Preeclampsia, Post-Partum Depression, and PTSD: My Story

Today, May 22, is World Preeclampsia Day. This is an incredibly raw and vulnerable blog for me to write, but I hope that it helps someone else struggling with PTSD after Preeclampsia.

You can learn a lot more about preeclampsia than what I'm going to list here at the Preeclampsia Foundation website (linked here). And, please remember, I am not a medical doctor (although I o feel more well-versed in preeclampsia than most of the physicians I interacted with, but please don't take any of this as medical advice). In a nutshell, preeclampsia is a condition that impacts multiple systems of the body that impacts approximately 2-8% of pregnancies. Specifically, the condition is associated with high blood pressure and protein in the urine (and, potentially organ failure with or without the protein in the urine). There are other symptoms too: vomiting late in pregnancy, seeing "spots" in your vision, severe headaches, sudden and severe swelling, and upper right quadrant pain. Preeclampsia usually shows up after 20 weeks of pregnancy, and the only "cure" is delivery.

Okay. I have three children. I had preeclampsia with all three of them. This is our story.

Infertility was part of mine and my husbands journey (another blog for a different day). It took us over 2 years to conceive, and when I found out I was pregnant with my first just 5 days before Christmas, I was elated. I had some risk factors for gestational diabetes and was sent for the early test around 12 weeks. I did have gestational diabetes with my first pregnancy. If you've had gestational diabetes, you know this comes with a lot of extras. Extra appointments, extra monitoring, extra stress (lol). I was briefly told that GDM is a risk factor for preeclampsia (from an informational flyer I was given!!), but I was not worried about it. I figured that the pregnancy had been enough stress, surely I would be spared any other worries. And certainly I wouldn't develop something that 2% of the population has! The odds had to be in my favor, right?? (Wrong.) Weekly monitoring with a non-stress test from week 32 on was part of what I had to do because of the Gestational diabetes. At my 36 week appointment, I begged my OB for a c-section (for reasons I won't go into here, I desperately wanted a c-section). She strongly advised against that, and later that day, I went in for my non-stress test. The baby was not moving enough. I was sent to the hospital. My husband and I flew there, not packing anything, not eating anything, nothing. They rushed me in and hooked me up to the monitors. The baby was moving just fine, but there was another problem: my blood pressure was high. Not an emergency high, but higher than140/90. I wasn't worried. Surely, that was from stress. One of the physicians told me there was an 80% chance I would be delivering in 2 days, when I hit 37 weeks, and he ordered a 24 hour urine collection, so I was stuck in the hospital that night. I clung to that 20% chance, and everyone (except that physician) really believed that I'd be going home the following night. There had been no protein in my urine at the doctors earlier that morning, my blood pressure had been fine, and I had no other symptoms of preeclampsia. The following day, a different physician and I talked about if I did have preeclampsia, what I wanted to do. I am so thankful for him. He offered me the opportunity to have a c-section, saying that my body was not ready to deliver, and there was a high likelihood that I would be induced, the induction would fail, and I'd end up with a c-section anyway. I readily accepted the c-section and asked that he tell everyone who was trying to talk me out of it (self-advocacy wasn't my strong point). I still truly thought I was going home. My husband had an interview scheduled, and I had him still go! All my blood pressures were fine, the non-stress tests showed the baby was fine. Then, at 10 p.m. that night, a different doctor came in and announced that I had preeclampsia and they would be starting medication for an induction. Thankfully, my husband was there and advocated for me saying that I wanted the c-section. Long story short, I got the c-section and my daughter was born the next day. Some of my postpartum blood pressures were around 140, but nothing that concerned the nurses, and we were released 3 days after my daughter was born.

My son, my second child, was conceived when my firstborn was 6 months old. We joke that he was our COVID surprise. So, I was pregnant with an infant at a time that the whole world was upside down. We truly didn't leave the house or do anything my daughter's first year of life for fear of how it could impact her or the baby inside me. I wasn't even seen by the OB until 16 weeks. I bought up preeclampsia at every since prenatal appointment, and every doctor that I saw had a different answer: some said I was at a lower risk because I had already had it, some insisted that I was at an increased risk. (From what I understand, at the time with the research both were essentially correct - preeclampsia is more common in first pregnancies, so a smaller percentage of women develop it in second pregnancies, but in women who have already had preeclampsia, the odds of developing it are higher. Still relatively low, but higher than other women). I knew I wanted a repeat c-section, so the baby would be born at 39 weeks, but I wasn't really concerned with preeclampsia in the beginning. Like my first, towards the end I had to have weekly monitoring. This time around, I did have symptoms. Severe ones. I had spots around my vision, I was gaining over a pound per day (swelling), headaches that wouldn't go away. I was told to montor my blood pressure, and did. It started trending higher and higher; increasing from 120/60 in the first trimester, slowly to 130s, then approaching 140s. I mentioned this at all my appointments, and was told I was fine every time.

