Third Trimester

I entered my third trimester in late April 2020, during the first of many Covid surges in my city. Because I was low risk, I was converted to virtual appointments from 28 weeks to 35 weeks. When I presented to the office at week 35, my blood pressure was elevated. It had been normal at home, and I have a history of white coat hypertension, but my OB decided to order a 24 hour urine test, just in case. 

35 Weeks

Two days later, on my birthday, my OB called to let me know there was excess protein in my 24 hour urine. My blood pressure was still within normal limits at home, so we elected to continue to watch and wait. My blood pressure began to climb over the next day, but I chalked it up to pain and stress, as I had had a stage 0 melanoma diagnosed and a wide excision performed. By Saturday, it was within the “call your OB” range consistently over a few hours. I called the after hours nurse line, and was instructed to present to L&D. Before we could make it out the door (we had NOTHING packed or ready for a small human and my husband was frantically trying to install a carseat), the on-call OB called, took a h&p over the phone, and was comfortable with me staying home and monitoring my blood pressure more closely. Over the next day or so, it remained elevated, but not so high that immediate interventions were needed. 

At 36 weeks, my OB decided it would be safest to induce at 37 weeks. My husband and I spent the week preparing for our little one’s imminent arrival. 

Labor, Delivery, and Hospital Stay

My labor and delivery went better than we ever expected, save for the process of getting an epidural. I was admitted on a Sunday evening, began pitocin at 4am on Monday, and delivered our baby girl after 10 minutes of pushing at 3:48pm the same day. 

Interestingly, the most traumatic part in this entire journey for my husband was the process of me getting an epidural. I had declined an epidural before the anesthesiologist on L&D that day went to staff a c-section. In that time, I started to progress very quickly, and knew I couldn’t wait until the L&D anesthesiologist was available. A backup physician was called, and they did a terrible job of explaining what was going on and preparing us. Even worse, they did not keep their cool when I began bleeding from the epidural site. My husband said that he has never seen a doctor look as terrified as that doctor looked. 

In the first hours post delivery, my blood pressure dropped and normalized. The hospital stay itself was totally overwhelming, and I was so anxious to get home after three days of a constant stream of people in and out of my room. As our stay progressed, my blood pressure started to climb again, but it was still low enough that we were discharged 48 hours post delivery. My OB discussed the signs and symptoms of postpartum preeclampsia extensively with me, and my husband and I felt comfortable with the plan to discharge to home with self-monitoring of blood pressure. 

72-96 Hours Postpartum

Our first evening home, I began to notice some strange symptoms. My legs were involuntarily shaking, and I had a few episodes of tunnel vision overnight. The whole next day, I felt like I’d been hit by a truck. I chalked it up to being 3 days postpartum, even as more concerning symptoms popped up. I pushed through, taking my daughter to a doctor’s appointment, trying to unpack from the hospital stay, and operating on a 2 hour feeding schedule to try to get my daughter’s bilirubin level down. 

By that evening, I had intense chest pain and heart palpitations. I realized I had never taken my blood pressure, and finally took it at 9:30pm. It was the highest it has ever been. I remember looking at the number, and letting out an ear shattering scream. I knew I was in trouble. I knew I was going to have to go back to the hospital, and leave my newborn and husband. I called the on-call nurse, who instructed me to present to the emergency room as soon as possible. I didn’t want to go, and tried to convince my husband not to take me. He broke down, and told me he could not raise our child alone. Only because of that, I agreed to go to the ER at the hospital I had delivered at, figuring that seeking evaluation at the institution where my OB was would allow for seamless care.

I will never forget the drive to the hospital. My 3 day old child was screaming in the back in her carseat because she was hungry, and I hadn’t fed her. Because of newly enacted Covid protocols at the hospital, nobody was allowed to accompany me. My husband dropped me off at the only door you could access because of Covid, and I walked into the hospital completely alone. 

Once in the ER, I followed the instructions I was given at discharge from L&D: I provided my name, my OB’s name, my symptoms, and prenatal diagnosis of preeclampsia. I repeated this process countless times, to anyone who walked into my room. Unfortunately, I was provided little to no information on the plan of care, despite my attempts to ask questions and advocate for myself. When I asked what medication was being pushed into my IV, I was told “something for your blood pressure”. When I asked why I was getting a chest x-ray, I was told “for your heart.” The ER physician finally informed me they wanted to work me up for cardiomyopathy. They stated they had called the on-call OB, who recommended I be released and follow up with cardiology in the morning. If I wanted, they could admit me for observation overnight. At this point, my symptoms were continuing to worsen. 

