Pre-eclampsia and high blood pressure in pregnancy
Emergency experiences with pre-eclampsia
Not everyone we interviewed had emergency experiences. It was often possible to manage pre-eclampsia with medication, and the condition did not become more dangerous. However, some women we spoke to had medical emergencies that medication couldn’t resolve.
For those who had pre-eclampsia and HELLP syndrome, the women were at risk of seizures, strokes, placental abruption (a life-threatening condition for mother and baby where the placenta comes away from the wall of the womb), liver problems and heart failure. Their unborn babies were also at risk of serious health problems or death as a result of being starved of oxygen. This sadly happened to Munirah’s baby, who had severe brain bleeding when she developed pre-eclampsia. She was advised by doctors to terminate her pregnancy at 25 weeks.
Some women needed emergency caesarean sections when complications developed during their pregnancy or labour. Doctors often had to make the decision very quickly. Some women who had stayed in hospital for a while had been warned it could happen at some point; for others, it came as a shock. Some also experienced complications with anaesthetics and heavy bleeding. A few women continued to have or had late-onset of pre-eclampsia after giving birth which could become an emergency.
Josie said that there was no real choice about what happened next, other than to have an emergency caesarean section. It became clearer afterwards that she had been in more danger than she realised.
Josie said that there was no real choice about what happened next, other than to have an emergency caesarean section. It became clearer afterwards that she had been in more danger than she realised.
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.
Women often spoke about a sudden realisation that things were getting more serious. Lyndsey remembered a “real ‘Oh my God’ moment” and Claire talked about a point when everything “kicked off”. A high blood pressure reading or other test results could signal that a medical emergency was unfolding. This included test results showing liver and kidney problems, that the unborn baby’s heartbeat was dropping (sometimes called fetal distress) and/or low platelet levels in the blood. If these results were picked up at a routine GP or midwife appointment, pregnant women were often sent to hospital for closer monitoring and sometimes treatment. You can read more about these experiences in the section, ‘Realising there is a high blood pressure problem in pregnancy’.
After being induced, Claire was monitored overnight. When her health deteriorated and after a scare with her baby’s heartbeat slowing down, it was agreed that a caesarean section would be best.
After being induced, Claire was monitored overnight. When her health deteriorated and after a scare with her baby’s heartbeat slowing down, it was agreed that a caesarean section would be best.
Onto the ward. And that was…I think it was between half an hour and fifteen minutes obs, so again it wasn’t a restful period. Overnight there was a deceleration where the baby's heartbeat was lost. That was sort of middle of the night, early morning.
So again that was that. The midwife was there thankfully, it wasn’t you know all the alarms going off; the alarms did go off a few times but the midwife was actually there and that was a red button hit and everyone came running, and placed on oxygen, rolled over onto my side, and the baby's heart rate came back, but by then I knew, 'Right, something really isn't, isn't right.' I was probably more aware then that things were getting serious.
That there was perhaps now going to be risks. I hadn’t felt her move as often but again I'd assumed that that was perhaps the stresses of what I was going through, that I maybe wasn’t feeling it because I wasn’t concentrating. So that kind of went on. But they decided to continue with the induction, which again at that point, was the best thing.
And that then changed in the evening. They had come round with soup and a sandwich about 6pm, and I thought, 'OK I've not eaten but I'll try soup; I know I need to for my strength and if you want me to deliver this baby I'm going to have to try and build my strength up and that." I managed one spoonful of soup and projectile vomited everywhere which is embarrassing for me because I had no… you know it just happened. And then it wasn’t till… you know I kind of looked and I thought, 'It's black and it's like lumpy and, you know what's going on?' So, I was still hooked up to the CTG machine as well, it was like, oh you know, I can't get up to clean it, and the midwife came and it was a case, "OK we'll get you cleaned up," and stuff; didn’t seem overly concerned at that point.
Until it happened again and it was a different midwife who then went and spoke to the consultant there, and I believe that’s when he came and checked and said there was fluid on the lungs. My tests, my blood tests still weren't showing everything, that I had sepsis and they started the Sepsis Six treatment.
So that was more medications and things.Kay’s kidneys stopped functioning properly. She thought this caused her to feel over-heated. Doctors and nurses told her that she was very ill, but she didn’t believe it at first.
Kay’s kidneys stopped functioning properly. She thought this caused her to feel over-heated. Doctors and nurses told her that she was very ill, but she didn’t believe it at first.
I thought, I just thought I was going to be sick; I was going to pass out and the end of it I fainted.
Oh gosh
And they came and got me and they rushed me down to intensive care. And I don’t really remember much about it. I know that… I remember being whisked on a trolley through the corridors and I knew that I was down the stairs in the obstetrician unit, and I knew everybody was fussing around me.