Until November 3, 2020. I remember the date because it was election day. I was around 35 weeks when at a non-stress test my blood pressure sky rocketed. It was 160s, 170s, 180s. I was sent to the hospital. I went home, grabbed my husband, kissed my baby goodbye and we went to the hospital. A quick test showed protein in my urine and I was again diagnosed with preeclampsia. My blood pressure stabilized and came back down. I was monitored for about 4 hours, and by the time I was discharged it was a normal, healthy blood pressure. They made a plan to return the day I hit 37 weeks to deliver again.

Things got bad. In retrospect, I truly believe I should have had the c-section that day. I went home, where symptoms worsened. I had delirium (my daughter and I would watch TV, and I couldn't distinguish between what was real and not real). I learned later that women with preeclampsia experience swelling in their brain that lasts for 3 months after the birth, so I attribute the delirium to that. My heaadaches were so bad. I could fit in exactly 1 pair of shoes (summer shoes and this was late fall). It was so, so bad. You might be wondering why I didn't call my doctor, and perhaps I should have - however, every time I had voiced a concern, I had essentially been told everything was fine and written off. How do you call the doctor and say "hey I can't tell on TV what's real or not?" without sounding psychotic? I worried my daughter would be "taken away". (No, this is absolutely not how that works, but remember, I wasn't thinking straight). Eventually though, we made it to delivery day. My son was born, tiny and perfect and I thought we were out of the woods. Oh man, how wrong I was.

Because it was the height of COVID, many families were discharged from the hospital early. And this was offered to us. My husband and I were hesitant, because our son was so little (we learned that he had intrauterine growth restriction as a result of the preeclampsia), and honestly, I think the doctor just didn't get around to discharging us yet. My blood pressures had been mostly fine. My husband was getting ready to go home and visit our daughter, when a nurse spilled boiling hot water from a heating pad all over me. He took the baby while they cleaned me and made sure I was ok. After that, it was time for me to have my blood pressure taken anyway, so she took it. It was 170/90. This nurse was really annoying, and had just spilled water over me, so it was like, okay, lets take a deep breath and try again. 180. 190. She ran and got the doctor. 195. 200. 210. My blood pressure peaked at 220/110. Lights flashed in my vision. IV meds pushed, quickly. Nothing was working. The blood pressure gague sounded every 5 minutes. Nurses ran in with IV meds in such a rush they couldn't help me with my son. They warned me that magnesium is hard to tolerate. It would make me feel hot. How bad could it be? I thought. They started a mag drip. Oh, it was bad. Like being burned from the inside out. Ice packs, all over me. Confined to the bed because muscle weakness is a side effect of mag. My anxiety went through the roof. Medicaton for that. A nurse, whom I was the only patient for. Emotions all over the place. Finally, finally my pressures started dropping from the over 200 range. Slowly dipping back into the 190s 180s. The nurses still gave blood pressure medication, but this came in the form of pills, not in the emergent rush of an IV. Because I tolerated the mag "well" (I cannot imagine how others tolerate it, as I truly think I'd choose death over experiencing mag again, and that is not an exaggeration), I was on it for as long as you can keep someone on mag (36 hours). I was taken off of it at the 36 hour mark, but my pressures were still too high - in the 160s. My husband had to return to work that day. A nurse came in and told me that my liver was failing. I was so sick, I just assumed that meant I was dying. I was too sick to ask. (This was most likely my body going into HELLP syndrome. If I hadn't been in the hospital, I could have died). If you haven't experienced this firsthand, that might be hard to understand. I was so out of it, trying to be a good mom and care for my son, while also rest and get better. I missed my daughter more than words can describe. Even now, 6 years later, my heart breaks for the week we missed together.

