New Moms
Pre-Eclampsia Isn’t Always Over with Delivery. What You Need to Know and Do Post Partum
September 7th, 2010
Pregnancy complications don’t always spontaneously resolve with delivery. Case in Point:
I just got an e-mail request from a mom’s group that I am a part of requesting prayer requests for one of our members. She just had a baby a couple of weeks ago and ever since she has had severely high blood pressure. She has been experiencing “migraine” headaches at home and her husband has taken her back to the hospital several times because of her high blood pressure and headaches. She was diagnosed with post partum eclampsia, excessive high blood pressure that occurred after pregnancy, and was sent home to rest with her baby. My friend’s husband has been monitoring her blood pressure at home and making note of her headaches. When her blood pressure soared again yesterday, he again took her back to the hospital. This time she had a CT scan and MRI scan. The scans detected a small blood vessel that had burst. This likely occurred around the time of her delivery and has been the cause of her high blood pressure and headaches.
Ladies, many pregnancy complications don’t spontaneously resolve with delivery and high blood pressure or pre-eclampsia is one of them. I don’t know if my friend had high blood pressure during her pregnancy and I don’t recall her being on bed rest, but I am reasonably sure that she did have high blood pressure before she left the hospital. Pre/Post Partum Eclampsia can quickly become a medical emergency and my friend could have died in the time that it took doctors to diagnose her condition.
As explained in a previous post on pre-eclampsia, the condition is characterized by high blood pressure, protein in the urine and swelling (especially of the hands, feet and face). These symptoms together create a toxic intrauterine environment for the baby as well as a dangerous physical condition for mama, so when the symptoms become uncontrollable, the baby is emergently delivered either via labor induction or via cesarean section.
In many instances, delivery is enough to quell the symptoms of pre-eclampsia and to restore stable health to both mama and baby, but it’s not always curative. Some women, like my friend, have persistent symptoms or, which may have been her case, develop symptoms after delivery. It is highly likely that her blood pressure was elevated at discharge, so the question becomes, why was she sent home? Hypertension is defined as blood pressure over 140/90, but as was also pointed out in the blog post on pre-eclampsia, if a woman normally has low blood pressure, say 110/60 and her blood pressure shoots up to 130/80, even though she does not have “clinically high blood pressure”, the fact that she has jumped 20 points on both her upper and lower numbers is cause for alarm. The more prudent course, regardless of which type of hypertension she had, would have been to keep her in the hospital for at least another 24 hours, to closely monitor her blood pressure at frequent intervals and at each vital sign check, to evaluate her for swelling and to ask if she is experiencing any headaches.
The other question that comes to mind is does my friend know what her blood pressure is when she is not pregnant? This is critical information. If she knew that her blood pressure is regularly 110/60 when she is not pregnant, if her blood pressure did not begin moving in that direction after delivery and most certainly if it steadily crept up, she could have quickly relayed that information.
Here is where I think we women falter. Did my friend ever ask the nurse what her blood pressure was? Dr. Linda Burke-
Galloway in her book, The Smart Mother’s Guide to a Better Pregnancy* (read our, and listen to our podcast interview), encourages women to be keepers of their own health records. She advises (as I do!), Whenever you visit your health care provider or while you are in the hospital, ask what your vital signs are and keep your own little log. You’ll know if you are gaining too much weight too quickly or if your blood pressure is creeping up. You will be able to notice trends in your own health and quickly notify your provider if there is something out of the ordinary. If we women are to be partners in our health care, we must share in the responsibility of caring for ourselves and that includes doing what we can to keep track of our health, noting and reporting changes. You know you best and in an emergency, may be your best lifesaver.
As for the headaches…Headaches in a person with high blood pressure are NEVER a good sign, and almost always indicate that the blood pressure is dangerously high (even if not clinically “hypertension”) for that person. Given that my friend was immediately post partum and having headaches and high blood pressure, I am again surprised and concerned that she was discharged and that it took about 3 weeks for her to be readmitted. Pregnancy itself creates a state of increased fluid volume throughout the body. This in part contributes to high blood pressure. The additional fluid pressure creates increased pressure on blood vessels that could lead to rupture. Additionally, the extra hormones of pregnancy put women at increased risk for developing blood clots. So between the increased pressure on the blood vessels, especially the micro-vessels in the brain, as well as the increased for blood clots, pregnant women are at increased risk of both hemorrhagic (bleeding) stroke and occlusive (blockage due to a blood clot) stroke. I am not sure if my friend was diagnosed with a stroke, but she did have a bleed in her brain, what they seem to regarding as a “small rupture of the blood vessel” (more like a leakage) that doctors feel competent they can treat. Treatment is great, but the question is, could this have been avoided if she had remained in the hospital and been monitored or have been admitted at one of her earlier presentations to the emergency room??
