A Pregnant Pause: My Personal Experience with Postpartum Preeclampsia

Illustration: Ken Tackett/shutterstock.com

By Kelly Jordan

Late last September, one week after giving birth, I woke up with a headache. I assumed it was probably due to a lack of sleep. Or dehydration. Or hormone fluctuations. All were true, especially the former. But, it gave me pause. Something wasn’t right.

Headaches are a rare occurrence for me. And I just felt ... off.

My mom, a retired nurse, had loaned me her blood pressure cuff and encouraged me to check mine in the weeks following delivery. I had not done so yet, and the cuff was sitting right there, so I checked it. It was high: 160/90.

I was inclined to wait and see if it got better—after all, I had a newborn. I was exhausted. I was probably just being overly dramatic. And, it was a Saturday. I really didn’t want to bother my provider, or ruin my family’s weekend. But, I kept looking at my baby girl. What if something was seriously wrong? She really needed me. Both my children do.

My close friend happens to live next door to the OBGYN who performed my C-section and encouraged me to text her. Familiar with being ghosted by providers, I was surprised to get a reply within minutes: Head to the emergency room as soon as possible. By the time I arrived, my systolic blood pressure was hitting 181 and I had received a diagnosis: postpartum preeclampsia. I was admitted and immediately given blood pressure medication, followed by a 24-hour magnesium drip to ward off a possible seizure or stroke.

It was scary, logistically complicated with my childcare and breastfeeding needs, and exhausting. But, it was possibly life-saving, too. I was told that I was very lucky and was commended for listening to my instincts.

I also had unique circumstances. The personal connection with my provider—and the quality of that provider—made a difference. I was listened to and taken seriously. I knew the markers of preeclampsia, and was able to articulate what I thought was wrong. I work at the Rollins School of Public Health and am aware of our nation’s maternal mortality rates. I had a blood pressure cuff at home. I live five minutes from a hospital, have access to transportation, and health insurance. I have a strong support system that stepped in to figure out tricky childcare logistics for a 4-year-old and a one-week-old.

Even with all of these factors in my favor, I still almost didn’t go to the hospital. This gives me very little confidence that most other women catch their symptoms in time or receive a proper diagnosis or treatment.

A Rare-Ish Diagnosis ... Maybe

Postpartum preeclampsia is often touted as “very rare.” However, reporting about this condition is a bit muddled, since it relies on hospital data for admitted patients receiving treatment. The other challenge with it is even if somebody shows up, gets readmitted postpartum to the hospital and they get a diagnosis listed on the medical record of postpartum preeclampsia, there's some challenge in determining what's truly postpartum preeclampsia versus something that's continued from delivery.

A 2021 article published in The American Journal of Obstetrics & Gynecologysupports the variation in reporting, with the authors noting the reported prevalence of postpartum preeclampsia ranges between 0.3% to 27.5% of all pregnancies.

Based on my own experience, I’m guessing it’s closer to the higher number. There is a serious information gap just waiting to be filled.

Preeclampsia During and After Pregnancy

For anyone who has been pregnant, or is trying to be, preeclampsia is a word you may be familiar with. It’s a condition that can occur during pregnancy—typically after 20 weeks—and is marked by high blood pressure and/or protein in a pregnant person’s urine. Other symptoms can include headaches, blurry or changed vision, vomiting or nausea, and swelling—which can feel very similar to other “normal” pregnancy symptoms.

“What we generally know about preeclampsia is it is some result of placental dysfunction, like the placental vascularization isn't happening exactly how it should,” says Kait Stanhope, PhD, assistant professor of epidemiology at the Rollins School of Public Health. “So, the treatment for conventional preeclampsia in many ways is delivery. We get the placenta out and, for many women, their preeclampsia symptoms will go away.”

Often cited risk factors include being pregnant with multiples, family history, a history of preeclampsia in previous pregnancies, using IVF, obesity, having kidney disease, having an auto-immune disorder like lupus, chronic high blood pressure, and diabetes.

The reason why preeclampsia during pregnancy is such a big deal, and why it’s monitored so closely by providers, is the risk it carries for the pregnant person and their unborn child. Left untreated, it can cause organ damage or failure, preterm birth, stillbirth, growth restriction, and death for the pregnant person or their child. It can also develop into eclampsia, which causes seizures and can result in organ damage or failure, a coma, or death. 

In some instances, people with preeclampsia develop HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, which can disrupt blood clotting, damage or destroy red blood cells, and cause bleeding in the liver. This is a medical emergency that requires immediate care.

Preeclampsia and eclampsia are among the top causes of maternal deaths—in addition to severe bleeding, infection, and complications during birth.

I did not have preeclampsia during pregnancy. So, what caused it? Stanhope notes there has been speculation that some labor characteristics may trigger the condition (like getting lots of fluids).

I was induced, received a lot of fluids, had a 30-hour labor with lots of high blood pressure readings during the labor, and a C-section. I am also 40, which could be a contributor as well. It is hard to know what caused it for me. Especially since there is little research on the topic.

“Part of the challenge is most of the time postpartum preeclampsia happens after people go home from the hospital because postpartum blood pressure does a little dip and then it rises a little bit,” says Stanhope. “So, in high-risk people who've had high blood pressure during their pregnancy, their clinical care team should see them about a week postpartum. But for low-risk people, if you had normal blood pressure during pregnancy, that's not done for the most part. And so, the only thing you get is being told about these signs and symptoms.”

Save Your Own Life

When I initially went home from the hospital after the birth of my daughter, I was given a piece of paper with signs to look out for postpartum, which included several indicators for postpartum preeclampsia, as well as other deadly conditions following birth. Risks of postpartum preeclampsia tend to be highest the first two weeks after birth up until six weeks postpartum. 

Warning signs directly related to preeclampsia:  

• A blood pressure of 140/90 or higher
• Extreme swelling in your hands, feet, and/or legs
• Sudden weight gain (2 to 3 pounds or more in a week)
• Shortness of breath
• Pain in the upper stomach
• Severe headache

Treatment for my postpartum preeclampsia ended up being a day-and-a-half at the hospital that ended up being covered by my insurance. I was given blood pressure medicine and then placed on a 24-hour magnesium drip, which left me feeling like I was hit by a truck. Friends took turns sleeping on my couch and helping to get my son to daycare while my husband stayed with my daughter and me in the hospital. Since I was a patient, I wasn’t allowed to be left alone with my baby daughter, so someone always had to be there with us. 

Maternal Instincts Can Benefit Mom, Too 

Then, I was good to go. My risk of a seizure or a stroke had been averted. But I was left rattled by the experience, and kept pondering the could-have-beens. Postpartum preeclampsia is one of many postpartum complications that may go unrecognized and untreated. Paying attention to all maternal warning signs  and being in tune with your body is important. 

This comes back to self-advocacy. Stanhope encourages those who are pregnant, thinking about becoming pregnant, or a friend or family member of a pregnant person to know the warning signs, know who to contact and how at the hospital or provider’s office, know where the emergency room is, identify who can provide support to other children in the event of an emergency, and to trust your instincts.

It’s a message I hope other women take to heart. Especially, my daughter.