Pre-eclampsia and high blood pressure in pregnancy

Postnatal care in hospital

Women we interviewed who had pre-eclampsia or HELLP syndrome in pregnancy sometimes stayed in hospital for longer than normal. Many had a caesarean section and so needed extra after-care. They often also had health complications, such as ongoing high blood pressure or headaches, which needed more treatment, or doctors wanted to keep monitoring them.

Even after birth there can be serious blood pressure problems, and they can continue or develop for up to eight weeks after the birth. Late-onset pre-eclampsia usually develops in the first 48 hours after birth but can appear several weeks postnatally. For this reason, it is important doctors and midwives continue to monitor a woman in hospital soon after she has given birth to her baby.
Medical care immediately after giving birth

After a woman’s baby is born, it is important that the placenta is removed. Dominie, who is a midwife, recalled that her placenta was delivered quickly and “they put up the higher amount of Syntocinon [oxytocin] to stop me from having a haemorrhage”. Melissa’s took a long time: “I had various people tugging on it and injecting me and oh, that and [having stitches] was the worst bit actually”.

Many of the women we spoke to had caesarean sections, planned or emergency, and some women who had tears or episiotomies (surgical cuts made to increase the vaginal opening) needed stitches. For many women who had emergency birth experiences, the need for medical care for themselves or their baby meant that aspects of their birth plan didn’t happen (such as skin-to-skin with their baby). This could be upsetting with a lasting emotional impact that sometimes affected early bonding.
Most women we spoke to were closely monitored after giving birth, as they were at risk of complications. Paige remembered having a room “next to the nurses office and I wasn’t allowed to keep my door shut; it had to be open at all times” so they could keep an eye on her. This could be a nuisance, but most women said they appreciated why it was needed. Kate stayed on a postnatal ward but wasn’t allowed to be in a side-room because the beds were too wide to get them out the door in an emergency. However, not everyone felt they had been monitored closely enough after giving birth.
Women who had been taking medicines to lower their blood pressure before birth usually continued, sometimes for a while after they were discharged from hospital and in recovery. Some medicines don’t affect breastfeeding, but others do. Doctors made decisions about medicines based on lowering or stabilising the woman’s blood pressure; it was usually the preference to give medicines safe to take whilst breastfeeding. However, in some cases, other medicines were needed which meant breastfeeding could not continue. Aileen, who had high blood pressure before pregnancy (chronic hypertension), went back to her previous medicines, which meant she couldn’t breastfeed her baby: “I thought ‘if that’s what's best, then it's fine’ because I thought, 'I have given the colostrum; I have given a little bit of breast milk’”. 

Set-backs and becoming very unwell soon after giving birth

Most women found their symptoms stopped soon after giving birth and they started to feel better. However, others continued to have symptoms and health problems. Some of these issues were thought to be related to pre-eclampsia and HELLP syndrome, such as: unstable high blood pressure; fainting; very heavy bleeding (haemorrhages); raised temperature; and ongoing epigastric pain. Other symptoms were unrelated, such as: hallucinations/night terrors (as a result of an infection); reactions to medicines; and ruptured stitches. Angela had some episodes where her blood pressure suddenly shot up – she remembered one occasion when she was going for a shower and her “heart rate went flying up, I was quite breathless, I didn’t feel right”. Samantha X had visual disturbances for about two days after giving birth. You can read more about women’s experiences of high blood pressure problems shortly after birth and the longer-term health impacts for women.
A number of women had been sent to an Intensive Care Unit (ICU) or High Dependency Unit (HDU) for a short while because they needed acute care until their condition stabilised. Whilst in the operating theatre for her caesarean section, Mairi remembered hearing a doctor say she needed to be taken to “ICU, and I used to watch Holby City [a medical drama television show] at the time” so she knew it was serious.
 
Waking up in ICU or HDU could be confusing and frightening. As Tracey explained, “I was on my own and didn’t even know where I was”. Hanna woke up in ICU with a sore throat because there had been some difficulties during the emergency caesarean section and she needed to be intubated (when a tube is put down the throat) to help her breathing. A lot of the women in ICU or HDU were in and out of consciousness for some time, as they were very poorly. You can also find out more about experiences of being in ICU in another of our sites about life-threatening conditions in pregnancy here.
Being able to leave ICU or HDU and move to a postnatal ward was seen by most women as a welcome sign that they were getting better and getting closer to being discharged from hospital. For those whose babies were on a neonatal unit, such as NICU (Neonatal Intensive Care Unit) or SCBU (Special Care Baby Unit), moving onto the ‘normal’ postnatal ward also meant they could more easily visit their babies (see also section on bonding). Dominie was pleased to be in a private room on the postnatal ward but also concerned about what would happen if she had a seizure because “no-one would see me”. Being discharged from HDU was “a step forward” for Helen X; however, it was upsetting hearing other mums with their newborn babies on the postnatal ward whilst hers was in NICU. 

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