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.
After giving birth, Kate had some swelling for about two weeks and bruising which lasted six weeks.
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.
Amy continued taking medicines to lower her blood pressure after giving birth. The dosage was lowered as her blood pressure returned to normal.
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.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.
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.
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.
Nicola had mixed emotions when she returned home. Her husband was back to work but her mum was able to offer lots of support.
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.
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.
Kay had her health checks done at the hospital when she was visiting her baby.
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.
Helen X had blood tests to check her liver was recovering in the weeks after she gave birth.
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.
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.
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.
Paige found that taking two types of medicines to lower her blood pressure worked best, which she continued after being discharged.
Angela was re-admitted for problems with her blood pressure and headaches. She started on a different medicine to lower her blood pressure.
Angela was re-admitted for problems with her blood pressure and headaches. She started on a different medicine to lower her blood pressure.
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.
Sally found it reassuring that she could self-monitor at home after giving birth.
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.
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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