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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.
 

Helen X didn’t mind recovering in hospital for a bit longer after giving birth. Her baby was in the Neonatal Intensive Care Unit, so being in hospital made it easier to see him.

Helen X didn’t mind recovering in hospital for a bit longer after giving birth. Her baby was in the Neonatal Intensive Care Unit, so being in hospital made it easier to see him.

Age at interview: 31
Sex: Female
Age at diagnosis: 31
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And as far as your health was concerned, why were you being kept in?

Oh blood pressure needed to come down still, and I guess some of it making it making sure the caesarean was healing okay and stuff like that. Yes, but I think it was largely the blood pressure thing that they were worried about and they were just making sure that those things were on their, you know, heading in the right direction basically.

And I guess also, I mean I, I probably could have pushed if I wanted to come home earlier, but in a lot of ways I was like well its really convenient. I’m on the first floor, the baby’s on the third floor, its going to get a hell a lot harder trekking from home which is half an hour away. I’m not in much of a rush to get discharged. So I didn’t really kick up a fuss. I was quite happy to sit back and go, still got my electrically operated bed [laughs]. I’m happy. I will stay here for a few more days thanks. So yes, because, I know that there was some, like you know, there was, obviously you chat to other mothers on the neonatal ward and stuff like that and some of them were bitching about how slow things were and how they really wanted to go home or whatever, but, and I just remember thinking, I think I might just take it for now. Someone else is cooking my dinner. Okay not what I’d like to cook, but its one less job to do and I may as well make the most of it. Recover as best I can and then we’ll worry about the rest, yes.
 

Claire had observations taken after she had given birth. She didn’t know that there was a risk of problems developing at this time and thought she and/or her husband should have been told.

Claire had observations taken after she had given birth. She didn’t know that there was a risk of problems developing at this time and thought she and/or her husband should have been told.

Age at interview: 39
Sex: Female
Age at diagnosis: 39
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The section monitoring, when I came out of theatre it was every five minutes, and all I wanted to do was just to have peace. By this point I had been up for forty eight hours and just wanted… I wanted to be with my baby but that was impossible, and I just wanted to sleep. And you don’t rest when you're being poked and prodded. I get now why they had to do it, but again that wasn’t really explained to me at the time. I think… and maybe, maybe it's a good thing they do play it down; if they're worried about your blood pressure and your heart rate they don’t want to have you unduly worried by saying, "We need to do these obs because things can get worse after delivery." I think for me the moment our daughter was born the anaesthesiologist told us this as well, is my stats immediately started stabilising; my colour changed; I felt better in myself – whether it's psychological or not I don’t know, but you know when your body's reacting like that you think, 'OK, that was the right decision, now let me heal, let me get better,' and so, I think if I was stabilising they probably didn’t want to give me any undue worry.
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.
 

Betty focused on her husband during the caesarean section. She was sad to have missed out on some things she had wanted for the birth but glad they got to see their son.

Betty focused on her husband during the caesarean section. She was sad to have missed out on some things she had wanted for the birth but glad they got to see their son.

Age at interview: 38
Sex: Female
Age at diagnosis: 37
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I was just looking at my husband. I could feel the cut but it wasn’t painful. It's a very strange sensation. I guess it's like when you've sat on your hand for a long time and it feels all rubbery, and you can feel something at it but it doesn’t hurt. There's no… you can't… it's a numbing… it's a numb sensation. And so I could feel the cut but I wasn’t worried. I think I heard a few sounds. They told us that the baby had… was healthy I think. I heard a tiny little cry from him and then I just remembered feeling really, really tired and peaceful, and I was dozing off but my husband kept trying to keep me awake. I don’t know whether that was dangerous and hence he was trying to keep me awake.

I still don’t know. If I had fallen asleep would that have been OK, who knows? And then I remember them sewing me back up; again didn’t hurt. And so we just spoke for a few minutes whilst they were cleaning [son’s name], and then they brought him round. He was all wrapped up. We had a quick photo taken. I mean it was… it was a little sad that I couldn’t have skin to skin but obviously the most important thing is to make sure he's OK, and they explained that they were going to take him immediately to the intensive care unit, so I understood that. Again in an ideal world I would have asked about cord clamping and requesting for that to take place, but it just wasn’t the time or place for it.

So, was it the ideal delivery – of course not. There were other things I would have preferred but I'm just very grateful that everything happened the way it did.
 

Nicola had an intense headache and felt very sick soon after she gave birth. She’s unsure whether this was linked to her epilepsy, her pre-eclampsia, the stress of the situation or the medicines she was given for delivering the placenta.