I ended up being hospitalized for 5 days. By the end, I was diagnosed with PTSD. By day 5 though, my pressures were around 140/90. Still high, but not 220/110 high. The doctor begrudgingly agreed to discharge me with the promise I would take my blood pressure daily and call if anything was off. Thankfully, my blood pressures did come down. At home, my toddler seemed not to trust me. She wouldn't come to me for a few days. My heart broke. Probably not too surprisingly, I slipped into a wicked postpartum depression. Truly it was a perfect storm: COVID meant isolation, my newborn had some medical challenges that put extra stress on us, and the extended hospital stay blended together until it overflowed in PPD that I hadn't understood before. I remember clearly, around the 6 week mark, giving my toddler breakfast, and my son napping on a lounger and just thinking how much better off they would be if I walked out the door into the freezing cold and never returned. Thankfully, I am married to a therapist. When I shared these thoughts and feelings with him, he taught me the GLAD method. Each day, list something you're Grateful for, something you Learned, something you Achieved, and something you Delighted in. I kept this on my Notes app on my phone, but it's more impactful to write in a journal (according to my husband). Sometimes, as a SAHM, the thing I Achieved was doing laundry or the dishes. But, the things I delighted in? Baby snuggles, our toddler learning a new word... Incredible. The PPD lessened within a few weeks.

I'm surprised, honestly, that we decided to go for a third child. Perhaps part of that was that I forgot how traumatic my experience with my son was, but another part of it was that my husband hadn't realized that my liver was failing postpartum after our son's birth (I was too sick to tell him, I had assumed he somehow knew). My anxiety was through the roof for the entire pregnancy. Every time I went to the doctor I was terrified of the preecamplsia diagnosis, of being sent to the hospital and especially of being put on magnesium again. My hospital bags were packed by 24 weeks, just in case. When I hit 30 weeks I started leaving food where I knew my young toddlers could access it in the event that I became unconscious (or dead) while home alone with them. But, overall, I felt much better than I did in my previous pregnancies. By the time I reached 34 weeks, I had no symptoms of preecamplsia! No swelling. No headaches, nothing. I felt worlds better than I had in either pregnancy (part of this, I believe, was the research I did prior to becoming pregnant. I researched supplements and "old wives tales" of prevention and took a myraid of supplements daily). But, at 35w6d, at a routine checkup, my blood pressure was 176/72. I was sent to the hospital. Labwork confirmed that I did have preecamplsia. However, the blood work showed that my potassium level was life-threateningly low - an EKG showed my heart was abnormal! I was prepared for a preeclampsia diagnosis, but not this! I was admitted and started on potassium intravenously. The supplements would work, but didn't raise my level enough, and then they would decrease (implying something was going on with my kidneys). I met with specialist after specialist, none of whom knew what was going on. The closest thing to an answer that I got was "sometimes things like this happen with preecamplsia" (okay??) Later that week, I went back to the hospital and delivered our last baby. My blood pressure came down, and then crept back up to the 140s after 24 hours postpartum. From there, they skyrocketed into the 150s, 160s, and 170s. I was downright hysterical about being on magnesium again, and I begged to be given anything before it got worse, and fortunately my doctor agreed and prescribed a medication for anxiety, and my blood pressures dipped back into the 140s. Baby and I were able to go home 2 days postpartum, and my blood pressure continued to slowly drop.

Between all of my experiences, but mostly my son and youngest daughter, I still have PTSD. My son's birthday has been a challenge for most of his life. I love him to death, but the reminder of almost dying has been challenging to work though. It has lessened as he's gotten older though, thankfully. I still can't have my blood pressure taken. I haven't stepped into a doctor's office since I was pregnant with my last, and don't really plan to for as long as possible.

I always dreamt of having 4 or 5 kids, but after my experiences with my 3, it did not feel like the safest choice for us to continue on to have a 4th. I imagine that a part of me will always grieve that and wonder what our family would have looked like with one more baby. I'm upset that preeclampsia forced us to make that choice, but at the same time, feel grateful to be alive and raise the three precious children that I have. I'm devastated that my daughters are at an increased risk for preeclampsia because of my experiences, and hope that by sharing my story on world preeclampsia day, awareness increases, better research is conducted, and by the time my daughters deliver, there is a cure.

This blog is written and maintained by non-clinical staff. Therefore, it should not be taken as medical advice. If you are experiencing a life-threatening emergency, please call 911. For a mental health crisis that is not an emergency, please call 988.