And I agree as well. I knew the odds when I decided to take on the 4th pregnancy. Even today I get a lot of "WTF were you thinking having another baby..." from people and I don't have a decent answer but I did it anyway.

Not trying to freak you out Laura--sorry!!!

(If need be--I know a number of women, myself included, who will stand between you and any stupid asteroid--and this **** disease as well.)

Hang in there.

Sleep well, Laura. [;)] I have to agree; the odds during a subsequent pregnancy, when the MFM *knows* you have this particular physiologic tendency, I suspect are drastically better than the odds during a pregnancy when you're expecting everything to be normal.

A good MFM will watch you like a hawk, and deliver before everything goes downhill.

And, you have to evaluate what point of view is most helpful to the choice immediately facing you: there's going to be
the big 'maternal health' picture- yes, this is a problem and we need money for research and a cure;
the near misses: dang, I dodged a bullet, I'm lucky to be here;
and then your own personal evaluation of how the risks and benefits mesh together to create circumstances that effect the choices that shape your life and family.

They're all valid, they're all worth listening to, but should have different weight in making choices about what you should do when faced with the choice to have another pregnancy or trying to get a good night's sleep because you've already bitten the bullet and entered one.

I've been following this thread with interest and trying to find my own perspective.

Clearly risk is something we all deal with differently. And, faced with the same statistics, some of us will be paralysed with fear, while others will believe in a fighting chance.

It's only since I found this site that it actually dawned on me how sick I was in my first two pregnancies. And I think the realization of that can scare you retrospectively. Of course, for many of us, our desire for a child outweighs the risks to our own health.

But while I find the lack of accessibility to mag in the developing world a disgrace, and the medical provision available to those in our own societies with little or no insurance often appalling, as Laura says, a well-managed high risk pregnancy may not produce a positive outcome for the baby, but it should mitigate enormously against the risks of death for the mother.

And that is why we always say the best defence against pe is to get hold of the most experienced peri/high risk OB you can find.

This discussion made me think...I was at a major medical center with a level I trauma center and all of the latest technology. At one point during the radiological embolisation procedure I woke up to hear them saying they could not get it under control. I think even with the best and most advanced care there is still a risk. I could have easily been given up on and died of DIC.
This disease stinks!

Point acknowledged, we are a very small subset... still, speaking from experience: when you're in the middle of one of these pregnancies, you have to keep in mind that you're as likely to get hit by an asteriod- because there's no turning back, and once you enter this path, you don't have any choice but to go forward and get to the other end.

Ruminate afterward and ponder the odds, but please remember there a whole bunch of us right now who are not in a position to dwell on it because we ARE in the middle of it- myself included.

Perhaps we worry because too many of us have been hit by lightning. When I just launched the PF I had bought a new fancy computer and plugged it into the wall--careful to install a shock protector in between. Little did i know (cause we had just bought our house--that the beautiful 300' cedar tree outside my window, at our house at the top of the hill had a working light that upon closer inspection was plugged in (by the previous owners) by an extension cord up it to a "shop" light so that the parking space could be lit up--and that cord being plugged (PLUGGED) into our house (not ground) and my brand new computer being set up in the office above this garage outlet. Naturally--the tree was hit (and split) by lightning and that shock fried my modem and fried my computer and did a number on our electrical panel.

My point is--we are the rare of the rare--so we do expect to get hit by lightning.

More to the point, I am working on another book about women dying in childbirth in the USA so I know too much about this subject. According to what I have read at the CDC (and plowing through reports that are blinding in more ways than one) 18% of maternal deaths in the USA are due to preeclampsia/eclampsia. They don't differentiate and they do miscategorize. Some states do mention hypertension in pregnancy on death certificates but most do not. Had I died--it would have been from renal failure--and no mention of pregnancy. I know that the CDC is working hard to improve this.

I think your guestimates are as close as I can find--200-400 is the range I have found as well.

Oh good- I do have a rather absurd sense of humor, but worried you'd think I was trying to be cute about the asteroid bit, so I censored myself a bit... I don't want you to think I'm not taking you seriously (because, heavens knows I know what you're talking about, especially when you have other kids at home to worry about- it is amazing how precious your own life becomes when you think about your value to your kids)

Okay Laura,

You are hilarious -- I love the asteroid comparison. (It's actually 1:200,000 from the website you quoted, but I get the point!)

I'm 1000 times more likely to die in a car accident and 500 times more likely to die from falling down than I am from PE. That does put it into perspective. I'm not going to stop driving or walking anytime soon, right!?!!

I just wish there was a guarantee, but as with all things in life, there just isn't.

So, I'm more likely going to get struck by lightning -- that's good to know!

Well, I have to say that most of us, especially those of us who experienced really severe disease have thought about it, and it is a concern. I had a great fear during my second pregnancy, but haven't thought much more about it since three of the doctors I saw all told me the same thing: maternal mortality shouldn't be a factor in the decision to have another child. I'd go with the expert's assessment of mortality- it is his bread and butter and his line of work- so you could say 38/4,000,000 or 1/105,000.

For comparisons sake, I looked up the odds of having some other sort of fatal outcome. According to the National Safety Council, the odds of dying from any sort of fatal accident during 2003 were 1 in 1,755 and a lifetime risk of 1 in 22.

The breakdowns according to different types of accident are on their webpage:
http://www.nsc.org/lrs/statinfo/odds.htm


Of course, the risks associated with pregnancy and preeclampsia are something we all have to consider for ourselves. Obviously, since I'm in hypertensive pregnancy #3, it was something I personally found that the benefits were worth the risk, as many things in life are. I hope you are able to find the right answer for you!