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Pre-eclampsia and high blood pressure in pregnancy

Recovery from pre-eclampsia after giving birth

Women we talked to recovered from pre-eclampsia or HELLP syndrome at different paces. For some, the signs and symptoms of pre-eclampsia stopped almost immediately after birth. Others found it took a few days or weeks, while some women found it took a few months. Their health was usually closely monitored with blood pressure readings and blood tests. Munirah’s blood pressure took about three months to return to the level it had been before her pregnancy. It took about a month for Helen X’s liver to return to normal after having HELLP syndrome. Kay found it was around four months before her kidneys recovered. 

Some women developed late-onset pre-eclampsia which complicated or delayed their recovery. Occasionally women had longer-term health concerns needing ongoing monitoring and treatment (see also the section on women’s future health). Sometimes there were other birth issues to cope with as well; such as stiches, bruising and scars.
 

After giving birth, Kate had some swelling for about two weeks and bruising which lasted six weeks.

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Age at interview: 35
Sex: Female
Age at diagnosis: 34
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How long did it take for the swelling to go down?

Well I had anti embolism stockings, very fetching, they were thigh high ones. I kept them on I think for four days, before I said, “Can I have some other ones, because these are really horrible.” So I got them changed. It took about, I suppose two weeks for it to go down completely, but the bruising took about six weeks, and I started getting bruising on the back of my legs as well, which was shocking and my GP said, If it starts to go purple then you need to let me know.” And I thought, oh what shade of purple are you talking about, you know.
 

Amy continued taking medicines to lower her blood pressure after giving birth. The dosage was lowered as her blood pressure returned to normal.

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Age at interview: 34
Sex: Female
Age at diagnosis: 31
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And the dosage got smaller and smaller each time until I came off it completely. I didn’t understand, actually, that I needed to do that. I thought, honestly, that I’d have the baby and then could leave all the tablets behind me and things like that but I didn’t realise that there was a risk that if you just stopped them completely your blood pressure would go up again and that was a bit difficult because when you get up in the night and your blood pressure is a bit lower.

And then you maybe reach down for the baby in the moses basket, your head, you know, you kind of see stars and things like that but it was a bit of a necessary evil really. So with some consultation from the doctor, they kind of adjusted the dose and weaned me slightly quicker maybe so.

Okay

I think it was six to eight weeks.
Although women were often very pleased to be discharged from hospital, it wasn’t always easy to recover at home. Women often found it exhausting to look after their new babies at home as well as recovering themselves. But it was also exhausting travelling into hospital regularly if their baby was in a neonatal unit like SCBU (Special Care Baby Unit) or NICU (Neonatal Intensive Care Unit). Samantha X and her husband decided that he should save his paternity leave for when their baby came out of hospital, which meant she “was at home on my own during the day” and had to get taxis to visit her baby in hospital.
 

Stephen took some time off to look after his wife, Mairi, and their new baby. He had to go back to work whilst Mairi was recovering from a caesarean section.

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Age at interview: 41
Sex: Male
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And the biggest challenge we had was the section rather than anything else because obviously then that limits what you can do. So, I had two weeks off work, paternity and everything, so that got us to a point but you still need more mobility than you had in terms of being able to drive the car and everything.

But then Mairi walked down to the doctors from our old flat; down to the doctors – in the snow because it was like the worst winter that we've ever had – and pushing the pram to see about when she might be allowed… and he said, "You’ve walked like a mile and a half down here pushing a pram; drive next time" you know. It was an empirical test for whether you're capable of that, and that'll do you sort of thing. So… you know and then things started to ease off a little bit and… but yeah it was good though.
 

Nicola had mixed emotions when she returned home. Her husband was back to work but her mum was able to offer lots of support.

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Age at interview: 33
Sex: Female
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So you must have been in hospital two weeks then – 

Two and a half weeks.

Two and a half. How did it feel then walking in through your front door?

