Trust your instinct

Posted On Tuesday, May 24, 2011  by S.

It's been a little over 6 months since I had an emergency c-section to deliver my baby and halt my eclamptic seizures. I learnt I was pregnant back in April of 2010, when I was 32. My husband and I had pretty much decided we did not want to have a child, so the news was unexpected, but nevertheless welcome. My pregnancy started off with nausea, some actual vomiting, and a lot of gagging. Alas, it never went away. I was nauseated pretty much 24/7 and for all 34 weeks of my pregnancy. During the first trimester I was miserable enough that my work suffered and I got a prescription for it although I never did take the medication. I had one decent month during my second trimester when the nausea was tolerable.

During my second trimester I felt increasingly uncomfortable due to pain under my ribs, on the right side. A little bit of google-fu suggested this may have something to do with my liver/gall bladder. However, the pain seemed positional and my obgyn wasn't too concerned although she was willing to do a liver function test if I wanted it. By the time I told her about the pain, however, it was manageable, seemed positional, and either I had gotten accustomed to it, or it had subsided some. Then it returned with a vengeance in conjunction with edema and itching on my extremities that I simply cannot describe adequately. I wanted to peel the skin off me but the most I could do was stick my hand and legs under scalding water, cold water, and scratch with a hair-curling brush. No cream would help. The liver function test, which I finally asked for, indicated my bile acid levels were within normal range but on the higher side, so I went on Urosidol for the rest of my pregnancy. The itching did subside some though not completely.

The tail end of my second trimester and all of my third were miserable on multiple levels. My weight gain which had been normal until then increased dramatically, mostly due to edema. I experienced unusual floaters, severe acid reflux no matter what I ate, a panic attack, shortness of breath, and yeah, that sense of impending doom. It all came to a head between 30-34 weeks. I felt like I was going to die, or the baby was going to burst out of me because there was no way my less-than-5-foot body could sustain so much weight. I was wishing that my baby would be born at 36 weeks. Friends and colleagues would look at me skeptically when I said I still had 2 months to go, I was so big and looked about as awful as I felt.

Throughout my pregancy my bp and urine protein levels were normal, so the major indicators doctors rely on to diagnose preeclampsia were absent, or so we thought. During that last month, I felt like I was coming down with a fever (actually, this was that sense of impending doom I rationalized as feeling under the weather), had pretty severe headaches, and vomiting and diarrhea spells. The nurse told me I could take Tylenol for my fever/headache which I did but didn't help all that much. Three days before the delivery, on a Friday, I had a routine 34 week check up at which my bp was 'normal.' I mentioned to the nurse in passing that a urine sample would be tough because although I had been feeling the urge to urinate frequently over the last few weeks, my urine output was minimal. I don't know that she even listened to what I said. A competent, experienced nurse, I think, should have had alarm bells going off in her head at that point because I was now presenting with decreased urine output, liver problems, severe and sudden edema (7 lbs in 2 weeks), headaches, and nausea. Instead, neither she nor my obgyn (who may or may not have known about the urine and headaches) seemed unduly worried. All my symptoms were perceived as 'normal.'

Over that weekend I once again had severe headaches and felt unwell. By this time it had gotten to a point that if I stood for more than 30 minutes, the swelling in my feet would be exacerbated, but I could not sit with my feet propped up because of the pain under my ribs. I could only lie on my left side and only for short stretches else my sciatica would worsen. So, I couldn't, sit, stand, or lie down in comfort. My recollections of the events leading up to delivery are spotty, but I remember waking up Monday morning on the bedroom floor, on my belly, a few feet away from the bed, next to a bookcase, with a few books scattered around me, and a lump on the back of my head. I was disoriented, of course, with no clue as to what had happened. I felt my baby move but I was worried and called my ob. The nurse seemed to think I had food poisoning even though no one else in my house was symptomatic having consumed the same foods as I had. Knowing that my baby was moving, she didn't worry. I don't recall the conversation per se, just the surprise that she didn't think this warranted a check-up.

My mum cam home from work to check up on me and then went back. That evening, when she got home and I was still feeling unwell, she took my bp because we thought I might have passed out due to low bp. I remember the worry on her face when my bp turned out to be 140/90 and literally within a minute my vision went strange. I kept trying to explain to her that I was feeling strange and that I couldn't focus and after that I don't remember anything about that day. I had what we now suspect was my second seizure. Between the time she called the paramedics and the emergency c-section occurred, I had another 3 seizures. Thirty minutes later might have been too late, the doctor told us because placental abruption had already started. Thankfully, my baby weighed in at 5 lb. 10 oz and needed no oxygenation. She was on fluids in the NICU, of course, but all things considered she came out of it well. I didn't see her until 3 days later. I was on magnesium sulfate for the 48 hours after delivery, had some cerebral edema, and didn't regain consciousness for good until late Wednesday. They wouldn't release me for a week because my bp got as high as 190/120 and wouldn't stabilize to an acceptable level. Finally, when it got down to 130/90, they released me and my baby and I went home.

I was on medication for hypertension for the next 3 months, still have not regained sensation in half my abdomen, and suffered short-term memory problems and that 'tip-of-the-tongue' phenomenon for a while. I tried breast feeding by pumping but it got increasingly difficult and when I stopped, lo and behold, my bp returned to normal. Interestingly, normal for me is 100/70. So, that 120/85 might have been a red flag if we had known what my baseline was.

I am kicking myself for not being more forceful and trusting my instinct over deferring to experts and not for reporting to my obgyn every single thing I experienced. All the signs were there and I just thought I was over-reacting. Friends, family, the nurse and ob all brushed away my problems as being something 'normal' during pregnancy and I went along with it because I thought I was just being a wimp. I do hold the nurse and obgyn somewhat accountable for failing to do their job in diagnosing me with preeclampsia, but I also hold myself responsible for caving into societal expectations. I had read about eclampsia (no thanks to my medical care there) and even considered having preeclampsia but figured surely my obgyn would have detected it.

When I look at the list of symptoms of preeclampsia, I realize in hindsight, I had all of them: hypertension, reduced urine output, edema, sudden weight gain, nausea, vomiting, right upper quadrant abdominal pain, headache, vision change, hyperreflexia, racing pulse, heightened sense of anxiety, shortness of breath, and sense of impending doom. Somehow, the condition still went undiagnosed. What I hope sharing my experience will do is underscore the importance of NOT trusting your doctor/nurse, doing your research, and NOT disregarding anything you might experience during pregnancy as being minor/normal/irrelevant.