The initial, early days of my pregnancies are usually low-key, low-stress, and aside from significant nausea, I pass by relatively unscathed. With my oldest, I learned that the end of pregnancy can be a worrying, trying time, as I developed gestational hypertension at 32 weeks pregnant, and severe pre-eclampsia at 36 weeks, meaning my son was born as a “late pre-term” baby, or “premature,” depending on the year’s change in medical terminology. Being a rare patient, my blood pressure did not go down with the delivery of the placenta and instead continued to climb until blood pressure medication stabilized the numbers.
With my daughter, three years later, we were able to hold off a gestational hypertension diagnosis until 37 weeks. Best practice indicated – and, continues to do so – inducing a mom experiencing gestational hypertension between 37-39 weeks; my OB agreed since the hypertension developed so late in the game, she would allow me to carry my daughter to 39 weeks. My daughter decided to grace us with her presence the day before the scheduled induction. Once again, my blood pressure decided it wanted to continue to rise until medication knocked it back down.
Our third pregnancy ended over six weeks ago, allowing me ample time to digest all that has transpired between all three pregnancies. And, given my record of high risk shenanigans, I have felt compelled to write about this most recent birth story.
A typical mother with a history of pregnancy-related blood pressure issues will be met with the following checklist of symptoms when she presents for later-in-pregnancy OB appointments:
- Any headaches which don’t alleviate with Tylenol and a nap?
- Any changes to vision?
- Any upper-abdominal, right-side pain?
If the answer is negative to all of those symptoms, OBs are usually pretty good at reminding their patient to head to Labor & Delivery (L&D) if those symptoms should occur. This pregnancy was no different, although early on, I remembered to seek clarification on what constituted a “change in vision.”
My first two pregnancies made me aware that I am usually asymptomatic, meaning my blood pressure is (sometimes dangerously) high, but my body doesn’t experience the headaches, changes in vision, or right-side pain.
One Sunday in April of 2018, toward the end of my third pregnancy, I was lying in bed. I had been experiencing fluctuating blood pressure for the previous week – sometimes reading 140/90, and other times hovering in the upper-130s/upper-80s. Other times, one number would be in the 130s, while the bottom number read over 90. My second pregnancy’s OB team wanted me to head into L&D when the bottom number read over 90, but weren’t as concerned about further monitoring until 140/90. Several times during that pregnancy, I found myself in L&D immediately after an OB appointment, in which they triaged, ran batteries of blood work, and sent me home to keep an eye out for symptoms.
This particular Sunday, however, as I spent hour number four in bed, just resting and periodically taking my blood pressure, I began to notice stars in the periphery of my vision. Initially, I brushed it off, took my blood pressure, and felt secure that I was imagining things – I convinced myself I was too highly alert to anything going on around me. A couple hours after that, I decided it was time to make dinner for the family. I got up, reached the top of the stairs, and noticed when I looked back toward my bedroom that the stars were back in my periphery.
At that point, I decided to go get triaged at L&D. Because I had four trips to L&D with my second pregnancy, and each one resulted in my being sent home, I told my husband I would drive in, get triaged and make sure nothing too severe was happening, and then be back home before the evening was over. Since I had a doctor’s appointment the day I was scheduled to turn 38 weeks, I felt confident they would allow me to continue home-monitoring for another two days, until my next doctor’s appointment. However, given my particular symptoms, I wanted to make sure any labs they would want drawn were taken prior to that appointment on Tuesday.
I drove to the hospital in a downpour, and informed the L&D triage nurse of my symptoms. She ushered me to a room, gave me a gown, a cup to pee in, and she quickly came back to draw some blood. She then settled me into a bed to wait for the military doctor on call. A couple hours later, he came in to meet with me, with initial results in hand.