Well, when I left the hospital I cried. I was incredibly, incredibly nervous. Just - I was actually very scared. Because I'd been there so long I'd become sort of institutionalised, really. And yeah, and then wonderful to be home – but it, I had felt very secure there, and I’d been there so long everyone knew my name, and you know, all of that. All the nurse, midwives would come in, "Oh hi, how's [baby] doing this morning?" You know. So yeah, mixed emotions. I think, you know, a lot of my friends couldn't wait to get out, because they'd hardly been there and were through the front door and it was all - I was actually very - and because of all the fuss, you know, the problems beforehand, and also with her afterwards, when she was unwell, my husband only had three days paternity leave, so that had gone, so we had – well, he had half a day at home and then had to go back to work, so that was all a bit of a stress. I mean, I have a super-granny, my mum. So that was, she stepped in. But it wasn't how we had - and I'm a real planner, I’m a - so it wasn't how we had planned it. You know, we imagined that we'd have a few days at home on our own, and then my mother would come, and you know, that kind of thing, so.
Checks and monitoring health

After being discharged, women continued to have extra checks to see if there were any issues related to their having had pre-eclampsia or HELLP syndrome. These checks were in addition to or sometimes combined with the six week postnatal check. Samantha X remembered having a midwife come to check her blood pressure daily for a week and then she had monthly checks by her GP for three months until “they were happy that my blood pressure was pretty stable”.

The checks usually involved taking the woman’s blood pressure, and some also had blood tests to check their kidney and liver function. For women who had had a stressful experience during pregnancy and the birth, these checks could be upsetting. Angela became very anxious whenever “the cuff went on” to measure her blood pressure and said this was “when I started to come apart slowly”.

Health checks were done either by the woman’s GP, at the time of home visits or back at the hospital. Some women whose babies were still in hospital preferred to have their checks there. Claire found it helpful seeing a midwife at hospital as she was there everyday visiting her baby in SCBU anyway. It meant that her postnatal checks “didn’t interrupt my time with my baby”. Paige hadn’t wanted home visits because “it meant waiting round for them [midwives] before I could go and see the baby”. However, getting to the GP surgery or the hospital could be tricky for women who had had caesarean sections as this meant they usually couldn’t drive for six weeks or so.
 

Kay had her health checks done at the hospital when she was visiting her baby.

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Age at interview: 42
Sex: Female
Age at diagnosis: 38
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After I was discharged from hospital I was in there every day seeing Imogen. And because it was a small maternity hospital it was just the bottom level was your pre-natal appointments and a triage system.

And I had to go in there every day and get checked. So, they would check my blood pressure, they would check my urine, they checked my stitches, they took the stitches out and I continued to go, oh weeks, weeks after because I was still on… I was still on blood pressure tablets at that point as well. So I was under their care basically the whole time Imogen was in hospital. And then when I came out I was in the care of my GP.
 

Helen X had blood tests to check her liver was recovering in the weeks after she gave birth.

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Age at interview: 31
Sex: Female
Age at diagnosis: 31
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The liver just for some reason I guess stopped working and processing and so build up of junk in there I guess, and so just taking time to get all those levels back down. That is as good as my understanding is, because no one really said anything more, other than, your liver functions off. That was about much detail as the liver got.

I mean how do, how are they measuring its recovery?

Blood tests. 

Okay.

Yes.

And how regular are those?

They’re not any more. The first four weeks after I was going twice a week initially to have my bloods done and then it dropped sort of down to once a week and then once it hit normal levels, they were like, “Okay, you’re fine now. Off you go.”
 

Munirah’s son was stillborn and she had home visits to check her blood pressure when she was discharged. However, the first midwife she saw was clearly unaware that her baby had not survived.

