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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).
 

Lyndsey expected to rest in hospital for several weeks until her baby was born. It soon became clear that her blood pressure was too high and she needed a caesarean section.

Lyndsey expected to rest in hospital for several weeks until her baby was born. It soon became clear that her blood pressure was too high and she needed a caesarean section.

Age at interview: 39
Sex: Female
Age at diagnosis: 34
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I knew soon as I'd been admitted that, 'Oh right OK, this is probably quite serious,' but I still felt quite calm at that point that, you know, you know I'm in hospital, I'm in the right place you know. You know I hadn’t finished work at that point but it was like, 'Well whatever, [laughs] I don’t mind.' I didn’t mind being admitted, yeah because I knew that they'd hopefully look after me and, you know within a couple of weeks' time that'll be fine; he'll be 37 weeks or even though he'd probably only really be 35 or whatever I might have actually been able to tell someone that… about that at some point before that… that got to there but it was the real 'Oh my god' moment was when obviously I got my high blood pressure; went through the roof and I got told I was going down to labour ward that evening, that was the, 'Oh right OK this is much more serious than anticipated,' so.

Why did they… how did they explain that you needed to go to labour ward? 

Well it was the nice nurse again. While she was taking one of my blood pressures she said, "Oh I'll just have to go and get the consultant," and I think she went to talk to them and they obviously looked at the readings and then the nurse… the nurse came back with a consultant and said, "Yeah we're going to have to deliver your baby, it'll be unsafe otherwise." So, I can't quite remember their exact words but it was… yeah it was quite a shock so yeah.
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”.
 

Janine was sent to hospital and was monitored on a ward for three days. Her doctors advised that her baby should be delivered by caesarean section.

Janine was sent to hospital and was monitored on a ward for three days. Her doctors advised that her baby should be delivered by caesarean section.

Age at interview: 33
Sex: Female
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It was just a 30, well, almost 30 weeks a routine antenatal scan and check-up at [local hospital] hospital and the consultant was sort of quite concerned with the scan that my daughter was still very small for dates, and my blood pressure was quite high and also I’d protein plus two in my urine test. Things obviously, lots of weight, was carrying a lot of fluid, and he advised that I went to [another hospital] to have nine weeks’ bed rest. So I was obviously referred on a Thursday tea-time, put on the monitors, just general check-ups, and then it got to the Sunday afternoon where I just had a really bad headache, obviously still had the monitors, blood pressure checks every four hours and so one of the nurses had to get someone else to check my blood pressure, and it was obviously dangerously high, that they just took me down to the delivery suite, put me on a drip to hopefully get the blood pressure down, which it did stabilise by itself, but they said, you know, due to the risk with the pre-eclampsia that had set in, the only way, you know, to sort of, you know, stop the pre-eclampsia of getting any worse was to just do a caesarean for the next day, which they did.
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.
 

Olivia stayed in hospital for a week. She wasn’t given any medicines but she thought rest helped her blood pressure lower. She was discharged but returned to the hospital only a few hours later.

Olivia stayed in hospital for a week. She wasn’t given any medicines but she thought rest helped her blood pressure lower. She was discharged but returned to the hospital only a few hours later.

Age at interview: 32
Sex: Female
Age at diagnosis: 28
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I was in for the week that week. So, 37+5 to 38+5 I was in. And every day I was saying, "So, what are you going to do with me?" and they said, "We're just going to monitor you." I was like, "OK." One of the consultants came round and he was like, "Most of the women in this hospital are because of pre-eclampsia, you know everybody on this ward right now, they're only here because of pre-eclampsia," and I was like, "Oh right OK," and he's like, "That’s what you’ve got," and I know, you know I know [laughs]; I diagnosed that myself months, you know months ago, I know I've got pre-eclampsia. And he said, "Yeah, that’s pretty much all we can do to make sure you don’t do anything." He was like, you know "We don’t want you going further than the bathroom; we just want you to stay still, don’t move and just wait to go into labour," and I was like, "Oh right OK." I had responded to lying still; my blood pressure came right down – I think it was around a 133 – it stayed high for a couple of days and then it came down to about a 133 and this was at 38+5, and he said, "You can go home if you want today." I said, "OK yeah, I'll go home now," and I said, "Do I just continue bedrest?" He said, "Yeah, bed rest until you deliver." Alright fine. 
 