And they had that monitor on constantly – you know blowing automatically, blowing it up, checking it had blown up and checking it, and it was something 200 odd over… and I was just like, "Do you know I didn’t know you could go that high." You know what I just wasn’t aware of it. Anyway everything seemed to calm down, and the next day I was back up on the ward, and I felt, 'Whoa that was just a wee blip.'
But they moved me from that day, they removed me to my private room right opposite the nurse's station, and I was like, "Why am I in here?" and they're like, "Because you are the illest woman in here," and still that message didn’t get through. I know I'd felt a bit hot; I know I'd… but I didn’t feel ill. During labour, the heartrate of Julie’s unborn baby dropped very low. The next steps of a caesarean section happened very quickly.
During labour, the heartrate of Julie’s unborn baby dropped very low. The next steps of a caesarean section happened very quickly.
Aileen was in and out of the High Dependency Unit whilst pregnant. Her blood pressure kept climbing and, when she reached 30 weeks, the decision was made that her baby should be delivered.
Aileen was in and out of the High Dependency Unit whilst pregnant. Her blood pressure kept climbing and, when she reached 30 weeks, the decision was made that her baby should be delivered.
But then blood pressure got controlled, went back to the ward , and then a couple of days later I had to go back down to HDU and yeah.
And the consultant came and said, "Now that you’ve reached 30 weeks I think this is the best time to get the baby out; we can't control the blood pressure anymore. And we've reached 30 weeks, so we'll just do it." Mm and of course the baby's stopped growing as well.
OK
Well the growth is slow, and I thought maybe that… OK fine, if the baby's in danger inside me. And we had… because they were continuing with my CTG.
The heart rate dropped several times so they were concerned about that as well.
It could be very frightening to realise how serious the situation now was. As Tracey explained: “Your life is in someone else's hands and there's nothing you can do about it”. Women often felt a sense of panic amongst the doctors, midwives and nurses too – which added to their fear. But some women were impressed by how calm and efficient their doctors, nurses and midwives had been. Aileen liked having “continuous care” from a midwife in HDU who knew her medical history well so that she didn’t have to keep explaining it. Having lots of medical staff coming into the room could be overwhelming. Tracey recalled “swarms of people appeared from nowhere”, and they didn’t offer her much reassurance.
When there were delays with fitting an epidural (spinal anaesthetic), Mairi realised that the situation was time-pressured. Even so, she appreciated the efforts of everyone in the theatre to keep the atmosphere calm.
When there were delays with fitting an epidural (spinal anaesthetic), Mairi realised that the situation was time-pressured. Even so, she appreciated the efforts of everyone in the theatre to keep the atmosphere calm.
There were lots of people in the operating theatre when Helen X had an emergency caesarean section. One of her doctors sent an emergency page out saying she was bleeding, even though she wasn’t, to be sure it was treated urgently.
There were lots of people in the operating theatre when Helen X had an emergency caesarean section. One of her doctors sent an emergency page out saying she was bleeding, even though she wasn’t, to be sure it was treated urgently.
Staying informed during emergencies
Most women said that, even during the medical emergency, they were kept informed about the unfolding situation. But there were gaps for women who lost consciousness. Kay passed out but remembered being wheeled into surgery: “the next thing I know, the ceiling was moving”.
The information given during emergencies could be quite brief. Aileen thought she wasn’t given much information because she is a neonatal nurse and so her doctors and midwives may have assumed she already understood what would happen after her baby was born. Julie thought there should be more information about emergency caesarean sections given at antenatal appointments and in classes so that women know more about what to expect.
Others said they were given a lot of helpful information when their situation became an emergency. For women who had known in advance that they may need an emergency caesarean section, there had usually been opportunities to meet a neonatologist or paediatrician to discuss their baby’s health. A couple of people were also able to have a look around a neonatal unit. But for some, lots of information at once could be overwhelming and hard to take in. Michael thought there was “possibly a bit of information overload [… as well as a] procession of one doctor after another”. Being upset and frightened could make it harder to process the information.
Some women remembered having to sign consent forms before their emergency caesarean sections. Samantha X had felt mostly calm until the anaesthetist explained the risks and “all of a sudden you’re having lots of forms shoved at you to sign”. Tracey felt it was “a real smack in the face” having to sign forms about organ donation because it highlights “how serious it is and poorly you are”. Some people would have preferred the communication during their emergency situation to be more sensitive. Tracey remembered her doctor say that her unborn baby was “killing” her, and Kay was told she needed an emergency caesarean section “or you die”.
Knowing that an emergency caesarean section was very likely, Samantha X and her husband had the chance to talk with a paediatrician beforehand. She found this really helpful for explaining how her baby was going to be looked after when born.
Knowing that an emergency caesarean section was very likely, Samantha X and her husband had the chance to talk with a paediatrician beforehand. She found this really helpful for explaining how her baby was going to be looked after when born.
