Wife just diagnosed with PE, what to do?

[caryn]

Hi, welcome to the forums. I want to say first off that I know exactly what a shock this is; I booked a homebirth midwife with my first and had to make the decision to transfer care to an OB at 33 weeks 6 days when my bp started spiking up really high.

Up to that point everything had been going swimmingly and I'd been counting on being normal. I left the birthing pool and my copies of Gaskin and Brewer and Kitzinger in the living room and spent a week in the hospital -- luckily I never quite had to be transfered into the ICU myself, and DS did swimmingly after a week in NICU. I was only discharged two days before he was, because they had me on a 24-hour seizure watch for some time and then on anti-seizure medication for three days following the birth while they waited for my blood pressure to drop. I got very seriously sick incredibly fast.

The main PE symptoms are really innocuous -- high bp and proteinuria -- and not everyone has the other symptoms. I threw up twice the day I transfered care, and started hallucinating from the cerebral swelling about a day after admission, but never had a headache or epigastric pain...

If your wife does have PE, it means the pregnancy has turned *very* medically complicated and that a midwife is no longer equipped to handle her delivery because she is no longer low-risk. Again, I know *exactly* how much that sucks.

Current thinking says the placenta is short of oxygen in PE, and that's causing it to produce some chemicals which enter the bloodstream and damage it (causing high bp and swelling), the liver, the kidneys, and the brain. Placental abruptions occur with high frequency in this disease because the arteries connecting the placenta to the uterus are damaged as well as often being shallowly implanted, probably because of a maternal immune system response to the invading placenta.

My hospital was very pro-breastfeeding and supplied me with a pump and made sure that all the medication they had to prescribe was compatible with breastfeeding.

Please ask any questions you've got -- I'm sorry you're in this boat.

ETA: I just realized you're in the East Valley -- so am I. I'll email you my cellphone number and the name of the doc I transfered care to and which hospital I was at, because I got great care.

[laura]

Hi Glen, we got a response from one of our doctors:

"This level of hypertension is life threatening. She has severe preeclampsia. She does not need more tests to confirm the diagnosis. Your wife should be seen in the hospital immediately. I am the Medical Director of the Midwifery at the XXXXXXXXX and am very supportive of midwifery care. By any standards, she is not a candidate for home birth.


The sooner she is at the hospital, the more likely that she might have a vaginal delivery. She needs to be on magnesium sulfate and treatment for BP. She is at risk to have a seizure or a stroke. "


I am sorry to be alarmist - but I am very concerned about your wife and your baby.

[for faith]

Hi - Everyone has given you great info., please take it to heart, I definitely learned through my PE experiences to be my own advocate.

I just want to commend you for coming to the site and gathering all the info you can on the issues of HBP.

I am assuming you both are like my husband and me who knew nothing about PE before 32wks with my first son. With my first son, I was hospitalized with 150/100 BP and he was born at 36wks (he had no issues, no NICU).

Wishing you all the best, I pray that all will be perfect with your wife and daughter. You are in my thoughts.

[blythe]

I'll echo everyone else and say this is sadly serious and with natural birth hopes it really stinks.

I planned a non-intervention hospital birth for my first, but after my bp went consistently into the 140/90s in week 36, my doctor decided to induce at 37 weeks. My little guy was growth-retarded, though, and along with other complications ended up spending 4 days in the NICU. I did, however, avoid an epidural despite the mag (magnesium sulfate / mgs04 - prevents seizures from PE and CAN have nasty short-term side effects of nausea, extreme muscle weakness, mental confusion... but some women have no problem with it, so it's not guaranteed to be horrible if your wife needs it, and if she does need it, it is life-saving.)

My second birth was much better, amazingly so, but I had all kinds of contingency plans if I needed more intervention. I'm also happy to talk to you or your wife more on email or phone - email me through the forum if you're not already at the hospital!

In general, I thought very hard about what was most important to me in the birth experience and how the necessary interventions might impact my birth hopes. You may have vastly different reasons for wanting a home birth, but I can share my experience and hope it gives you some ideas.

Healthy mom and baby are at the top of the list, which I know are #1 for you also. This is also #1 for the medical people. It was very hard but very important for me to remember that when they were doing things to me I didn't want!

After that, I needed as much information as possible about the complications and the medical treatment plan. Sometimes in PE even that is not possible because the doctors need to move very fast. Does your midwife have hospital privledges, or at least hospital training? I would want her along as a doula instead of a midwife, a support person to explain what is happening if the doctors and nurses don't have time.

I wanted to avoid an epidural and other interventions because I wanted freedom of movement. With high bps, I knew I might be confined to labor on my left side to keep blood flow to the baby. You can still use relaxation techniques in bed - it's harder, but it can be done! Sometimes an epidural is necessary to bring bp lower, out of stroke range. I wasn't thrilled with this possibility - but knew it might be life-saving.

I wanted to have immediate skin-to-skin contact with the baby. I did not get that with my first baby, partially because of my doctor. For my second baby, I emphasized to my doctor how important that was to me, always adding that if the baby needed immediate care, the baby's health was obviously my priority. Depending on baby's health and mom's health at the time of birth, I knew I might have no contact, or only a few seconds or minutes of contact. I emphasized my hopes to my doctor and had to trust that she would help meet my emotional need for contact only if safely possible.

