of employees were men and those women who were working, typically did so only until they started their families, then they stayed home and raised their children. But clearly this is no longer the case. According to the US Department of Labor,
- Of the 122 million women age 16 years and over in the U.S., 72 million, or 59.2 percent, were labor force participants—working or looking for work.
- Women comprised 46.8 percent of the total U.S. labor force and are projected to account for 46.9 percent of the labor force in 2018.
- Women are projected to account for 51.2 percent of the increase in total labor force growth between 2008 and 2018.
The rules governing the workplace are no longer applicable to today’s workforce. Ladies, why do we stand for them?
Women are capable of making wise medical decisions. They are also capable of holding down full time jobs while taking care of themselves and their families. The laws governing personal rights and freedoms must be applied to women (as guaranteed by the constitution of the United States)-even if women make unpopular decisions or decisions that those in authority don’t understand. Women have the legal right to make those choices.
Likewise, Department of Labor and other workforce organizations need to re-evaluate the workforce, paying close attention to how the American family has evolved and our workforce rules need to reflect this evolution. It is unacceptable for women to be forced to choose between their jobs and their families with the assumption that women can’t competently manage both. The assumption that women must be regulated by outside bodies (Pun intended!) is also unacceptable. Given that women are fast becoming the majority in the workforce, isn’t it time that the laws reflect this majority? Without re-evaluation and application of individual rights to women as well as re-evaluation of our workplace rules and standards, we stand to see many more cases like Burton v. Florida.
