Hanna

Age at interview: 39

Age at diagnosis: 37

Brief Outline:

Hanna was pregnant with her first child. She developed high blood pressure, and tests showed she had protein in her urine. She was kept in hospital for a couple of weeks before her baby was born by emergency caesarean section. Her baby was fine.

Background:

Hanna is married with two young children. She is Somalilander and works as an operations representative. Her daughter was born in 2012 and her son was born in 2013, both by caesarean section.

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Hanna was pregnant with her first child. As it was her first pregnancy, she feels that she did not pick up on the signs of developing high blood pressure at an early stage. When she went along for a regular check, at about 33 weeks gestation, her blood pressure was high. She was kept in hospital for further tests, which also revealed protein in her urine. She also had a pain in her right side, which doctors thought was related to her liver, but was not explained. So doctors decided she should remain in hospital.

After 10 days, doctors decided it was time to deliver the baby as she had developed pre-eclampsia. She was induced, but needed an emergency caesarean section. Her daughter was born, at 35 weeks gestation, and was small but healthy. However, Hanna’s blood pressure stayed high and she was in a lot of pain after the birth. On day 3 after birth, she started hallucinating. Doctors diagnosed a haematoma and put her on intravenous antibiotics.

Hanna was in hospital for almost a month. She was given a private room, and her husband was able to stay with her for a few days, which she found very helpful. But being in so much pain, and unable to get around the hospital very easily, meant that she felt very isolated from other new mothers.

After she was discharged, she was not offered any follow up from the hospital. She never did get an explanation of what was wrong with her liver. Her GP was very supportive and checked her blood pressure and blood results regularly in the first few weeks to check that there was no infection left.

Hanna has gone on to have a second baby. During her second pregnancy, she did not develop high blood pressure or pre-eclampsia. She did, however, have a caesarean section again, as her second baby had meconium in the waters.

Hanna was sent to hospital after a routine check showed high blood pressure.

She sent me from the, her department to another department so as I was walking to the other department, I called my mum and I said, “I’ll be home late I think.” So, “I’ll call you back when I’m out.” So I waited. I went to the other department. They sat me down in the reception area. They had my notes already and they said, “The doctor will come and see you.” And I thought, that’s weird to be seen a doctor. Normally, it’s the midwives you see and then as I was just sitting there reading a paper I remember my name was called, so I looked up and there was two doctors standing over me in the reception, small reception area and one was in his, I would say, in his late 50s, early 60s and one was a very young chap and they said, “Can you come with us?” So they took me to a cubicle and they strapped monitors on and they said, “How do you feel?” And I said, “I feel fine.” They looked at my feet and they said, again the midwife came in to the little cubicle and she took the blood pressure again and they said, “We’re not happy with your blood pressure so we’d like to keep you in for observation.” And I said to him, “For how long?” And he said, “We don’t know at this stage because we’ve taken your blood pressure, at many different intervals throughout, for over an hour when I was with the midwife in the other building so and it doesn’t seem to have come down in your resting position and you haven’t done anything strenuous in the last two hours so, therefore, we cant understand, we have also seen protein in your urine so we’d like to keep monitoring you.” And I said, “Fine.” So I, even then, I wasn’t panicking too much because I was thinking, they’ll do a check on me and then they’re going to let me go home tomorrow. I’ll be able to go home and just have a normal baby delivery on my due date.

Hanna was monitored overnight in hospital. She didn’t feel ill but was told by doctors that she was very unwell. She had an ultrasound to check on her baby.

