Interesting articles Anne. Thanks for sharing those. It too is appalling to me that-according to the second article-HALF of the US maternal death rates are preventable. This is not good news for such a developed country. I also agree with the fact that OB's should be in the hospital setting caring for those "high risk" patients and not miles away seeing patients. Nurses are intelligent and are specially trained to notice problems and changes (I am a nurse myself), but they can't do but so much under their license. Like I said earlier, I have a wonderful OB who promised he will do all he can to help me have a healthy pregnancy next time--although he said he couldn't promise they same scenario wouldn't happen again- just that he would watch me closely and do more checkups and ultrasounds, etc and watch me to the best of his ability. He is not a perinatologist, but does see high risk pregnancies.

Renee mom to Alyssa 26 wkr now 19 mo

Preeclampsia, eclampsia, and HELLP are responsible for 18% (depending on where you live and what your risk factors are) of women dying in childbirth in the US every year. There are 4 Million births (approximately) and our death rate here in the US is about 8-9 per 100,000 or roughly a few hundred women a year. 18% or around 65 die from our particular condition. Your risk is quite low--but you are right to be vigilant. Our doctors tell us that most women who die--die from inadequate care. Personally--given our technology--the fact that the US ranks 16th in the developed world in terms of the maternal death rate is just appalling.

There are of course exceptions--a close friend whose wife died despite the fact they were both hypertension researchers, a doctor who died despite being a colleague of the perinatologist who treated her--there are those deaths that just cannot be avoided--but your risk is very very small and smaller still if you are well cared for, well educated, and proactive.

The following are some interesting links about the topic.

Take care and best wishes--I know it is a tough decision but no one can know what is best for you but the two of you.

http://www.geocities.com/Wellesley/5510/wagner.html
http://www.news-star.com/stories/090598/lif_cdc.html

Anne Garrett
Executive Director
Preeclampsia Foundation

I am amazed and humbled by the tenacity and hope that so many of you have. Good luck to each and every one of you, with your children, your pregnancies, and life in general.

Sharel

[:)][:)][:)][:)][:)][:)][:)]

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Sharel & Kevin
Aaron - 28 weeker
Born 5/2/02 due to preeclampsia & HELLP

Our miracle boy is doing great!!

Renee,

The decision is such a personal one and people who have never been through this, will never understand. For my husband and I, it was never in question - if the doctors said we could try again, then we would. I think that the certainty of our decision is very influenced by the fact that our son did not survive. The second I got to lay eyes on him, I realized why people say that you can never be prepared for the love you will feel for your child. When I got to hold him as he went to heaven, I knew that instant that I would try again. I have heard that it is a selfish decision to try again, that I should be thankful just to have my life. Thankful I am indeed. But still wanting to try again. I have confidence in my doctors and, like you, believe they will watch me like a hawk. I also have learned so much from this Foundation that I really feel empowered to be a part of my medical care, not just a bystander this time. About your question on fear of dying yourself, I don't think that is an unreasonable fear at all. I remember willing myself to stay awake in the hospital because I was so sure that if I fell asleep, I would not wake up. It took my doctor coming in and personally promising me that I would wake up in the morning, I asked her to have the nurses come check often to make sure that I was still breathing - I was terrified. Even after the C-section, when I was in recovery, I would not close my eyes until my doctor came up and promised that I would live and the nurse would not leave my side until I was able to see my husband again.

****Laura, your post was very comforting on this and I am printing it out for my husband to read as well.

Good luck with your decision, you will find support here no matter what you decide.

Julie
Zachary James, 7/22/03-7/27/03, born at 26 weeks due to severe pe

Laura brought up a really good point: In this forum, people start passing out the cigars at 32 weeks. A lot of us have already come to grips with the idea that we might never carry a baby to term. When your first baby weighs 1 pound, 4 pounds seems huge. To others, it probably seems crazy, but all you can do is start from where you are, if that makes sense.

Carol (38)
DH Bill (39)
Tara Mairichi
12/7-12/9, 2002
The Mightiest Little Angel

You know, as far as maternal mortality is concerned... I think the US rates are running .01% or 11 per 100,000. Not likely at all. With PE, I think our risks for PE are eclampsia and hemmorage, and stroke. With PE, it's far more likely that, like Carol and baby Tara, our babies will bear the brunt of PE.

I have heard it said that maternal mortality is a function of the quality of medical care the mom's receiving and baby's mortality is a function of how sick you got, ykwim? We shouldn't be dying from PE, it's largely preventable, and one of our docs always says that PE IS curable, by delivering the pregnancy. Your chances of having a successful pregnancy are greatly increased as your quality of care is increased.

I did find really great proactive care- and that has changed my ideas of whether it's worth the risk or not. I'm glad I risked pregnancy #2, I'm still on the fence about pregnancy #3. I've resigned myself to the inevitibility that my pregnancies are going to be complicated- but then again, I delivered 35-36 weekers, too. (this is the only place on the planet I can come and say- hey my kids were really close to term- only one month premature!) This is hard stuff. I hate how capriciously people can just say- you shouldn't do it. Like it's just that easy. Like the hard choices we make are that easy to live with. And face it- it's just plain not fair.

