2 Time Post-Partum Hypertension/Preeclampsia

Posted On Monday, August 08, 2011  by julie

I just delivered my son, via a second c-section, a month ago.

My daughter's birth almost 2 years ago was not a smooth process.  I endured a 36-hour labor of pitocin, getting an epidural after my water broke.  I stalled at 5 centimeters and had to be delivered via c-section.  I had my baby girl on 10/24/09 and she was 10 lbs. 8 oz.  I was not diabetic.

The recovery was painful, and I was swollen like a grape.  My eyes were so puffy.  My toes were spread out on my feet and I couldn't bend them because my feet had swelled to much.  But despite this, my blood pressure only started to rise slightly on my last day in the hospital, and it was still under 134/80 - elevated for me, fine for others.  My normal bp is around 100/65.  I was sent home, with no instructions other than to make a 6 week follow-up appointment with the doctors, unless there is an issue with the c section incision site.

That week, I had a rough recovery from the c section pain and I was really suffering from the long induction process.  And I was so swollen, which the doctors kept saying was just "par for the course, and completely normal," and "no, we don't prescribe diuretics for this swelling."  I had lost only 3 lbs. since I had my daughter a week before, although she was over 10 lbs herself. 8 days after delivery, 5 days after my hospital release, I started getting a headache.  I thought it was hormones, or lack of sleep.  I could touch my feet, which were very sore, and the indentation of my finger would stay there - there was so much fluid in my tissues.  The headache didn't go away, despite being on Tylenol/codeine for my c-section pain and ibuprophen.

I believe that when you're getting this type of sickness, there is a type of tunnel vision that occurs, especially as you get worse.  I couldn't see how sick I was getting.  I just knew that this was a really bad headache, and after two days, no matter what my husband was saying, all I would say is "I'll be fine.  Just let me close my eyes for a little while so the light won't hurt."  It was my mother who finally came over after work, with a blood pressure cuff.  She said that my face was so red, and insisted that she take my blood pressure.  I really believe that she saved my life.

I thought the machine was broken.  My BP was 198/100, quite a jump from 100/65.  I have had blood pressures as low as 90/55 in the Dr's office.  "The machine must be broken.  Take it again, Mom."  199/98.  "Take Rob's blood pressure," my husband.  His was 128/74, normal for him.  "Ok.  Take mine again."  I finally agreed to call the Dr's office, which alerted the dr on call that night.  When she called back 5 minutes later, she said to go directly to the ER, she will call them for me, and they will be waiting.

Despite IV meds in the ER, my BP was never really under control, and my headache never went away.  However, I was told that I was going to be discharged.  So I got dressed and signed the papers.  I was just waiting to talk to the Dr. before we left.  The Dr. from my OB practice came in, started asking me a few questions, and as she talked, started taking my reflexes.  I almost kicked her in the face when she bumped my knee.  I joked that at least my reflexes are good.  However, she kind of smiled and said that actually, this is not a good thing.  She looked at my feet.  She said that, she was really sorry, but that I was going to be admitted after all.  She said that she could not send me home because my blood pressure was dangerously high, and that there was a chance that if I went home, I could have a seizure, and that the possible outcome if I had a seizure could be very bad.  That I could die.  I also had cellulitis around my incision site and needed antibiotics for that.

I said "I don't understand."  You see, I was always told that pre-eclampsia was a disease of being pregnant, that the cure was delivery.  No one person ever told me that there could possibly any issue after the baby was born.  No research ever talked about it.  I never knew to look for a headache after the baby came.   For the second time that day, my life was possibly saved - first, my mom checks my blood pressure over my protests, and secondly, my Dr. re-admits me after I was virtually walking out of the ER.

I am also very lucky.  Although Mag sulfate makes me feel sleepy and hot, I somehow don't feel as bad as some people describe through a 24 hour drip.  The thing I hate is the being tied to the bed by IV's, a blood pressure cuff, a catheter, and compression boots pumping blood from my legs.  You can't move in bed other than a few inches here or there without pulling on a tube going into some place in your body.  And then there is the hourly urine/BP/lung checks that you get woken up for.  I made a game out of counting down the hours.  It's so tiring.  My breasts were so sore because my milk came in, and were leaking all over me.  I missed my daughter and family so much, and I felt physically horrible, although my headache was finally gone.  This was the worst I think I have ever felt.

I was released from the hospital having lost almost 10 lbs.  I lost another 10 lbs that following week.  My legs were black and blue due to the compression boots.  I felt beaten and bruised, and the exhaustion was overwhelming.  I loved my new baby, but she was not a good sleeper, and had colic.  After my long failed labor, a c section, and a return hospital visit, my strength was gone.  For the next 6 months while my husband was working overtime, I struggled to take care of my baby, and may have ended up with postpartum depression.

During this pregnancy, I have been so worried about everything.  I was too tired to think about surgery last time.  This time, I had ample time to worry, which of course never helps.  But most of it went fine.  We were released and came home 4 days after the surgery.  I was taking my blood pressure at home daily, and was noticing it going up over time.  Then about 7 days after delivery, I was spiking again.  But since I was monitoring with an at home bp cuff, I only got into the 160's before I went to the hospital, where it climbed into the 180's at times.  I had another 24 hour mag drip, repeat post-partum hypertension/preeclapmsia with hyperreflexia and a headache, but my labs were good besides.  I had only 1 week of bp meds before I came off this time, and here I am 5 weeks post-partum at 100/64 again.  I really think that catching it three days earlier has helped me recover more quickly, and also not risk the sky high blood pressure that carries such adverse outcomes.

I want every medical student to know that even after a woman delivers a baby, that there can be very serious health risks, and I want these risks communicated more effectively to patients.  I want new mothers to be asked to come back to the office, or to get their blood pressure checked, at 1 and 2 or 3 weeks post-partum, instead of only at a 6 week post-partum checkup.

I was never told to look for the signs of serious high blood pressure after delivery.  I researched pregnancy information online and in books when pregnant with each of my children, and there is no information regarding these complications.  I mean NO information, except in a few medical articles, which is why this foundation is very important.  There may be arguments made that these complications are 'rare', but it happened to me twice.  In light of the devastation that can follow, patients need information to save themselves.