Pre-eclampsia and high blood pressure in pregnancy

Aileen

Female
Age at interview: 40
Age at diagnosis: 35

Brief outline: I had pre-eclampsia in both of my pregnancies, with the births at 7 months (34 weeks and 30 weeks respectively). I have a history of high blood pressure and so I was seen by a specialist consultant. Both of my babies spent some time in a Neonatal Intensive Care Unit.

Background: My name is Aileen; I am 40 years old and a nurse. I am married and have two children, one daughter aged 7 and one son aged 5. I identify as Filipino.

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High blood pressure problems

I developed pre-eclampsia in both of my pregnancies. My children were born at 7 months (34 weeks and 30 weeks respectively). I have a history of essential hypertension (high blood pressure without a known cause) which meant that I was seen by a specialist consultant in both pregnancies. I changed my blood pressure medicine to one which would be safer during pregnancy (labetalol). I didn’t have many symptoms and, in each pregnancy, the diagnosis was made because tests showed that I had high blood pressure and protein in my urine (proteinuria). The only symptom I had in my first pregnancy was some swelling in my legs and face, though I thought this was just a normal part of pregnancy at first. In each pregnancy, I stayed in hospital for about two weeks to be monitored. I had emergency c-sections when the medications were unable to control my blood pressure and it was decided it would be safest for my babies to be born. 

My first pregnancy

Pre-eclampsia was diagnosed in my first pregnancy at a routine check at 7 months (32 weeks). I was admitted to hospital, which was a shock. I felt well and just wanted to go home but I was told that I couldn’t. I had good support in the lead up to having an emergency c-section, and my husband and I were kept informed throughout. It was a good experience on balance rather than a traumatic one. The hospital’s neonatal team resuscitated my baby, Emma, and took her to the neonatal unit. She was given antibiotics in case of infections but didn’t need any further medical care. 

After I had given birth, my blood pressure was monitored on a High Dependency Unit (HDU) and I was then moved to the post-natal ward. Both Emma and I stayed in hospital in transitional care for two weeks to be sure she was feeding properly. I struggled to express milk at first and my blood pressure was still very high. The consultant advised me to return to my previous blood pressure medication, but this would mean I couldn’t breastfeed any more. The advice I was given by the midwives on the ward conflicted with this, as they wanted me to keep breastfeeding Emma. In the end, I decided to return to my old medication and use formula milk because I figured that if I'm not well then I can't look after my baby. My blood pressure settled and I was discharged with Emma. Taking my baby home made me happy but also scared in case anything went wrong.

My second pregnancy

I became pregnant a second time about 11 months after the birth of my daughter. I changed my blood pressure tablets again to ones which would be safer in pregnancy and I took a low dose of aspirin. High blood pressure and proteinuria were detected at a GP appointment 6 months (28 weeks) into my pregnancy. I was sent home with a 24-hour blood pressure monitor, but it was tricky to keep on top of recording measurements with my young daughter at home. When I returned to discuss the results, I was admitted to hospital. I was very worried as the high blood pressure problems seemed to have started earlier in this pregnancy than my one before. There were also some concerns that my baby wasn’t growing properly and so I had some checks on the placenta blood flow. The monitoring was reassuring and I was glad someone was keeping an eye on it, though I was also worried about what might happen next. 

I spent two weeks in hospital – I was in and out of the HDU as blood pressure would rise before settling down. Once my pregnancy reached 30 weeks gestation, the consultant advised me to have a c-section because carrying on the pregnancy could endanger the lives of both me and my baby. My baby’s heartbeat dropped several times and, early in the morning, I was rushed into surgery for Bertie to be born. My son was taken to NICU (Neonatal Intensive Care Unit). He was given something called CPAP (Continuous Positive Airway Pressure) which keeps air blowing into the airway. This didn’t work at first and he needed to be in intubated (a tube inserted into the airway). 

Once Bertie was stabilised and back to CPAP for breathing support, I found out that he would need to be transferred to another hospital because the NICU ward was over-crowded. This was extremely upsetting – the hospital was many miles away and it would be difficult for me to get there to visit him because I’d had a c-section and couldn’t drive for some weeks. I was told that I would be transferred to the hospital Bertie was being sent to, but this was not arranged in time so I had to wait an extra day. I was discharged a week after giving birth, despite some delays with hand-over between the hospitals. Getting to the hospital to see Bertie proved difficult. It helped that my husband was self-employed and able to re-arrange work commitments to some degree, and also that my parents-in-law lived nearby to help with lifts. My young daughter was also in nursery, which helped some of the time, but also meant it was difficult to find visiting times so she could meet her baby brother in NICU. Bertie stayed in hospital for a total of seven weeks. He has ongoing check-ups every three months to keep track of his health.

Messages for others

My advice to other women with pre-eclampsia is to not be afraid of asking questions. I’m a neonatal nurse and so I had insight into the environment in which premature babies like mine are cared for in. Even so, it was scary being on the receiving end. It has given me insight into what it is like for parents and how hard it is having to ask permission to touch their own baby and being restricted to visiting hours. I tried to be involved in caring for my babies but found the neonatal unit staff were often reluctant to let me do tasks. My message to doctors and midwives is that communication is very important and they need to speak sensitively. More communication between neonatal units and maternity units would help, and could have avoided the extra upset I felt when my baby was transferred to another hospital without me.

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