Nicola had an intense headache and felt very sick soon after she gave birth. She’s unsure whether this was linked to her epilepsy, her pre-eclampsia, the stress of the situation or the medicines she was given for delivering the placenta.

Age at interview: 33
Sex: Female
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I don't know whether it is related to the epilepsy, but in my - I sort of imagine it does, because of the amount of drugs I have in my body. But I sort of had a bit of reaction to that. I also had a reaction to the drug they give you to, so that you deliver the placenta. And everything I'd worried about, about having epilepsy, sort of came about afterwards. Having felt absolutely fine, I then went into the most terrible post- - well, what I would describe as a post-fit headache, which is what I get after a seizure. And it's like a migraine, it's terrible, in one place, want to curl up in a ball. And that came on very quickly after I'd had her, and I didn't really hold her for the rest of the night. I mean, I was just curled up in a ball, and in the end I had to ask the - I felt sick - although I wasn't being sick, I felt sick with this headache, and I had to ask the midwife who'd then taken over the shift, you know, I had, "You're going to have to give me something, to get rid of this sick feeling and this headache, because I'm not going to be able to take my epilepsy pills at ten thirty, and I need to take them, not only because I need to take them, but because I've just given birth and I'm exhausted, and I don't want this to start perpetuating.” So they had to give me something, and then I, after, you know, I was ready to go to the ward.
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.
 

Olivia tested positive for a bacteria called Group B streptococcus during her pregnancy, so needed 48 hours of observations after she gave birth. She was told they would keep an eye on her blood pressure too, but this was not always done.

Olivia tested positive for a bacteria called Group B streptococcus during her pregnancy, so needed 48 hours of observations after she gave birth. She was told they would keep an eye on her blood pressure too, but this was not always done.

Age at interview: 32
Sex: Female
Age at diagnosis: 28
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In terms of your blood pressure, what further investigations or treatments did you need after your son was born?

I didn’t have any. Nobody told me that I needed any; nobody was that bothered. I mean I was supposed to be on four hourly observations the week I was in hospital but I was the one who had to set my alarm and go to the midwife's station and tell somebody, "I need my blood pressure checking." "Oh yeah," you know and one night I didn’t wake up for the alarm – nobody came you know, so it wasn’t checked for twelve hours, and then I was like, "Do you want to check my blood pressure?" "Oh yeah we'll do it after breakfast," you know nobody gave a shit really at all. 

And then for 48 hours after I think they checked it once and they were like, "Yeah it's back to a hundred and twenty," or some number that was low enough for everyone to be happy and they were like, "Yeah we're happy with that," and that was it you know.
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.
 

It was frightening when Angela’s blood pressure shot up the day after she gave birth.

It was frightening when Angela’s blood pressure shot up the day after she gave birth.

Age at interview: 36
Sex: Female
Age at diagnosis: 34
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And then the next morning she brought in breakfast for me and my husband, and suddenly I was just eating it and out of nowhere my heartrate just went flying up really high like de de de – hundred and fifty kind of thing going… because I was on the monitors I could see it, and I was really panicky. I was like, "What's this [husband’s name], can you go and get someone, can you go and get someone?" She'd come back in, she knew nothing and then they were taking my blood pressure and it was still quite high, and the problem is every time I would look at the monitor my heart rate; everything went up, I was like really anxious. And I then… it was weird because then what kept kicking in to my head was because I'm a… because you know a cardiac nurse I knew kind of what… I don’t know what was going on and kind of thing like that. And then what worried me was they weren't cardiac nurses; they don’t know what's going on. So she was just... and it just stopped and it just then settled. And then again I think… then that day… they blur a bit because I spent a couple of days in the HDU but all I remember was it was really strange – where it was… normally it's like the baby's been born, it's all about the baby. To me it was all about me.
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.
 

Helen X was sent to a High Dependency Unit immediately after her baby was delivered by caesarean section. She stayed there for two days, although her memories of this are blurry in parts.

Helen X was sent to a High Dependency Unit immediately after her baby was delivered by caesarean section. She stayed there for two days, although her memories of this are blurry in parts.