At 32 weeks into her pregnancy, Helen X agreed to stay in hospital overnight to check that medication to lower her blood pressure was working. It came as a shock when she was told the situation had become more serious and her baby would be born that day.

At 32 weeks into her pregnancy, Helen X agreed to stay in hospital overnight to check that medication to lower her blood pressure was working. It came as a shock when she was told the situation had become more serious and her baby would be born that day.

Age at interview: 31
Sex: Female
Age at diagnosis: 31
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And so anyway, eventually on Monday, they decided to put me on medication. And initially they said like, “We’ll put you on medication. We’ll just keep you in overnight, just to make sure the medication’s had an effect on your blood pressure. And then you can probably go home tomorrow morning.” And so anyway I said, “Fine.” So I spent my first night in hospital and I was actually quite happy, because they had the electric beds and I call pull my bed head upright and I was actually comfortable sleeping, and I was like this is great actually. I’m quite happy to be here [laughing]. And then the next morning was when it really kicked off like, so I’m sure it was about 7 in the morning. I just had this army of doctors come in and say, “You’re liver function is so far off, we have to delivery your baby today. It’s going to have to be by caesarean, because you’re too early for any of the drugs we’d give you to induce it to work. So basically you have to have a caesarean and your baby’s coming today, and that’s it.” So I was just [blerrr] [laughs] and then I wanted it, so obviously I’d been anticipating that someone would tell me my blood pressure was better and I could go home. And that’s what happened, and so obviously I just immediately called Michael and said, “Come here now, your baby’s coming today.” And then we just, the rest of that day, I think, we were just completely shell shocked. We just had a parade of, you know, anaesthetists, neonatal specialists, just every single specialist coming in and giving us information that I’m sure didn’t sink it at the time at all, and we just, you know, we were flabbergasted by all these people coming in and out and everything that was going on and all of the rest of it, and its really funny actually. I look at, we have photos from that day, and like one of the anaesthetists came in and he, Michael was all dressed up in the blues to go into surgery, and like there’s this photo of us and we’re both smiling about this day, and I just look back at it now and think ‘how were we smiling?’ [Laughs]. And we’re just, I think we were just shell shocked. We just had no idea of what had hit us, you know, it was so far from what we’d anticipated for the birth of our child. It was just bizarre.
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 admitted to hospital to stay had a big impact on Josie’s life. The news came out of the blue and she felt unprepared.

Being admitted to hospital to stay had a big impact on Josie’s life. The news came out of the blue and she felt unprepared.

Age at interview: 45
Sex: Female
Age at diagnosis: 39
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Well it completely changed it. So, within a few hours I was suddenly in hospital. You know I was worried I… we didn’t even have a Babygro you know, let alone having any kind of preparation. I had no stuff with me; I'd only gone for an assessment, so I had nothing; I had no clothes; I had no night stuff; I didn’t have a toothbrush. So those were all brought to me, and yeah it just felt like… it just felt like my life completely changed. I had to get in touch with my work and tell them I wasn’t coming back and, you know so things just changed very…a lot very quickly.

Mm. And what did you tell them at work?

I told them at work I had pre-eclampsia and I was having… and I was going to stay in hospital until I had my baby and I wasn’t going to be back for a year.
 

Samantha X was admitted to hospital 29 weeks into her pregnancy when her tests came back showing high blood pressure and proteinuria. She was shocked to learn that she would need to stay in until her baby was born.

Samantha X was admitted to hospital 29 weeks into her pregnancy when her tests came back showing high blood pressure and proteinuria. She was shocked to learn that she would need to stay in until her baby was born.

