Angela

Age at interview: 36

Age at diagnosis: 34

Brief Outline:

I had high blood pressure at the end of the third trimester of my pregnancy. I went into labour and vaginally delivered my baby at 9 months (40 weeks). My pre-eclampsia was labour-induced and started when I was 7cm dilated.

Background:

My name is Angela, I am 36 and a nurse. I am married and have one daughter. I identify as White British.

More about me...

The start of a high blood pressure problem

Most of my first pregnancy went well, despite some morning sickness and feeling quite tired. However, about a month before my due date, I had a GP check-up and it was found that I had high blood pressure. My GP said I should contact the hospital. However, when I phoned them, they said that my blood pressure was not that high and so there was no need for me to come in. At a later antenatal appointment, my blood pressure was taken again and the results caused concern. I was sent to the labour ward to have a series of blood pressure measurements taken, all of which came back as fairly normal. I was discharged home and asked to return in a few days for more testing. I was also told about a research study for self-monitoring blood pressure during pregnancy, which I decided to take part in. For the next few weeks, my blood pressure stayed mostly the same. I had some swelling on my hands but not my ankles.

Labour and giving birth

The night before I was going to be induced on my due date, my waters broke. I went to my local hospital who have a policy to see a pregnant women once her waters have broken. I was examined and my cervix was 2cm dilated, so I was sent home and told to come back the next day. However, my contractions were so strong and frequent that they made me be physically sick. I went back to the hospital where they examined me again and found I was now 7cm dilated. I was relieved to get an epidural to help with the pain. However, my pre-eclampsia then kicked in. As my labour progressed, the midwife and my husband noticed that my face had become more swollen. A sample of my urine was tested and this showed a high level of protein. I was given medicine to lower my blood pressure, which helped, and I vaginally delivered my baby girl. 

After the birth

A few hours after giving birth to Amelia, I noticed some unexpected bleeding. It wasn’t pleasant but a doctor had to manually remove a clot from my uterus, which at least meant I didn’t have to go into theatre for surgery.

The next day, my blood pressure shot up and I felt breathless. I stayed in hospital for an extra five days so my blood pressure could be checked and I was given more medicines. It was a very worrying time and it was difficult to balance getting better myself with looking after my newborn. Once I had been discharged from hospital, I kept taking my blood pressure tablets. This was mostly fine, until one day when I had a severe headache and a high blood pressure reading. The results didn’t settle after taking my tablets and so I had to go back to hospital. I started on a different high blood pressure tablet (ramipril) which meant I couldn’t breastfeed my baby anymore. I didn’t like having to take medicines for my high blood pressure and I stopped them as soon as I got the all-clear from my doctor that my blood pressure was back to a ‘normal’ level.

The emotional effects

My experience had a big emotional impact on me. It left me feeling constantly worried and I had panic attacks, sometimes about other health issues. For example, I had a pain in my thigh which I thought could be a blood clot, though this was ruled out with tests by my doctors. I think my anxiety and high blood pressure became a cycle, reinforcing one another. My GP prescribed me with anxiety medicine and this helped me to feel calmer over time. I also paid privately for counselling and had some good support from friends as well as through an online ‘traumatic birth’ group. My husband and I are unsure if we want to try for another baby. For me, there’s the fear factor that I might have high blood pressure problems again. I know that a subsequent pregnancy would be closely monitored but I would want a guarantee of a booked-in caesarean to avoid the birth getting out of control again.

Areas for improvement

I feel I have been left with many unanswered questions. For example, why did I start to develop high blood pressure and why was I able to have a vaginal delivery when other women with pre-eclampsia need emergency c-sections? I met with a midwife at my hospital at a later date to go through my medical notes, but this added little insight into why it happened. I think the immensity of pregnancy and having a baby is often under-estimated, but this is probably because the reality of pregnancy and birth might scare and put off some women. I feel strongly that consistent care from doctors, midwives and nurses is important – it would be good for each pregnant woman to have a named midwife throughout. I think everybody should receive good quality and free pre-natal information, especially given that many people can’t afford to pay for classes if their local free ones are fully booked.

Angela thought the public perception underestimated the risks of pregnancy and the reality of having a baby, perhaps to avoid frightening those who are currently pregnant or plan to become pregnant.

I don’t know if it's from just public perception of having a baby, because I remember even before I'd be pregnant you hear, 'Well you're not …you know pregnant women, well they're not ill, they're not…' you know when people are like, 'Oh I'm pregnant and I've got this, that and the other,' that kind of thing.

But it's like I'm not, you know…but it actually is a big thing, it's huge, it's huge having a baby and people just under-estimate it massively, and I don’t, you know …yeah it's funny, it is big. And there's… I don’t know if there's still that…that kind of that school of thought, like not until you’ve had a baby you realise but then you don’t want to scare other mums off, so no-one really tells you the true picture of what's happening.