Betty had to sign forms consenting to her caesarean section, but she also felt there were no alternatives and that she was not in the best frame of mind to process information.
Betty had to sign forms consenting to her caesarean section, but she also felt there were no alternatives and that she was not in the best frame of mind to process information.
Well I don’t think there were any options. It was get baby out as soon as possible. They were trying to gauge the approach to take to get baby out. We weren’t given the option not to do it, only forms to consent to doing what needed to be done.
So I didn’t think there were any options but I can't imagine myself ever saying, "No, don’t do that," because obviously the risk is that the baby's going to die.
And what was the role of your husband in all this? So, it must be a very challenging situation?
Yes, yes. He did ask about the blood pressure; what should it be. He kept a very close eye on it. He would answer a lot of the questions on my behalf and I'd correct him [laughs]. He didn’t actually look at the consent papers I don’t think, that was given to me which is right but equally I don’t think I was really in the right position to sort of digest it properly, but at the same time what options what are there? They can't… my husband shouldn’t be reading and signing on my behalf, and unless I didn’t want to go ahead with it there was little option other than to sign it.
Often the decision to perform a caesarean section was made very quickly. Betty described a “race against time”. Ruth X remembered that “everything was so unscheduled and unplanned and uncontrolled” with the emergency caesarean section in her first pregnancy; for this reason, she opted for a scheduled (planned) caesarean section the next time.
Women who had emergency caesarean sections were often surprised how quickly the operation happened. Ruth X said it happened “very, very quickly”. You can read more on the site about the women’s experiences of birth, including both emergency- and planned- caesarean sections.
An emergency situation could develop quickly and suddenly, but there could also be delays and waiting involved. Kate thought she and her doctors had different ideas about how urgent her situation was – she was in a lot of pain but felt her consultant was slow in responding. For some women, their doctors were waiting on test results before taking a particular course of action. Other delays included having to wait for an operating theatre to become available or needing to postpone until a blood thinning medicine had worn off. However, waiting could be dangerous and doctors had to balance these different risks in deciding what to do next.
It was only after her second caesarean section which was planned that Mairi realised how quick her emergency caesarean section was.
It was only after her second caesarean section which was planned that Mairi realised how quick her emergency caesarean section was.
Mm. And how did it feel that sort of quickness? So, it seems like…
I thought that was normal.
Things…OK
That was just normal to me, and actually when they… they were taking ages with [second son’s name]. I was like, "God, is everything alright?" but I realised that that was normal, and the speed at which they did the first one wasn’t normal. And again I have no idea what the time was; maybe it wasn’t that fast but I do remember thinking, 'My god like…' again because you don’t feel anything, it's a bit surreal, and I remember them like, "Oh, it's a boy," and I was like, "Oh my God." So and it's only in comparison to the second one to realise how quick that first one was.Josie thought there was a balance of risks in the run-up to her caesarean section. She had recently had an injection to prevent clotting, which meant delaying the operation.
Josie thought there was a balance of risks in the run-up to her caesarean section. She had recently had an injection to prevent clotting, which meant delaying the operation.
I think that again, you know I just wonder about those decisions that were made at the time about [son’s name] welfare and my welfare, and whether they were having to… having to balance somehow the fact that I was needing this blood clotting thing to work. Had they given me blood clotting… probably I can't remember, I don’t know. That they were, you know just waiting for my blood count to rise was it? My blood count to rise, something, I can't… again I can't remember the technical aspects of it. And that was what was actually holding it up in the end. So, I was having, you know consent forms put at me; I had something in my arm here and something in my arm… you know it was literally… it was so much happening and I was on my own – it was… you know I'd had a lot of friends and family visiting all the time but here I was just on my own surrounded by a lot of doctors, a lot of nurses, a lot of midwives.
Sometimes emergency situations resolved quite quickly; other times, it took a while for the situation to gradually improve after treatment or another medical intervention. After giving birth some women were in recovery and they had postnatal care in hospital, before preparing to go home. There could also be impacts on the health of women and their babies. All of these aspects could be affected by having had an emergency medical situation related to pre-eclampsia.
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.
For some women, it wasn’t until after the emergency situation was over that the fear and worry really kicked in. They reflected on the experience afterwards and realised just how dangerous it was. Some women had met with medical professionals in the weeks, months or even years after having pre-eclampsia. They often said these debriefing meetings had an emotional impact in terms of trying to make sense of what had happened.
Some women wondered whether the emergency could have been prevented. For example, Claire had been discharged 10 days before she was rushed back into hospital and thought perhaps keeping her in could have avoided it becoming “such an emergency at the end”. Julie wondered whether it would have made a difference if she had been induced the day before rather than when it had escalated “to the point where it was horrendous”. At the same time though, she felt grateful that she and her baby were ultimately okay: “if they hadn’t have acted very quickly I think it would have been a very different outcome. Very different”.
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