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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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