Because I remember me and my [national patient charity] group, we were like…I said, "Do you know I'm going write a book called The Truth, and really what it's like." And then as time passes you're like, 'No, I don’t want to scare my friend who's just about to go through all this.' I've got two pregnant friends now. That’s, you know they know what I went through and they know it's hard but they didn’t go through it so it's fine; they don’t know how I feel, but I wouldn’t scare… I'm not going to go through and scare somebody, so I think that’s where it all just gets watered down again.

Angela’s waters broke whilst she was at home and before labour had started. She went into hospital to be examined and had some tests taken. Soon after being discharged, her contractions began.

Anyway, 4am I woke up and my water's had broken. So, quickly woke my husband, and then the policy at our hospital is once your waters break you go down to be checked.

And, you know then we'll probably going back home kind of thing, but their policy is waters break, straight for a check-up. So, got up, showered, took everything with me as you do [laughs], the bag and everything. And was feeling a few cramps but nothing big, so I was thinking, 'OK, this is OK, this is alright.' So I got there about 6am in the morning; was checked and there was a lot of umming and aahing about how much the waters had broken. Because it had been in the bed they kept saying, "How much pads?" and all that, but I didn’t have pads in. I don’t know but it was a lot because I ran to the toilet and there was a lot, a lot of water and there was a lot coming out. So, I was convinced and then there was talk of high waters, low waters, all that kind of thing. 'Maybe it's just your low waters,' – I don’t know, you know it was all news to me these different waters. So I was just like OK. But to me they had properly broken. So, did all the tests – blood pressure; blood pressure was again always hanging at around a 150/90s – always about that. And I said to the woman, you know I've been monitored for high blood pressure, this is a… and they examined me and I was two centimetres. So, she said to me that they had a lot of inductions booked in that day and because I was booked in for the induction the next day, to go home and if nothing happens in the day, to come back tomorrow for your continuing… for your induction. 

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

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.

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

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.

Angela described how she felt in the weeks and months after having her baby.

I often want-, you know, I'm like was it postnatal depression, was it post-traumatic stress. I was always in the line of post-traumatic stress; it was an incident that happened. Quite a lot of the time I explained it like I just feel my head's here, my body's here, they're out of balance, they’ve gone like this.

And they each just line up again; like my body's doing something my mind's not letting it, you know it was kind of like that and we were… I was just so out of balance. And it just felt like the adrenaline tap was on all the time and it had been left on and I'm trying to turn it off. But I just felt like shhhh, so I just… I don’t know if it was the hormones, the drugs, the whole episode you know. 

Angela had panic attacks after giving birth and became very anxious that she might have other health problems.

Every time I heard… say if I heard my husband on the phone telling people, "Oh you know, this is what's happened," my heart was racing you know, and I used to say to him, "Can you not tell people, or in my earshot, and can we not talk about it to anyone today because I can't… I get panicky." So I was just was, yeah just constantly panicking; constantly worried I was short of breath to the point where I was having follow-ups at the hospital every day. 

They… again I think… I don’t know if it's because I'm a nurse or what, or I work for the same Trust, but they were brilliant. I virtually was seen… we'd go down and see this consultant in the medical management, like the AMU [Acute Medical Unit] kind of thing every day [laughs], and she would do a top to tail, and she was checking my stats and that and… but this is where like the hypochondria, I think kind of started kicking in, and I was convincing myself I had a PE [pulmonary embolism]; no, a DVT [deep vein thrombosis] I think first. Then I… or I thought I had a PE – one of them – to the point where I virtually ended up convincing this poor consultant that she ended up… the only way I could ever appease my mind was to go and have tests. So she… I went and had a scan, looks fine, no PE and everything, and there was nothing, they couldn’t find anything wrong with me. I was having… going to go for a 24 tape monitors because my heart rate was still high; it was still in the 90s, 100s. Blood pressure was OK on the tablets so it was fine, it wasn’t going up anywhere. But then sort of… so, I remember coming home and my mum going… cos she was brilliant; she would stay up, and she was like…"So, have you… so, you're fine there's no PE?" I said, "No, that’s good," and then I just sat there and thought… I had a pain in my thigh and I went, "Aah I've got a DVT." That was it. I was convinced I had a DVT. It kept moving and it was so scary because this isn't me, I'm a very rational person, very, you know just not like it. And it was real, it was so real that I was driving my husband round the bend; I was driving, I think, everyone round the bend. I just always thought something was wrong.

Doing the dreaded looking through Google making things then a whole lot worse; laying awake, panicking, worrying; worrying that I was unwell; never wanted to be far from the hospital in case I needed to go back in it. So in the end… and the consultant after that PE time did sit there and say, "Maybe there's something else going on here in your head," you know nicely, and she suggested I go and see the GP, which I said, funnily I have arranged.

Angela’s friend helped reassure her when she was struggling after the birth.

Yeah and I…and I remember my friend saying to me, "I need you to know, you know that…" and she goes, "I don’t want you to be hard on yourself because I know what your like." She was like, "But you can see what happened, you know this, that and the other, and this is, you know; don’t be hard on yourself, just…" and that’s what I needed and that’s why I needed like the counsellor and the therapist – she was brilliant. She was, you know just kept reassuring me. It was funny, as at the time I just wanted to be surrounded by women because they were just kind and just really like, "It's OK, it's hard, no-one will tell you how hard it is." It's kind of like until you’ve been through even having a baby that’s when you know. And yeah. So, you know a lot of people supporting and saying just, "Be easy on yourself, be kind; be kind to yourself." And I was… I'm such a strong person. I've got to be strong; I've got to be strong.