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Age at interview: 27
Sex: Female
Age at diagnosis: 27
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They wanted it to be managed by my local maternity unit, so they got in touch with my local maternity unit and they tried to arrange this discharge, and they were like, "We'll get the midwife to come and see you." Generally I think it…the discharge was quite smooth but the only problem was, because it was a Sunday evening and they have to give me lots of medication, and try and get the pharmacist available and then get me all the medication that they needed, because there was blood pressure medication in there. There was something for clotting as well, so injections and they were like, "Oh you need to give yourself-, and like you need to give them to yourself," and I thought, 'I can't put injections in myself,' so then they had to find someone to find… who could explain to my husband how he needed to give me the injections and things like that. Then they said to me, you know, "It's up to you but you can kind of check your blood pressure at home," and actually my blood pressure monitor's actually in the corner there. And they were like, "The midwife will come and see you and if she doesn’t, you need to ring this number," and to be fair the midwife came when they said she would come. And we had a really lovely midwife for the first week, and she was really, really kind and helpful and stuff. The next week she was off, I think she'd taken some annual leave or whatever, and a midwife came and she clearly hadn’t read my notes because she walked in and she said, "Congratulations." And we didn’t say anything to her; we didn’t say, you know, "Why are you saying…?" We didn’t confront her about it or anything like this, and then I kind of said, "I'm just having my blood pressure checked because I had pre-eclampsia and we lost our baby," and she didn’t acknowledge that she said it either. We just kind of tried to ignore it as much as we could. And she checked my blood pressure and she came back for a couple of days, and then someone else came to check up on me and my blood pressure at that point had… it was about two weeks after, had gone back to normal but I was still on the medication, and they said, "Go back to your GP after you’ve finished your medication for a month and then your GP can decide." And at that point, after about two weeks, after that then I went to see my GP and my GP was happy with my blood pressure and stuff and said, "I've got no concerns," so you know she was quite happy to take me off the medication. 
Taking medicines and self-monitoring blood pressure at home

Some women had taken medicines to lower their blood pressure when pregnant or during labour and birth, and these medicines were often continued. Others were started on medicines after birth. Aileen had pre-existing high blood pressure and went back to the medicine she had been taking before her pregnancy. This helped her blood pressure settle but it meant she couldn’t breastfeed whilst taking it. Angela took blood pressure tablets for six months before being told by her doctor that it was okay to stop.

For women taking medicines, the dose was usually decreased gradually as their health returned to their normal and stopped when it was no longer needed. Emma’s blood pressure medicines were “taken down very slowly so I had to keep going backwards and forwards from the doctor” for about a month. Kay was initially told she would be on blood pressure tablets long-term, but found things seemed to settle back to normal after a few months. Samantha X stopped her taking blood pressure medicines about three months after giving birth.
 

Paige found that taking two types of medicines to lower her blood pressure worked best, which she continued after being discharged.

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Age at interview: 20
Sex: Female
Age at diagnosis: 19
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Afterwards I was on two lots of medicine – labetalol and nifedipine. While I was still in hospital…I was in hospital for nine…well like nine days after having her because they just couldn’t control my blood pressure. One minute they're like, "Yes we've got it sorted," and then all of a sudden it was, "No, it's right back up to a hundred and sixty and it needs to be…" I was bed-bound, so eventually they found the two, although apparently they're quite similar; they had to be taken together, so I was on very high dosage of them.  When I went to the pharmacy to go and pick them up the guy; the pharmacist actually come over to me and said, "Why are you on tablets this high; we don’t give these to people unless they're really…they're much older?" Once I'd explained to him I had pre-eclampsia he said, "Right that’s fine." So I was on them, I think for about six months and I was slowly being weaned off them. I was on the highest dosage for eight weeks and then slowly they were dropping the one; keeping the one the same and I had to have weekly appointments with my GP just to make sure. When I first got discharged from hospital, for a week afterwards I was having daily blood pressure monitoring up there just to make sure it was… they had controlled it and it wasn’t still laying there.
 

Angela was re-admitted for problems with her blood pressure and headaches. She started on a different medicine to lower her blood pressure.