My protein in urine count had a number attached to it, which indicated gestational hypertension. He had to wait a little longer to see if my liver enzymes were elevated; if they were, then he would know it was another case of pre-eclampsia. If they were not elevated, then he would call the case another gestational hypertension case. However, he emphasized the mortality rate for gestational hypertension is similar to that of women who develop pre-eclampsia. And, therefore, he was recommending induction, “Between 37-39 weeks.” Since I was 37 weeks and 5 days, he proposed inducing me in any case. What that meant for me that evening was that, unlike the back and forth trips to L&D I made during my second pregnancy, I would not be going home.
When the liver enzymes came back, there was no significant elevation. Therefore, he was diagnosing me with gestational hypertension for the time being.
I called my husband, told him the recommendation, and we agreed there would be no 38 week OB appointment that following Tuesday. My husband packed the overnight bag for our older two children, a task I had been putting off until the following day, and an overnight bag for himself. He grabbed the baby’s and my overnight bag, and he met our friend at the hospital. Our friend graciously took the older two children around 10 PM, and the medical team began working on the pitocin for my induction at 11:30 PM Sunday evening.
When I experienced my first delivery, I was placed on magnesium sulfate to (successfully) keep strokes at bay. With that, came a catheter. During that particular delivery, I had decided to try to have as natural a birth as possible. Unlike other women who experience “Mommy amnesia,” I distinctly recall the pain of the catheter being placed without the epidural. Secondly, with magnesium, I was required to remain hooked up to the drip, and confined to the bed for 24 hours postpartum – 24 hours and 7 minutes, to be exact, even though the epidural had worn off several hours prior. My goal with every delivery since then, has been to avoid the magnesium at. all. costs. With my second pregnancy, while pitocin was not used, I did notice after the epidural was given, my blood pressure went into more normal ranges, ensuring magnesium was avoided.
Therefore, when the contractions began to get excruciatingly painful, I requested my epidural. I wanted to make sure I avoided magnesium, and knew my blood pressure was slowly rising.
Little Boy Blue was born shortly before 10 AM on Monday morning. And, everything looked good – he was healthy, and my blood pressure seemed to be stabilized.
Yet, the birth story doesn’t end with his birth.
We were both discharged at 24 hours post-delivery, even though I had one strange blood pressure reading on file after his birth. I was looking forward to heading home to bask in the sleep-deprived haze of newborn baby bliss.
The doctor who authorized my discharge informed me (yet again) of the symptoms of pre-eclampsia, and when I reminded him of my previous two pregnancy histories of blood pressure rising post-delivery, he decided I could go in to the OB for a two week postpartum check, rather than waiting the typical six weeks.
I did, however, point out to him that two other military treatment facilities wanted to see not just my newborn at 24-48 hours post-discharge, but they also wanted to have my blood pressure checked within 24-48 hours of my discharge. He informed me I could stop in and have my blood pressure checked at the same time as the baby’s appointment within 24-48 hours post-discharge.
We went home with a plan to follow up the same day as Little Boy Blue’s appointment.
I was discharged Tuesday, and a comedy of errors ensued, which I hope to write about someday soon! We went to the baby’s appointment Wednesday, and had my blood pressure check. My blood pressure, unsurprisingly to me, was slightly elevated. Therefore, the doctor on call that day prescribed some blood pressure medication and told me to come back on Friday.
Friday, we presented ourselves as a family for another blood pressure and medication check. My blood pressure had continued to rise and was sitting at an upper number of lower-150s, with the lower number reaching lower-100s. Therefore, the doctor ordered some blood work, and changed my medication dosage. He told me he would call me if there was anything abnormal in my blood work – “No news is good news.”
Less than two hours later, I was answering his phone call. While there was no protein in urine detected, my liver enzymes were signifcantly elevated. Therefore, I was to take the new blood pressure medication dosage through the weekend (keeping an eye on symptoms), and report back on Monday morning for another blood pressure check and blood draw. He explained that HELLP Syndrome, while usually rare postpartum, can still develop after a placenta has been delivered.
Monday morning, we made the trip back in to the OB department. The decision was made to abandon the blood pressure medication I was using entirely, and try something new, since my blood pressure was still significantly elevated. Blood work, however, indicated my liver enzymes, while still noticeable, had, “Decreased drastically.”
