Pre-eclampsia and high blood pressure in pregnancy

Being asked to stay in hospital for pre-eclampsia

Some of the women we spoke to had spent time in hospital because of pre-eclampsia or HELLP syndrome before the birth of their baby. Others were just in hospital during labour and birth.

Although having to stay in hospital was not ideal, women understood it would help them and their unborn babies. In hospital, their health and their unborn baby could be monitored and they could be given treatments. A baby is full-term at 9 months (37-40 weeks), but pre-eclampsia can mean that women deliver before their due date. For women who became ill several weeks or even months before their due date, the main aim was to keep the pregnancy going as long as possible. This would give the baby more time to develop and get stronger before being born. However, pre-eclampsia can be harmful to the health of both the pregnant woman and her baby, with delivery of the baby being seen as the only ‘cure’. So keeping the pregnancy going has to be balanced with the health needs of the woman and her baby (see also the section on decision-making in hospital).
Being admitted to stay in hospital

Women had often been referred to hospital after a routine antenatal check showed signs of a problem, such as a high blood pressure reading or protein in a urine sample. Sometimes there was a sense of urgency. Paige remembered her GP saying “I'm sending you in by ambulance, you need to get there now”. Olivia was told she would have to wait four hours until a hospital bed became available: “so I literally went and sat on a bench outside maternity assessment until they could admit me”. Dominie said the seriousness “didn’t kind of click in” and, after the doctor appointment, she “drove myself home. I got myself ready, I got a night bag. I waited for my husband to come home; we went and got some lunch on the way […] When I look back now that [my blood pressure] was dangerously high and anything could have happened”.

In other cases, women were admitted to hospital because they were concerned and had taken themselves in for checks. Kate called an NHS medical helpline when she felt very unwell and, despite initially being dismissed, went into her local maternity ward. She was later diagnosed with HELLP syndrome. Some maternity units have a dedicated walk-in service so that pregnant women don’t have to make an appointment or wait in Accident and Emergency (A&E).

Some women had extra checks and were sent home if the results were okay. Some were asked to come back for more tests in the next day or so. Sometimes, women were asked to stay in hospital overnight or for a longer period of time. Emma was 38 weeks pregnant, when her GP referred her to hospital and said she would need to pack a bag. She was told it was unlikely she would be able to go home until her baby was born – this advice helped her feel “well prepared”.
Some women found being admitted to hospital long-winded. It could involve speaking to different people, including NHS medical helpline, their GP and midwives, different hospital departments and units within maternity services. Olivia’s midwife sent her to hospital but she had to wait for several hours until a bed became available, despite the fact she felt very unwell. But others found it a rapid process. Emma gave two urine samples when she first arrived at the hospital and she was told quite quickly that she would be staying in, at which point a midwife “tagged me [with a hospital wristband] and put me in a bed […] it was very quick, no hanging around”.

Expected duration of stay in hospital

While some women were told how long their hospital stay was likely to be, others found it was more of a ‘wait and see’ situation. Length of stays varied from a few hours to several weeks and depended on a number of factors: how many weeks pregnant they were, whether they were admitted because they had started to go into labour, the severity of their pre-eclampsia, and whether they had any other health concerns affecting their pregnancy (such as having epilepsy). Some women were kept in hospital for a few days to rest and for their blood pressure to come down, and were then allowed home. Others had to stay until their baby was born. This could be a matter of hours, days or weeks. Tracey arrived in hospital at 10pm and, five hours later, her baby was born at 32 weeks by caesarean section. By contrast, Josie spent two weeks in hospital before her baby was born.

The length of hospital stays were difficult to predict. Samantha X hoped she would be in hospital for “a long, long time” when she was admitted at 29 weeks but sudden and uncontrollable rises in her blood pressure meant she gradually accepted that her baby would be born soon. Kay was admitted to hospital at 25 weeks and was told she would probably need to have her baby right away because she was very unwell. However, her doctors and midwives managed her pre-eclampsia so that she was able to spend a further 3 weeks in hospital before the birth, giving her unborn baby some extra time to develop.
Feelings about being admitted for a hospital stay

Being told that they would have to stay in hospital until their baby was born came as a huge shock for some women, especially if they were still quite early on in their pregnancy. Hanna explained, “it was a pretty terrifying moment for me when I was told that you can’t go home”. Their normal lives went ‘on hold’. Everyday tasks, like shopping and doing laundry, had to be abandoned. Plans had to be cancelled. Paige couldn’t “get my head around” the fact that her baby would be born 8 weeks early. The arrangements for her universities studies “went all out the window”. 

Being away from home could be especially hard for those who had other children at home, both emotionally and practically. For Kay, it was “hard not being there for my [14 year old] daughter because I felt like I was letting her down”. Those who were still working at the time had to get in touch with their manager to let them know the situation. As Samantha Y found, employers were not always very understanding.
Being kept in hospital was a worrying time, especially if it looked likely that their baby would be born prematurely. Sarah’s response to finding out that her son was going to be born at 33 weeks was “my God, it’s too early – he can’t come out, he won’t survive”. Aileen remembered thinking that “the outcome is still good [for a baby born at 32 weeks] but it means the baby will have to stay on the neo-natal unit and there are risks […] that things can go wrong”.
Being admitted to hospital could be a relief. Olivia had suspected that she had pre-eclampsia for many weeks before it was officially diagnosed. She had already started self-imposing “as much bedrest as I could” and trying to balance staying active without over-doing it. So being admitted felt like her concerns were finally be taken seriously and she would get better medical care. 

Although being in hospital for some time could be an inconvenience and was not an ideal situation, many women said it was worthwhile if it meant their health and the health of their unborn baby would be looked after.

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