90% of other mom's considering a subsequent pregnancy are thinking- do we have the room? will movie tickets for size X family be too much? And we're thinking- will I live? Can I afford a $25,000 pregnancy? $100,000 NICU stay? Can I handle it if my baby doesn't live? (that's my big stumbling block. I'm willing to take the personal risk, but my constant- well founded- fear of stillbirth during pg #2 was enough to spook me badly) Nobody can really understand these fears unless they've been there. And blithely throwing out- it's not worth it- tells us that the troubles we deal with in getting our kids here aren't worth it. I think our kids are worth it, don't you?

good luck, and either way you go, we're with you!

Laura-28
DH Jack-30
Allie 5-13-98 (35 weeks-pre-e)
Baby Camille 4-17-03 (36 weeks- htn and oligo)
http://www.babiesonline.com/babies/c/camilleandallie/

You ARE taking a risk and you ARE lucky to have a healthy little girl; you don't need anyone to tell you that. Whether to take that risk is a very personal decision, but try to be patient with the "ignorant and insensitive." They're frightened by the thought of losing you, and that's more important to them than the prospect of another baby.

That said, your normal workup and wonderful OB are great signs! I don't have any stats for you, and I'm not in the same situation because our baby didn't survive, but my husband and I had no trouble deciding to try again. We've discussed the risks with doctors, we're taking all the precautions we can, and we've decided it's all worth it. Good luck!

Carol (38)
DH Bill (39)
Tara Mairichi
12/7-12/9, 2002
The Mightiest Little Angel

Hmm...seems to be several of us with young toddlers... My son Aaron is 18 months old. He was born at 28 weeks, when my preeclampsia became critical and I developed HELLP Syndrome.

My husband and I also want to have more kids, but we DO NOT want to risk another pregnancy. (Even without pree, I'm not sure I could stand another 4 months of severe morning sickness, working full time, AND caring for Aaron! [xx(])

Instead, we are in the process of adoption. We have decided to adopt our child(ren) from the foster care system. Hopefully, in the next year or so, Aaron will have his sibling(s)!

Good luck with your decision. I know from reading this board that lots of women ARE successful with a second (or more) pregnancy... but for me, I just cannot risk Aaron growing up without his Mommy. (It would be one thing if I were hit by a car, but I feel like the odds of getting pree again - - early and severe - - is like playing Russian roulette. Just not worth the risk.)

Take care!
Sharel

------------------------
Sharel & Kevin
Aaron - 28 weeker
Born 5/2/02 due to preeclampsia & HELLP

Our miracle boy is doing great!!

My name is Renee and I delivered my dd, Alyssa, at 26 wks on march 28, 2002. Dh and I were able to get pregnant with the help of clomid-irregular cycles-. I had a pretty normal pregnancy up until 25 wks. At 25 wk 1 day, I developed severe nausea and vomitting-leading to dehydration and uterine cramps (any significance b/t this and PE?). I went into the dr. office for IV fluids and IV Zofran. My BP that day was 110/60. I started swelling Sat/Sun and by Tues. I had so much edema, I couldn't tie my shoes--had alot of facial edema also. I was convinced by a former L&D nurse I work with to check my BP. It was 180/100! I dipped my urine at work and it was 4+!. I was having no other symptoms. I was 26 at the time, avg. weight, no prior BP issues, or history of pre-eclampsia in my family. There was absolutely no reason for this!. To make a long story short, I was admitted to the hosp. for bedrest until delivery, but needless to say, I only made it 2 days. I was placed on Mag. and Alyssa was born on Thurs weighing in at 1 lb 4 oz. 12 in long (IUGR). She was in the hosp for 3 mo--vent for only 9 days, a few infections, no IVH, and a hernia repair. She is a happy and healthy-yet busy- 19 mo old who has no lingering medical problems and is catching up nicely developmentally.
I had a thorough work up including seeing a nephrologist, and all my test and blood work were normal except one of the immunoglobulins was high (not one associated with PE--IgA maybe?) But because of this my OB will place me on ASA and Heparin next pg. But that's just it, I'm struggling with thoughts of having another. Dh and I want to have another one. I'm not only terrified of having another preemie--we have been so blessed that Alyssa is doing so great (God is so good!)- but I'm also so afraid of dying myself. IS this a reasonable fear? ARe the stats low for maternal death in a second PE pregnancy? I'm sure my OB will watch me like a hawk--he is so wonderful and I trust him. Some ignorant and insensitive people have told me I should be thankful for what I have and not to push my luck with another. Needless to say, they got a mouthful from me. But, is there some truth to what they say? Please help me with this. I struggle with this everyday. NOt a day goes by that I don't think about it and it's really weighing heavy on my heart.

Renee--mom to Alyssa 26 wkr now 19 mo