Tackling Preeclampsia as Wonder Woman: Scenes from the Real World

After realizing you have Wonder Woman super powers, here are some ways you can put them into action when confronted with real life scenarios.

1. My doctor/nurse/midwife is not taking my symptoms seriously. How can I get them to pay more attention to the symptoms I’m reporting and conduct the necessary tests to confirm a diagnosis?

Women and their concerns are treated with everything from healthy respect to downright contempt. While there are many women who have positive and validating experiences with their healthcare providers, some encounters leave us frustrated. If your provider is refusing to do basic testing after you have reported symptoms of preeclampsia or your blood pressure is elevated, use the following language with a kind and respectful voice:

“I understand you don’t think this is important. Please note in my medical record that I reported these symptoms and asked to have "x test" on this date and that you feel that test is unnecessary."

Ask for a copy of your records. Meaningful Use laws enacted in recent years make it a requirement that a patient’s medical records be easily and freely accessible to her. Follow through via your patient portal or other mechanism to ensure these notes are in your record.

Highly emotional or overly dramatic displays may contribute to people dismissing or invalidating your concerns. Use specific language to describe your symptoms. Don't say, for example, "My stomach hurts." Instead, try "I have a sharp/dull/stabbing/throbbing (pick the best one) pain here" and point to the spot. Sometimes being more specific will aid in the diagnosis. 

2. I was told I should not worry myself, that it will raise my blood pressure.

While your pulse can heighten with increased anxiety, preeclampsia is a disease that is set in motion in the placenta and not produced or aggravated by mental anxiety. More often than not, anxiety is a symptom of an elevated heart rate and may be evidence that your blood pressure is rising.  

At the same time, women often do have a “sixth sense”; they know their bodies and when something just doesn’t feel right, you should pay attention to that voice. See #1 above.

3. You should not believe everything you read on the Internet.

While it is true that the Internet has a reputation for unpoliced and bad information -- particularly in the area of medical information, the Preeclampsia Foundation takes its obligation to provide medical information very seriously. Our Health Information articles have been reviewed, edited, and approved by a consensus of our Medical Advisory Board, a veritable “who’s who” of experts in preeclampsia. Our website is frequently cited by the media and other health information websites. Further, our tear-pads and other printed and electronic materials have been adopted by numerous preeclampsia toolkits and national patient safety bundles, and are being used in dozens of healthcare centers across the country.

4. I'm the doctor, I know best.

Yes s/he is. You need to listen to your doctor. But your doctor also needs to listen to you. This is your baby. This is your body. You deserve to be treated with respect. You deserve to be taken seriously. You deserve to understand and participate in the decisions that are being made. You can take your business elsewhere AT ANY TIME - even at 38 weeks - even at delivery. It is important to be polite, but your greater obligation is to your health and your baby. You can apologize later if you were rude. You cannot undo medical mistakes.

5. You should trust us.

Doctors and midwives are people and people make mistakes. Hospital systems have to move large numbers of women safely through childbirth. Systems often need to improve their processes. The Alliance for Innovation in Maternal Health (AIM) was created to address this reality, developing and implementing the Hypertension in Pregnancy bundle, now taken up by at least seven states, and built upon the 2013 American College of Obstetricians and Gynecologists Guidelines. The bundle provides a framework for implementing consistently good quality of care for the various hypertensive disorders of pregnancy. Is your healthcare provider following these guidelines? Feel free to share a copy or an online link with them. If your doctors don't agree, even with each other, it is certainly your right to ask reasonable questions about your body and your baby's health or to get your care elsewhere. Ideally, you’re doing this vetting before you’re in crisis mode, but your birth partner is entitled to get answers on your behalf.

When in doubt, get a second opinion. Maternal-fetal medicine specialists, sometimes called perinatologists, are obstetricians with advanced training in high-risk pregnancies. You can locate specialists in your area here.

6. You're pregnant. What you’re experiencing is normal.

That may be true. Preeclampsia mimics many normal symptoms of pregnancy. You can ask, “What else could this be?” Expect a thoughtful answer that includes consideration of “differential diagnoses”; that means, other conditions that could be causing the same symptoms.

7. You did not tell me about all your symptoms.

Delays in reporting symptoms or not recognizing the importance of symptoms have been found to be a factor in a large number of preventable deaths. You may forget to mention something “key” such as blurry vision, or seeing spots. It is better to say too much than too little. At the risk of forgetting something important, write down your questions, concerns, and symptoms, and raise them with your physician or midwife. Don't go on and on. These folks are definitely running short on time and they may lose their patience, so get organized before you go in and then just go down your list. They should appreciate your thoughtful approach and take your input more seriously. Of course, react to any new information with questions if you don’t completely understand and write down their answers.

If you’ve honestly tried some or all of the above recommendations and are not getting the care you expect, maybe it is time to see another doctor.

With acknowledgement to the original founder of the Preeclampsia Foundation, Anne Garrett Addison, who penned some of these still relevant ideas in 2003, to patient advocate Ushma Patel who wrote more recently from her perspective here, and to CNN Senior Medical Correspondent Elizabeth Cohen who wrote the very instructive book, The Empowered Patient, after her own near-death experience with preeclampsia.

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