Angela knew that she might continue to have high blood pressure. She didn’t want this and was very reluctant about needing to take medicine long-term.

I just really didn’t want to take tablets. 

I don’t know if it's because I was in the profession, I don’t know, something was just in me that didn’t want to… I don’t know, it was really strange why I didn’t. And then at that point then I was on tablets which then I didn’t mind, but then it crept in again, you know eventually I was like… when people did say, you know there might be a chance that actually you might end up, you know there's a varied school of thought, you might end up with high blood pressure kind of forever, or this might just pass and, you know we don’t know… again we don’t really know why but some end up on blood pressure tablets for the rest of their life, and I was just like, 'I really hope it's not… I'm going to do my upmost… I don’t know why because what I think I can do… you know apart from, you know normal diet and all that, but I'm not going to be on blood pressure tablets.' 

Angela talked about some of the things she would want in place before trying to get pregnant again.

The way it's left at the moment is before we would even think about conceiving again I would meet with a consultant first, and I wouldn’t even risk… until I've got everything in paper now, like done, OK this is what will happen, this is what happens, this is what we'll do, this is the likelihood of this, that the other, and at the bottom in black and white, yes you can have a caesarean, then that’s… yeah so I'm at the moment I'd like more information but I know where to seek it and I'm just waiting for the time.

I think to appease my… I know a lot of this is in my mind. So, I think I would need to be quite closely monitored which I have been told I would be classed as high risk; you come under the obstetrician which I don’t mind... you know I don’t mind either way but I know I would be closely monitored, but I have in my head that I would want to be booked in for a caesarean beforehand because I… even though, you know I'm so happy that she was delivered naturally, I can't risk the going out of control again. 

It was all about this control element and I think it needs to be… I would need to be structured – regularly monitored and have a caesarean.

Angela had recently joined an online forum. While her midwife initially told her about a support group, it wasn’t the right time for her to engage then and she preferred one-to-one counselling.

And that’s just really nice where you just read each other's stories, and it just can be quite helpful, therapeutic to know. For a long time after you give birth and it doesn’t go to plan kind of thing and all this, you get quite envious of people who have normal births; quite like it's funny, it's …you don’t want to hear about them, you don’t want to hear about…their birth was fine, you know you're like you do a lot of 'Why me, why me?' You can be… yeah it's quite… it's quite funny. So, those groups were really good in the fact that there were other people out there who say exactly the same as you - 'Why me?' 'Aah de de de had this great birth.' You get a lot with people who say, "Oh you should be over it by now." This is what they say in these groups, and it's so nice that I don’t think that they don’t think that, each other doesn’t think that so it's OK. And they're very supportive.

There was… again when it was right in the early days I remember this midwife ringing and leaving this message saying, "Oh and just to let you know here's the details of this pre-eclampsia group; here's the phone number and that," and it was just like, [click] and that was it, I just… I didn’t have anything in me at that point; no-one… I felt like I had to fix myself. I was the one who had to go and seek medical help. I had to go and seek psychological help. I had to pay for it all, which is fine but I did… you know it was… and I was… yeah so I saw the counsellor about eight, a good eight months I think to the point where I wanted to come off the medication, the anti-depressants, everything, with her support and did it all kind of thing.

And finished it even though I do get days where I would love to still be seeing her. But I feel that she was there for that reason, and it's finished and I think you can't always drag everything on with you.

Angela was prescribed anxiety medication for her panic attacks. She thought an NHS counselling referral would be a long wait, so she arranged to see one privately.

So, after… it must have been after two/three weeks after delivery; it must be actually even two I went to our GP and she did a postnatal depression screen. And where I remember like ticking the… because there was no way I was going to harm her; if anything it was… I was… she was… I'd look after… you know she was the one thing that had to be looked after. It was the anxious ones I didn’t realise I was ticking until she looked at it and she said, "That scored really quite high, how about we try you on an anti-depressant, citalopram, for your anxiety?" So, I was like, "OK," and then I remember it was just ten milligrams she said we'll start slowly. And then on the… I took it the next day, and I was staying at my mums for a couple of days and it was horrific. The anxiety levels had gone pff right up to the point I was… you could pull me off the ceiling.

Very panicky; kept getting panic attacks; was turning to things on the internet, you know that you could do deep breathing, you know anything; things that would tell you it's fine, you're not going to die, this is what it is.

And it gradually, over the weeks, it slowly all started calming down. But in the meantime I'd had a lot of midwife support and health visitors and things, and they'd said, you know we can refer you to a counsellor but I just knew that would be weeks and weeks and weeks.

So, within a week or so I'd sourced it myself privately. I needed… all I wanted to do is feel better, and I just felt awful, absolutely awful.