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Age at interview: 36
Sex: Female
Age at diagnosis: 34
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Yeah, so there was a whole… we had, a month afterwards I think where I was home for two days, and then one night I had a banging headache all night, and I thought maybe it's the hormones or not. And I had a blood pressure monitor at home; again something that was not a good thing; and I took my blood pressure one morning; that morning and it was really high – it was a hundred and eighty over something. I remember my dear friend, this midwife, and she was like, "Take your tablets, give it an hour." OK. Take it again, it was still high and I just didn’t feel right. So, it was a Saturday again, so she took me down the hospital where this time it was much more busy and I… it was different to say the week before when I'd been there having the baby; it was different; different staff.  I was really panicking about these blood pressure and that was obviously bringing it up again.  Because what had happened actually, sorry, in hospital is a registrar had come up to me a few days in talking about my blood pressure, and she said to me that pre-eclampsia can sometimes stay or come back after four or five days after delivery. But said something that always stuck, and she said, up to six weeks after. Now, that was it, it was stuck in my head. I virtually counted down that six weeks in my head, and it might have just… I don’t even know to this day even if it's true or not, but it…I was constantly anxious, panicking thinking I was going to die; didn’t want to leave her. It really… really weird like questioning what my mortality all the time.  I ended up in hospital; they started me on Ramipril this time, and that’s when they said, "But if you have ramipril you can't breastfeed at all," because at that time I was then expressing because I couldn’t breastfeed so there was no breast milk at all. And there was the consultant that turned up the Monday really cross with someone's decision for doing that. But that point I didn’t mind. It was kind of like breastfeeding was one element in everything that we didn’t need, and my husband was quite… you know let's get rid of this breastfeeding – bottles, let's stick with this because this is an added element that we need to get rid of, so we got rid of breastfeeding, bang, out the way.
The number and frequency of medicines could be overwhelming. Kate remembered feeling like “a pill factory”, with medicines to lower her blood pressure, for pain-relief and antibiotics for a possible infection. She also had to give herself anticoagulant injections daily for six weeks, to reduce the chances of a blood clot. 

A few women, like Munirah, also started monitoring their own blood pressure at home after giving birth for a few weeks: “just to check and it had actually been quite consistent […] it was after about six weeks, we were quite happy with where the blood pressure was so we were like ‘we don’t really need to monitor it anymore’”. Women taking part in the BuMP research study were asked to continue self-monitoring for six weeks after having their babies.
 

Sally found it reassuring that she could self-monitor at home after giving birth.

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Age at interview: 38
Sex: Female
Age at diagnosis: 38
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It was almost the self-assurance as well to be able to do it and know, keep an eye on myself while I was at home because you, especially when you when you stay, I stayed in hospital for four or five days and you’re so tested so rigorously there, suddenly you come out and you’re doing your own medication yourself and it was just another self-assurance really to. See that your blood pressure is doing okay.

Yeah. Yeah.

Because I know, on the last day of being in hospital, I was meant to go home and they, suddenly my blood pressure shot up again and it was just, they don’t know why.

Okay.

But then that did drop back down but it was just the, almost again, just to check it yourself.
However, taking medicines could become yet another task added to an already long list of things women were trying to do. Kate remembered “being given a timetable of what was going to happen to me each day and each night and I remember saying to the nurse, “When am I supposed to sleep?” Because not only was I obviously feeding my baby, changing my baby, trying to play with my baby [but also] trying to eat some food [and] trying to get some exercise”. Emma made a chart with tick boxes to help her remember to take her medicines throughout the day. Claire set reminders on her phone.

Sometimes women forgot to take their medicines on time. Some said they didn’t feel so worried after their baby had been born and were less committed to taking medicines. Women who self-monitored their blood pressure often said it was reassuring to keep a close eye on their health. It wasn’t for everyone though – Paige thought about buying a home blood pressure monitor when she was discharged from hospital but ultimately decided against it “for my own sanity” as she thought using it might panic her.

Longer-term recovery

Most women we spoke to found their physical health returned to normal eventually, but some found there were longer-term health impacts and concerns. Some women also told us about lasting emotional impacts from their illness. Some women who were hoping to have more children in the future were also worried about the chances of developing pre-eclampsia in future pregnancies.
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