I am happy to say that my friend is doing much better. The doctors are tending to her blood pressure and to her leaking blood vessel and I will continue to pray for her full recovery. But this could have easily become a really bad situation. If her leaking blood vessel had gone undetected, it is very likely that my friend would have had a full on stroke, with potentially cognitive and physical deficits. How awful that would be for a mother with 3 small children, one a newborn infant. Even worse, she could have died leaving her husband a widower with 3 young children to raise.
Ladies, please be active partners in your health care. It’s okay to have faith in your obstetrician or midwife, but know for what is going on with your pregnancy, ask questions and give input. Remember, you know you better than anyone else and if something is not feeling quite right, talk with your health care provider immediately! Make them listen to your concerns and don’t stop talking, asking and if necessary demanding until all of your questions and concerns are addressed to your satisfaction.
Update 9/8/2010
Just got word that my friend’s blood pressure is down, the brain bleed has been treated and she is resting at home comfortably. Let’s hope it’s for good this time!
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The Preemie Primer: Recommended Reading for Mamas on Bedrest
September 2nd, 2010When you are pregnant, you are bombarded with information and advertisements for everything from infant swaddling blankets, to formulas, to cord blood banking, to strollers. Much of the information that I received in my bag at each of my first obstetrical visits was useless. They were simply little leaflets trying to sell me things that I didn’t really want or need. How much better it would have been if I had received a copy of The Preemie Primer: A Complete Guide for Parents of Premature Babies-From Birth Through the Toddler Years and Beyond.
The Preemie Primer was written by Jennifer Gunter, MD, a board certified obstetrician/gynecologist, who is also board certified in pain medicine and board certified in physical medicine and rehabilitation. At a first glance it seems like Dr. Gunter is yet another “expert” telling you what the “scientific evidence” says you should do for your baby. While Gunter offers comprehensive information on caring for a premature infant, the book is far from dry and overly ‘jargoned’. At its best it is a deeply personal account of how Jennifer Gunter, wife and mother, navigated the peaks and valleys of caring for her markedly premature boys Oliver and Victor (born at 26 weeks) while also grieving the loss of their triplet brother Aidan, born at 22 weeks. She is simply sharing what she learned and knows with other parents and has created a powerful resource for parents of preemies.
Now I don’t want to discount Dr. Gunter’s knowledge. She has done a great job of pulling together the necessary medical information pertaining to preterm labor, prematurity and caring for mom and baby (ies) post partum. But the honest truth is that much of the “medical” information is freely available-on the web and in books and texts. But The Preemie Primer is for parents of preemies who, at a time when this information is in critical need, they dont’ have a nanosecond to spare seeking it out. Part of what makes it such an excellent resource is that not only is the medical information readily at hand in one place, Dr. Gunter also includes information on self care for parents (asking for help with post partum depression for example, deep breathing, meditating…) and navigating the complex US insurance system to get the care premature babies and children desperately need. Yes, the chapters on “The Mind-Body Connection” and “Making the System Work for You” were really helpful and informative and a welcome departure from the sterile statistics, instructions and definitions.
But far and away the “precious jewel” of this book is that it is written by Jennifer Gunter, wife and mother to two 
navigated the peaks and valleys of caring for her markedly premature boys Oliver and Victor (born at 26 weeks) while also grieving the loss of their triplet brother Aidan, born at 22 weeks.premature little boys and an angel in heaven. The success of The Preemie Primer results from the fact that as I read it, I felt as if I was sitting across from Jennifer Gunter, drinking coffee and chatting as she tells her story. I think the most powerful parts of the book are the gray insets that tell her personal story, her personal struggles to care for her living boys while at the same time grieving her angel Aidan. The times she was so overwhelmed with emotions that all she could do was cry. At those times her credentials were irrelevant. She was a mom, struggling for herself and for her sons, and as vulnerable as the rest of us.
One of my favorite vignettes was her conversation with the hospital representative as she disputed charges for Aidan. Anyone who has ever had the frustration of speaking with hospital representatives who are insensitive, unyielding and basically ignorant to medical procedures will totally relate to this conversation. Gunter was arguing to have charges made for Aidan’s “care” removed from her hospital bill. You feel the pang in your own heart as you hear Gunter tell this representative that Aidan died and did not receive care as is indicated on the bill.
While I like and highly recommend The Preemie Primer (Remember, I said it should be in every new OB bag!), I realize it is a tough sell. In the same way that obstetricians don’t discuss the possibility of bed rest until a woman is having it prescribed, I doubt The Preemie Primer will become recommended reading for mainstream pregnancy. And this is unfortunate. Having had a late preterm birth, I would have loved to have had even an inkling of what to expect. As high risk as I was, no one ever even mentioned that I was at risk for preterm labor. I was never counseled about the signs and symptoms of preterm labor. When I delivered my daugher at 36 wks and 6 d, I fully expected to have her put on my chest, to nurse her and then to have her in my room. Instead she was whisked away from me by nurses and neonatologists and then admitted to the NICU (which is never mentioned or visited in hospital tours). I was completely blind-sided by the entire experience.