So the next morning, that was the panic time. Throughout the night they were taking my blood pressure and, because I was so anxious to go home, I kept checking as well but wasn’t coming down, at that point. It was still doing, it didn’t cause me much panic and I slept really soundly that night but they kept waking me to check my blood pressure, to put the monitor on the baby, everything. It was the following morning, after breakfast, when the doctors were doing the rounds, I had a female consultant with her entourage of her students and she said, “We’re not happy.  How do you feel?” And I explained that I feel fine. “Have you had any pains whatsoever?’ And I did explain that I had a dull, aching pain and I’d had it for a while, at that point, over two months I would say and I said, told the midwife about that and the GP, just a dull pain on my right rib, just underneath the breast area, the rib cage, on the right hand side, had that for a while and I did tell her about that but, other than that, there is nothing. I felt well and she said, “Well, the way your blood pressure is, I am, we are rather surprised that you actually feel well and able to walk. So, therefore, we’d like to keep you in until your blood pressure returns to normal or we’ll have to do further tests as well before we can decide what the other options are.” And I said to her, “What other options?” She said, “We have to think about the baby and it’s not good for the baby for your blood pressure to be that high and for you to have that dull ache in your rib area, we’re going to do some more tests just to find out what the problem there is and send you for a scan, the baby as well, to make sure it’s developing fine.” So they sent me down to, the porter came, they took me to the scan area. It was fine. The baby was fine. 

Hanna wished her doctors and midwives had been better at keeping her informed. She didn’t think information about her situation was shared between the doctors, which meant she had to keep repeating her story.

I think they could have explained to me what was happening. The problem was, I felt they weren’t forthcoming with what was wrong and they weren’t, they didn’t, they might have diagnosed what was the problem, but they never told me. It was my body. It was happening to me. I should have known. They should have advised me of what was happening to me but they didn’t tell me and I felt the communication was lacking, with I felt they were a bit indifferent as well from their attitude. It was their attitude that troubled me the most. It was not the fact that they didn’t tell me, it was the attitude, very dismissive, very indifferent, “Oh we’ve seen it all before.” But I hadn’t seen it all before. Surely we are individuals. We are not, I felt like I was, it was like a conveyor belt.

What could they have done differently? 

A bit more, empathy is missing I think. That’s missing. There’s no empathy and there’s no frankness. I’d rather someone be frank with me as to what is happening and honest, that was missing. I felt like they weren’t being honest because if they were, they would tell you exactly what was happening. And you could decide. Other things they could have changed was allowing you to take part in the decisions. Answer the questions you ask and see the same doctor. You see a different doctor every morning, thinking, and who are you? And it got to the point where I had to repeat the same message that I told them yesterday, to the new one, to the new one, to the new one, you feel like you are repeating yourself, when they should have known how long, how many weeks that I was there. Is she, everybody should be singing from the same book and the same hymn sheet, you know. When you tell them, “Well, It should be surely in the notes.” “Oh, it’s not here but could you tell me anyway. I wasn’t here yesterday. So forget about that doctor, you tell me now.” “And who are you?” “I’m the new registrar.” Well, I don’t feel inclined to actually repeat myself again and someone who’s very, very I’m into detail. I was really disappointed I can see where the errors happen because a lot of the medical notes were missing, well nobody bothered to put the notes in or write it down and I found that really frustrating because I kept watch. 

Hanna wanted the expert advice of the consultant she saw when she was first admitted to hospital. It was also helpful to talk to her mum about the options available.

So that was on the 16th of February, when I went in to have my normal check. By the 26th, we’re talking about having, delivering the baby early because they didn’t like what was happening to my body. And then, the worst thing was, I was hearing from the young doctors and I didn’t see that female consultant ever again. That annoyed me a little bit because I felt I wasn’t I wasn’t important enough for her to come round again ever since that first visitation, that was it and I felt very annoyed. So on the 26th, I remember a young female doctor that came in to see me. I was not particularly nice to her. I said, “I want to see that consultant. Why is she not here, especially when she told me that we needed to deliver the baby early?” So I demanded to see the consultant and it wasn’t it wasn’t until the 27th, morning of the 27th, she came to see me and I said to her, “I want to hear it from you, what do you, is the best option?” And she said, “The way you are, yes, we need to have this baby delivered and options are either caesarean or we’ll induce you but we prefer the caesarean.” And I said, because of the hidden, I’ve heard about people having caesarean and always people that I know of, like relatives and they’ve never had a good experience with it.