Age at interview: 31
Sex: Female
Age at diagnosis: 31
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And I can remember coming round and we were in high dependency by then, and I can remember waking up and [son] was in my left arm. I can remember holding him. [husband] said I was off my trolley and just completely woozy, but I do have a memory of him being in my arms, which is a really nice thing to have, and then I’ve got no memory of kind of the rest of that day, and the next few days are really, really hazy because I had to stay in the high dependency unit, because I had to have some very strong drug I think to get my blood pressure back down, so I couldn’t go and see [son] for about two days. And I was just in this high dependency bed. And it was an odd experience again, because I think again because of the drugs, you know, and I could tell people coming in and out and talking to other patients and things, and I just remember feeling really lonely there in my bed. And thinking I want them to talk to me [laughs]. I was obviously like I was fine and I didn’t, you know, I wasn’t a demanding kind of person so they never talked to me. They talked to the annoying woman over there [laughs]. And I was like talk to me, I’m lonely. But very odd time warped kind of days. It was very weird. And then eventually they pulled out the drains and let me go to the ward, and I just remember feeling like a little old lady hunched over with this scar, and everything and then we got to go up to the neonatal unit and finally meet [son] which was lovely of course and all of that. So then I was in for a week just recovering myself I guess. And I felt fine fairly quickly. Physically I guess I was in a bit of pain, but, I didn’t think it was too bad really to be honest.
 

Kate was transferred to another hospital and into a High Dependency Unit. She didn’t like being unable to look after herself and it took a while to sink in that her baby had been born.

Kate was transferred to another hospital and into a High Dependency Unit. She didn’t like being unable to look after herself and it took a while to sink in that her baby had been born.

Age at interview: 35
Sex: Female
Age at diagnosis: 34
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So yes high dependency [small laugh]. They were ever so good there. And I couldn’t sit up, couldn’t wash myself, didn’t really feel like eating. I was in a lot of pain. I was really swollen and not used to being a big person, it was quite horrible to look down and not recognise oneself. You know, having to lie in bed for four days, I don’t do that [laughs]. I’d love to do it now. But I was lying on a bed that undulated by itself. I think its to stop you getting bedsores. But not being able to push yourself up or reach out for things. Horrible feeling. Just everything is taken away from you. 

And obviously I didn’t see my son for four days. Such an odd feeling. I mean not expecting to have the baby so early and then I wasn’t a mother. I was just some useless person lying there. I did have some physio on the fourth day when they finally got me to sit up and I felt really sick [small laugh]. But I couldn’t walk anywhere because I was so wired up to the machines, so I could go about a metre and then I couldn’t move any further. Just the lack of dignity was tremendous. You know, people having to wash you everywhere and I could feed myself eventually, which is good. But they kept saying, you know, you’ll look forward to seeing your son. And I thought what son? What do you mean? Didn’t really mean a lot to me.
 

Betty stayed in a High Dependency Unit for a while but, for various reasons, moved to private-insurance medical care.

Betty stayed in a High Dependency Unit for a while but, for various reasons, moved to private-insurance medical care.

Age at interview: 38
Sex: Female
Age at diagnosis: 37
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So, I was in the High Dependency Unit and two things I remember – one, is that I was always thirsty and it was a full ward and I… there was only one jug of water and you have to request the nurse to fill up your glass. Because it was so busy and I knew… I just wanted water, it wasn’t that big a deal.

I felt bad asking… you know pressing the button every time. And so there were points when I, you know, my throat was completely parched but I just didn’t want to be a nuisance. But you know if there was a jug next to me I could have helped myself. But it did make me think, 'Oh I couldn’t understand why there are all these reports about old people's homes and older people getting to a point where they're so dehydrated that they fall ill or they die,' because you know no-one wants to be that nuisance and they were very, very busy nurses. You know I don’t want to discredit them in any way because they were doing a fine job. And then the second thing I remember was the fact that I've always had sinus problems and I don’t know whether that was the cause, but every time I started to drift off to sleep naturally, all the alarms would go off on my monitor to say that my breathing had slowed down to a dangerous point. And so that would wake me up; the nurses would come round and again I felt like a nuisance because it's just my sinuses being bad. And so I remember not sleeping at all after surgery. Well, I didn’t sleep for a couple of hours and then I woke up and the ward seemed to be a lot emptier, so people must have been discharged whilst I was asleep. There was one new lady next to me and I could hear the entire conversation between her and her family; they were describing her birth – it sounded horrific. I remember writing a handover note to work. So I gave birth at 3.58am and I was writing a handover note at six something, and I thought, 'I'd better do this before I forget; before I forget what I've been working on and all my passwords.' And then I was just lying there I guess waiting for my husband to turn up because they can't stay. The nurses were great. Later on they said they could put me in a side room if I needed to sleep because we explained how I wasn’t being… I wasn’t able to. But then I was worried if I was away from the main ward it would be even harder to get water and it would be even further for them to walk to switch off all my monitors when my sinuses got in the way.

And so my husband, because he has insurance, managed to get me into the private wing where things improved a lot.
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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