Therefore, I was sent home with instructions to be back again on Wednesday to again check the blood pressure and evaluate further medication management.
Wednesday, my blood pressure had gone down to lower-140s/lower-90s. Therefore, the decision was made to continue the blood pressure medication, and have me report the following week for my two-week post-discharge appointment. At the two-week post-discharge appointment, my numbers read in the upper-130s/lower-90s, and, given my previous history of responding positively to the blood pressure medication, the doctor walked me through steps toward possibly weaning from the medication if my numbers at home began reading in the 110s/lower-70s.
My blood pressure is still elevated, and I am just now being transitioned to a long-term blood pressure medication. In the past week, since my six week appointment, my blood pressure finally seems to have gone from stabilizing, to lowering. However, the OB queried whether or not I may have chronic hypertension as a result of this latest pregnancy. And, I have completed the trifecta of pregnancy-related blood pressure issues.
Along with this entire process have come very difficult discussions with two separate OBs treating my discharge case, a priest, a Catholic medical ethicist, and my husband. Given my history, the OBs are recommending that Little Boy Blue be the last child for me. The Catholic Church is pretty clear on her teachings – taking permanent steps to avoid pregnancy for the sake of avoiding pregnancy (i.e. sterilization) is immoral.
As I look back on my birth story for this baby, I realize it is a pretty emotionless recount. However, my entire approach to the last six weeks of my life has been matter-of-fact. My goal has been to make sure I am alive for my children, and I have had tunnel vision on ensuring I have done the bare minimum in all areas of my life, to further allow my blood pressure to stabilize and return to normal.
Not every woman experiences happy birth stories. And, thankfully, my birth stories don’t have a tragic ending. However, if I were not on top of my knowledge and game regarding my own health history, I could have experienced a more harrowing labor, delivery, and postpartum scare. I suspect my autoimmune issues mask my body’s ability to recognize when the placenta has been delivered without the use of medication; however, not enough is known about Chronic Fatigue Syndrome to know its impact on pregnancies.
Each OB department has had their share of disbelief regarding my postpartum health history. As one OB put it this time, “I finally believe you now.”
When they were born, our oldest weighed just under six pounds, and our second weighed just over six pounds. At birth, Little Boy Blue weighed just over eight pounds, and is the first of my children to have my hair color. He immediately took to nursing like a champ, and continues to eat every two to four hours. While he is not sleeping through the night, I feel pretty confident he is beginning to recognize the difference between nights and days, although I suspect he sometimes feigns ignorance. Some research indicates gas pains peak between six to eight weeks postpartum, and he is letting us know he is right in the middle of that time frame. He will, singlehandedly, keep diaper companies in business for quite some time. He has begun smiling, and is extremely squirmy, trying to keep visual tabs on his older siblings. I am becoming suspicious that he may be our most mobile at the earliest age.
Perhaps the most emotion-producing moments in the past six weeks have been watching my older two adjust to their youngest addition. My oldest son loves his baby brother, and asks to hold Little Boy Blue several times a day. My daughter, on the other hand, took some time to warm up – nobody better ask if Little Boy Blue is her baby, otherwise she looks at them as though the questioner has two heads. However, nobody but Mom is allowed to touch the baby!
Watching the three adjust to each other, and knowing they have a big change coming up as we move this summer, I am amazed at everything that has transpired in the past month and a half.
And, I am deeply grateful – for my knowledge, for my self-advocacy, for doctors who listened to me when I (respectfully) questioned them, for doctors who are sometimes so blunt they border on sounding crass, and that God has entrusted me with three little lives. I am also deeply grateful for my life, and being given an opportunity through modern medicine to enjoy a life with my children.
While I still wonder what He was thinking entrusting me with three, I know He is willing to guide me – should I be willing to be guided. I know He has great plans for
my His children, and I am looking forward to seeing how His plans unfurl.