Our culture likes to “stay positive” and always “look on the bright side”. But turning a blind eye to potential catastrophe is just plain stupid. No woman wants bed rest, a premature infant or, heaven forbid, to have a stillbirth. But the reality is that these events happen. Just because we don’t talk about them or “don’t have that in my family or medical history” doesn’t mean that they can’t happen to us. Obstetricians and midwives should talk about them (at the very least) and give parents tools and resources that they can readily access in the event that the most awful and unexpected happens. So yes, I do think that The Preemie Primer should be put in OB bags-or made readily available in OB offices, hospital gift shops, family resource centers and the like.
We have to face the fact that not everyone has the picture perfect pregnancy, labor and delivery. But things needn’t spiral completely out of control. Research shows that patients who feel that their health care providers are honest and up front with them, explaining every test and treatment and potential outcome are far less likely to come away with ill feelings or to sue their providers. We have to have the hard conversations. But if OB’s and midwives don’t want to do that, or feel uncomfortable or as if they are “scaring” their patients, then have resources readily available. As Dr. Gunter said herself during our podcast interview, “Plan for the worst but expect the best”.
The Preemie Primer is available on this website via our Amazon.com store in the Infancy/Childhood section. We respectfully ask that if you decide to purchase The Preemie Primer as a result of reading this blog post or listening to the podcast interview with Dr. Gunter that you do so via our store as it helps to fund the operation of this website.
Share your stories of preterm labor and caring for a premature infant below.
5 Tips to Enhance Your Post Bed Rest, Post Partum Walking Program.
July 22nd, 2010As many of you know I have been traveling around the country with my kids visiting family and friends for the past several weeks. Early on I wrote a blog describing how many new mamas were working diligently to regain their pre-pregnancy physiques in a park in East Tennessee. These mamas were walking and while I wholeheartedly support their efforts, observing them prompted me to write Walking Gets Mama into Shape After Bedrest giving 4 tips on how to start a walking program after being a mama on bed rest.
I’ve thought about those mamas and the many others I’ve seen along my journey. The gentle strolls around the park are a good start, but if they want to enhance their effort, they should incorporate these 5 tips into their walking programs.
- Increase the duration of the workouts. Many new mamas, especially mamas who had been on bed rest prior to delivery, start out only able to walk for just a few minutes. But as you get stronger, try to exercise for longer durations. Walking for 30-45 minutes daily at a moderate pace will increase cardiovascular health, increase leg muscle tone and will aid in weight loss when combined with a reduced calorie diet.
- Increase the intensity of the workouts. Now that you are stronger, press yourself a bit. Walk faster and see if you can cover the same distance in a shorter amount of time. Vary your route. If you typically walk in a flat park, try to find a route that has a few small hills. Increasing the intensity of your workouts will increase your cardiovascular health, improve your muscle tone and will increase your energy expenditure . This is important if your goal is to lose weight. To lose weight you must burn/expend more calories than your take in. So walking more intensely will burn more calories than strolling.Walking a more strenuous course will increase muscle tone in your legs. The more muscle you have, thttp://www.mamasonbedrest.com/wp-admin/post.php?action=edit&post=1418he more calories you burn. Combined with a reduced calorie diet, you will be more likely to lose your pregnancy weight faster and keep it off.
- Practice contracting and holding in your abdominal muscles while you walk. One of the most common complaints of post partum women is the “poochie belly”. The abdominal muscles are so stretched from pregnancy that they must be rehabilitated not only to regain the flat pre-pregnancy belly but also to improve posture and to increase core muscle strength. While walking, draw your abdominal muscles in, pulling your navel to your spine. DO NOT HOLD YOUR BREATH!! Hold for 1-2 seconds and release. Repeat several times during your walk. Gradually increase the amount of time you are able to hold your abs in while you walk. With practice, you will be able to hold you abs in for an entire walk.
- Do Kegel Exercises while you walk. Kegels are also important exercises to help strengthen the core as well as the pelvic floor muscles. Several repetitions should be performed several times a day in order to strengthen the pelvic floor, strengthen the core, reduce incontinence and reduce the incidence of organ prolapse. Our blog post Kegels: Essential Exercises for Mamas on Bed Rest gives a full explanation of the benefits of Kegels as well as how to do them.
- Get Support. Numerous studies have shown that exercise and weight loss efforts are enhanced when people, especially women, have a partner. When I was walking in the park and watching the mamas walk, I was really pleased to see a dad walking alongside a new mama. While working out with a significant other can have its challenges, it can also draw a couple closer, an added benefit for new parents who may be feeling stressed.
What are your tips for working out post partum? Please share with our community by posting in the comments section below.
Reading this while on bed rest? Wondering what exercises you can do? Sign up for our free e-newsletter and receive a free download of 10 lower body exercises, stretches and Kegel exercise instructions.
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