So, when I told my mum, she advised me against it and she said, “Go for natural birth. They’re there, the medical experts to help you and you, they wouldn’t give you those two options if they weren’t safe for the baby to be delivered naturally.” So I said, “I’d rather to have a natural birth.” So they said, “Okay. We’ll wait until the 35th week.”

After everything she had been through, Hanna felt exhilarated to be alive and make the most of life.

How did it impact you in your mood, sort of your mental health do you think in those in those weeks and months after your daughter was born?

I was actually, I felt I wanted to experiment, to do all the things that I never experienced. I felt life was too precious. After what we’d been through, I felt lucky so I my husband probably found me irritating at times but I wanted to be spontaneous all the time and enjoy life. And I remember him to saying to me, at one point, “You are a mum though. You must remember that you are a mum. There are certain things that you’re not to do when you’re a mum.” And I said, “But I want to do them. I want to experience them. I might never have the opportunity again.” So yeah, I was different. I felt more, I felt I was loving every minute of my life. I it was, I, it was almost like, the first few months after having her, my daughter, was like a whirlwind. I just wanted to experience everything that I’d never done because I felt I was given a second chance so I wanted to do everything that I could possibly think that I thought that I ever wanted to do, I wanted to do it.

Whilst recovering in hospital, Hanna’s mum helped her bond with the baby.

How did you find bonding with her after after the initial couple of days?

I think I would have found it difficult had it not been for my mum being there encouraging me, putting her in my arms every day. Every morning, she would come into the ward, as if she was coming to work, my mum would be there, eight o’clock in the morning and they were saying, “No, no, it’s not time for visitation.” She’d say, “I need to come in.” So they’ve got used to her and they would let her in [laughs] and she’d be there with her flask of hot tea and she’d come in and she would say, “How are you?” And I would say, “Fine.” And before I even finished, I’m fine, she’s picking up the little one and she used to change her, sponge her and massage her. That’s what I remember. She used to massage her every morning, massage her with oil all over. She says it’s good for the baby’s limbs to stretch and then, when she’s wrapped her up, she’d put her in my arms and say, right, there you go. 

Hanna wasn’t sure if it’s related to having had high blood pressure problems in her pregnancy, but she has had some ongoing health problems and was diagnosed with supraventricular tachycardia (SVT) a little while after giving birth.

After the initial weeks, for the first pregnancy, yes, I had so many different, I got really painful headaches afterwards, really painful headaches and then I developed painful feet. In fact, so much so that the doctor referred me to at the hospital and they still don’t know what’s wrong with my feet and I’m not they sent me to the rheumatology department and they said I don’t have any rheumatoid or arthritis or anything like that. In addition to that I felt very fatigued. In fact, a few, after a few months afterwards, I was very, very tired all the time and the doctor, I kept seeing the GP and I kept saying, “I’ve changed my diet and I’ve changed this and I’ve changed that and yet I don’t feel much better.” And he kept taking bloods, after bloods and nothing. So to actually make myself feel better, I felt I was being, perhaps maybe because I was a new mum and I was staying at home, I wasn’t really, I wasn’t exercising that much and I was in that much pain with the caesarean my daughter and I was bent over in pain so much that I didn’t feel confident enough to start any exercise immediately. It was only after a few months that I started doing some exercising. It was only then, when I actually developed a shortness of breath, really and I thought, you know, I was being unhealthy so I continued with my exercise routine thinking okay, I’ll come back to normal soon. One of the assistants in the gym, said to me, “That’s not normal. You are really, really breathing really fast and it’s not normal. Maybe you should go to see the GP.” So I went to see the GP, Doctor [name] and I remember I said, “I feel shortness of breath and, in fact, I feel it even when I’m at rest sometimes.” And he wasn’t happy with that so he requested a 24 hours ECG to so they did it at the GP, attached it to me and went home, had it for 24 hours, went back, took it, came back a week later for the results, went to see him and he said, “We’re not happy with the results that we got from the ECG. Your heart rate is just very high and so we’re going to send you to the cardiology department for a referral.” So that’s where we’ve been so I was diagnosed with what they call a SVT.

Okay.

I don’t know if it’s related to my, what I’ve had previously but.