Age at interview: 32
Sex: Female
Age at diagnosis: 31
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I thought I was going in for a check-up and actually I was all dressed to go to work and I, I kind of knew the routine by then, because I’d been in there a few times for check-ups so I knew they were going to check my blood pressure, I knew they were going to take blood. I knew they were going to ask for a urine sample. So we did all that and I sort of sat there, and I had my book, because I know that it takes a little while, and when the midwife checked my, my urine sample, and there was a, I think she said it was a plus 3 reading of protein which is like, I think is like the highest they check. I thought to myself then, okay this is bad. And she said to me, you know, “We’ll get the doctor to come and see you.” And one of the registrars saw me, looked at the blood pressure, looked at the blood results and the urine sample and she said, you know, “You’re got pre-eclampsia and we’re going to admit you.” And I think even then I just thought, oh I’ll just be in for a couple of days and I said to her, “Oh you know, how long am I going to be in for?” And she said, “Well basically until your baby’s born.” At which point I was, I was I like, I just sort of went oh okay and I don’t know, it just didn’t seem quite real. And I suppose it’s one of these things were you just kind of get on with things. So I thought okay, well I’d better ring my husband and let him know and then secondly, I’d better let work know, because I have quite, I have a job with quite a lot of responsibility, quite a lot of stress I manage a team, and there was a lot going on, that I needed to look, look after before I went on maternity leave. And I just thought, that was one of my first thoughts actually was, what are we going to do about work? And I rang my boss, and I could tell that she wasn’t very happy, but, and because there was, I suppose what was wrong with me, was slightly intangible. It’s not like, I could point to something and say, oh you know, I’ve got to stay in hospital, because I’ve got a broken leg or something like that. It was, you know, high blood pressure and pre-eclampsia and unless you know what it is, I suppose it doesn’t feel like something that’s very serious. And when they sort of said to me, “You know, you’re going to be in here for a long time.” I thought, I just thought, oh God that’s going to be awful. 
 

Ruth X had pre-eclampsia in her first pregnancy and she self-monitored her blood pressure in a subsequent pregnancy. She explained that she may become unwell to her young son so he was aware that she may have to stay in hospital.

Ruth X had pre-eclampsia in her first pregnancy and she self-monitored her blood pressure in a subsequent pregnancy. She explained that she may become unwell to her young son so he was aware that she may have to stay in hospital.

Age at interview: 42
Sex: Female
Age at diagnosis: 42
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He’s older and, he’s old enough because he’s five to understand and we’ve been quite honest with him and he’s come to some of the hospital appointments so he knows that, you know, he has to be a bit careful with mummy and all the rest of it because, you know, mummy’s growing a baby and, you know, needs lots of monitoring and I could be sick and I could end up in hospital. So he knows that, you know, it’s not going, if I do end up in hospital, it’s not going to be a sudden shock to him and he know, understood that part of you know, mummy being a little bit poorly with the pregnancy, was, you know, she’s going to have to monitor her blood pressure and do a test, sometimes he’s actually reminded me [laughs].
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”.
 

Munirah felt okay when she was told she would need to stay in hospital for several weeks because of high blood pressure, as she expected to have a healthy baby at the end of it. It was devastating when tests showed her baby was seriously unwell.

Munirah felt okay when she was told she would need to stay in hospital for several weeks because of high blood pressure, as she expected to have a healthy baby at the end of it. It was devastating when tests showed her baby was seriously unwell.

Age at interview: 27
Sex: Female
Age at diagnosis: 27
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When I received the diagnosis there was… I still felt…I didn’t feel as bad because to me it felt like that they could do something, like they could bring my blood pressure down and everything would be OK, because when I spoke to… when I got to the ward and the midwife was there and I said, "How long am I going to be here?" She said, "You'll be here for as long as… till we deliver the baby," and I thought, 'OK, that’s fine.' She's like, "We'll get your blood pressure down, we'll deliver the baby, it'll be OK," and I thought, 'OK, that’s not too bad.' I go, "It's a small thing and I'm in a hospital and in the best place for it and I might have to…" And I remember I said, "Realistically, how long will I be here?" and she goes, "You might be here for a few weeks; if you need to be here for a couple of months," and I thought, 'Actually that’s not too bad, I can do that because I will have a baby at the end and if it’s a little bit sooner than I expected but there would be a baby at the end of it.' And I thought it's not until I had that ultrasound scan later on that day, in the afternoon/evening time, I think that it really set in that I've got a really sick baby and that if he'd had a brain haemorrhage, he really wasn’t going to make it.
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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