I agreed to be admitted, and found myself on an internal medicine floor. I again repeated my speech to all the nurses and physicians who walked into that room. My blood pressure was only being taken every 2-3 hours. I learned my liver enzymes were elevated, a lab that was written off by the medical team as a normal variation. I began to experience a pounding headache, and swelling of my hands and feet. I had no supplies to care for the 2nd degree tear I had sustained during delivery. Because I had no one available with knowledge of medications in lactation, I had to dump all the colostrum I pumped.

At 7am shift change, I begged my new nurse to call my OB directly. I was brushed off, and told the internist would see me that morning. Not once did anyone explain what was going on, what labs were being drawn, what medications were being prescribed, or what the plan of care was. It was at that point I knew I needed to take things into my own hands. As soon as my OB’s office opened at 8:30am, I called them directly. 

I will never forget my OB’s name flashing across my cell phone, a mere 5 minutes after I had left a message with her nurse. She told me she had never been informed I had been readmitted, that I never should have presented to the ER, and that I needed to be on the L&D floor receiving magnesium. She began getting me transferred, and also began obtaining appropriate authorizations for my husband and newborn to return. Due to another Covid surge, the hospital was not allowing any visitors at that time. 

The moment my daughter and I were reunited after 18 hours apart

I made it onto the L&D floor and began receiving magnesium at around 11am – 13 hours after I had walked through the doors the night before. The nurses and staff on the L&D floor were amazing. I was in shock, and then added magnesium to the mix. If you’ve never received magnesium, you may have it explained to you as “it will make you feel like you have the flu”. If you have received magnesium, you know it is much worse than that. The floor manager ensured that my husband and daughter were allowed back in, and threw verbal elbows when the Covid door screener suggested that I should just pump milk rather than breastfeed. The lactation consultant gave me guidance on how to relieve engorgement and use the pump correctly. The nurses and OBs took time to explain what was going on, what every drug they were prescribing was, and what to expect next. 

The Aftermath

I was released a few hours after completing a 24 hour infusion of magnesium, and continued to take antihypertensive medication for a few weeks. My blood pressure did eventually return to normal. I elected to file a complaint with the hospital system, given the situation. I was informed via a letter that an investigation had been completed, and I simply didn’t advocate well enough for myself in the ER. 

After I received this letter, I began having intense flashbacks. I would lay down at night, and as soon as I would close my eyes I was back in the ER. I lost all confidence in my abilities to seek medical care. I suffered through what I now know was intense PPD and PTSD, simply because I didn’t have the emotional energy to try to navigate a system that had let me down on so many levels. I spent months feeling so desperately alone. All I could think about was wanting a do over. I finally sought the care of a reproductive psychiatrist and a therapist trained in EMDR. After many intense sessions, I finally began to see improvements in PTSD symptoms. 

I know I still have a lot of work to do. I recently had my 1 year follow up appointment with my OB, and the process of having my blood pressure taken brought me right back mentally and emotionally to being in the ER. My OB and I spent some time looking at my records from that night, and cannot piece together how things went so wrong. Not having an answer to that is so hard. 

I will always give the same advice to pregnant and birthing people: ask specific instructions regarding where to present should you have any postpartum complication. I have started to share my experience with postpartum preeclampsia more openly, and have come to find that I am not the only one with this story. It both makes me so profoundly sad that other birthing people have experienced this, but so grateful that I am not alone. I hope that I can continue to integrate postpartum preeclampsia into my story, and eventually use it to help educate providers and patients alike. 

About Kate

Hi, I’m Kate! I’m a certified genetic counselor specializing in oncology in Texas, a wife, dog mom, and mom to 1 daughter. In my spare time, I love to craft, read, and rewatch Gilmore Girls for the upteenth time. I am a MoMMA’s Voices Certified Patient Family Partner. I also recently opened an Etsy shop (https://www.etsy.com/shop/Midwesternerintexas) with all proceeds going to the Preeclampsia Foundation.