I wanted to breastfeed. I pumped for 9 weeks before my firstborn learned to nurse, so I knew I could do that again - I just didn't want to. I let my doctor and nurses and nursery staff know my hopes, and had to trust they would help me if the baby's health meant breastfeeding would have to wait.

I would recommend making a very short list of birth hopes. Again, if you'd like to email me privately I can share more of what - *in my limited experience* - is likely to be possible or not possible. I did massive birth planning for #2, and have some specific suggestions [:)]:

start with a short sentence about 'our birth plans have changed, we know mom's bp is serious, we are very happy to be at this hospital to ensure a healhty mom and healthy baby.' Butter them up with how grateful you are for their excellent training and medical and individual care! Personally, I wouldn't mention your home-birth plans... Then, 'we know the seriousness of mom's condition. we hope the follow things may still be possible": I'd list 3-5. For *ME*, they were:


honest and complete information about complications and prognosis and treatment plan

please don't offer pain medicine, I will ask for it if I need it - I appreciate other coping advice!

prefer a natural tear to an episiotomy – thank you for your help avoiding either!

immediate and continuous skin to skin contact with baby if mom and baby are healthy

if emergency separation is necessary, kangaroo care as soon as possible

finger feeding if supplementary formula or pumped breastmilk is necessary – please teach us!


Well, I have 6 [;)]. Good luck. You have my sympathies and highest hopes for healthy mom and baby, and a happy birth experience would be icing on that cake!

[annegarrett]

Glenn,

I sent you a private email but wanted to also openly "push" you to go in now. I had NO signs other than 140/90 and a slight bit of proteinuria at 38 weeks and they decided to deliver. 12 hours later I was having kidney failure. Frankly, new proteinuria is a sign of serious damage to the kidneys. It's considered a "late-stage" symptom--meaning that by the time you get proteinuria--you are already very very sick. As I said in my email (and say now for the benefit of others who might be in a similar situation)--this post is possible the most frightening one I have ever seen in my six years doing this work. None of those pressures are safe and I would urge you to get her to the hospital. At least there they can check the baby, check her proteinuria, her liver enzymes and give you more information than you have right now. Right now every hour is a gamble and it's concerning to us. We are only being pushy with you because it is our hope that you can avoid some of our more tragic experiences by getting good care as soon as possible.

Also, I had a baby just prior to 36 weeks and he didn't require a day of NICU. Was a bit scrawny--5#5 oz but I have learned from my work here that so many women would kill to bring home a healthy, scrawny little guy who is breathing fine and only needed his blood sugars monitored for 12 hours.

We do wish you the best--but urge you to get a second opinion--this evening. It could save your baby and possibly your wife.

[sandy]

Glen,
As you find the time, will you please post back and let us know how things are going?

You and your wife are in our thoughts.

[julie f]

Glenn,

I can't offer any new advice but just wanted to jump on and say that my prayers are with you guys. I hope that you're being seen as I type.

[tooleyg]

Sorry for the delay in posting, I'm sure you all know how things like this go. Thank you all for the information and caring and the prayers. We all appreciate it.

Right now my wife's BP is down and stable at 130/80, not great, but for sure lower than it was. The lab results show no problems with the kidneys or the liver. The protein is also in a healthy range. The plan for now is to continue to monitor my wife and the baby. If things stay in healthier ranges then we should be able to wait until full term. Of course if things change induction will follow quickly after.

So at this point we are in a pray and see mode and hopefully things will stay in the healthy ranges.

Again THANK YOU VERY MUCH for everything. I will post again when I get a chance.

[caryn]

It is such a relief to hear that. I even left my cellphone on vibrate during symphony rehearsal. [:)] Please do feel free to post here or call me with any more questions or if you need any help (or company in the hospital, or whatever.)

I'm sure you've seen this by now: the formal diagnostic line for PE is two readings of either of 140/90 six hours apart (she's hit that for certain) and proteinuria of +300 mg/dL in a 24-hour catch. The dipsticks are notoriously unreliable and what they really tell you is to do a 24-hour, because they can be thrown off by things like your wife's level of hydration. Mild PE doesn't require bad bloodwork. One reading over 160/100 (which she's hit) plus proteinuria of 300 means she's got severe PE, as do proteinuria over 5000, bad bloodwork, and a bunch of other symptoms can also mean PE like a bad headache that won't go away with Tylenol, epigastric pain, visual disturbances, etc.

When is her next 24-hour scheduled? Have they done a BPP to check on your daughter?

Please let us know how you get on.

[sarab]

Thank you so much much for the update. I know many of us have been waiting anxiously to hear how things are going with your wife.

It's good to hear that lab results are still normal at this point. I don't think anyone has posted a link to signs and symptoms page yet. To be honest, I think we were all counting on immediate delivery when you mentioned 180/114. Here's the link:

http://www.preeclampsia.org/symptoms.asp

If your wife starts experiencing any of these, PLEASE don't hesitate to get it checked out immediately. How often is she being seen now? Are they planning on doing any repeat labs soon?

I'm sure we must seem like a bunch a zealots to you. [:)] The truth of it is that we are just people who have been there and know first-hand how quickly this disease can go from "not great" to life threatening.

Please keep a close eye on your wife's symptoms, and let us know how you guys are doing.