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What you need to know about pregnancy & pre-eclampsia by a labor nurse. Part 1

My journey into motherhood has been anything but textbook ordinary. I struggled for 2 years with infertility. We did 7 intrauterine inseminations. Yes, SEVEN. and none of them worked. Just when we decided to stop those and start saving for IVF, I got pregnant. Our son became our miracle baby and I had an uncomplicated pregnancy with him besides some mildly elevated blood pressure towards the end. When you struggle with infertility you don’t ever think about contraception… and a few months later I was pregnant again with my 2nd all while working as a labor and delivery nurse full time.

High Blood Pressure

With each pregnancy my blood pressure would become elevated, but in each pregnancy it began to happen earlier and earlier. By the time I was 19 weeks with my third baby my blood pressures were in the high 130’s low 140’s systolic. Why is this even a problem you might ask? The higher elevated your blood pressure becomes (>140 for the 1st number or >90 for the 2nd number) the greater risk you are for seizures, stroke, and other very serious health issues. A seizure while pregnant could end up with a loss or emergency delivery.

In pregnancy #3 from 19 weeks on because of this blood pressure issue, I started to have WEEKLY doctors appointments (when you normally only have one a month).

From 28 weeks to 32 weeks I found myself in labor and delivery at least once a week for blood pressure monitoring and finally at 30 weeks was put on blood pressure medication to help regulate it.

Pre-eclampsia can happen at anytime

I was being monitored very closely. I mean once a week office visits, once a week blood draws, twice a week non-stress tests, and once a week labor and delivery visits. Basically 4 days a week I was at the hospital and each and every time I went the blood pressure was borderline but all of the bloodwork came back completely normal. In fact I had completely normal labs 24 hours prior to my emergency delivery.

Pre-eclampsia is basically “pre-seizure” it is caused by an insufficient placenta and if it progresses too far it can actually lead to multi system organ failure, HELLP syndrome, but most commonly growth restriction for the baby. The placenta isn’t working to provide your baby with all the nutrients it needs. Your baby stops growing (or slows down in growth). The only way to treat pre-eclampsia and stop it from harming you and your baby is delivery… which in my case and many other cases means delivering a premature baby.

Pre-eclampsia at 32 weeks

My first delivered at 39.5 weeks gestation, my 2nd scheduled for 37.0 weeks… and then my third an emergency 32.4 week delivery.

I went to my normal 32 week appointment and was still recovering from having pneumonia a few weeks prior (yes, I was pregnant in June and got pneumonia). I felt as though I was still having episodes of shortness of breath with an elephant sitting on my chest so my doctor ordered a heart Echo to make sure there wasn’t anything wrong with my heart.

The results came back with three options. 1. pneumonia could still be lingering. 2. I had a blood clot 3. I had pulmonary hypertension (2 of the 3 options were REALLY serious). My doctor told me to head in the next day to rule out a blood clot, but that night as I was sleeping I awoke to the shortness of breath sensation and knew, just knew I couldn’t sleep any longer. I got ready and headed to the emergency room by myself so my husband could sleep and stay with our then 2 1/2 and 3 1/2 year old.

Once you are >23 weeks gestation the ER will almost always make you go up to labor and delivery first to clear anything pregnancy related before handling your medical concern and since I was 32 weeks thats what should have happened. But the labor nurse in my got stubborn and insisted I didn’t need to go upstairs. This was a mistake.

I sat in the ER and my blood pressures were 173/126 (if you don’t know.. that is VERY VERY HIGH for someone who is pregnant). I sat there for over 4 hours before I got the scan rule out a blood clot, and then I was given some medication for my blood pressure and instructed to drive myself to my delivering hospital 30 minutes away. (if I wouldn’t have been stubborn I would have gone to labor and delivery, had my high blood pressures, gotten on the correct medication to protect myself from seizures, and flown via helicopter to my delivering hospital). I had pre-eclampsia when 24 hours prior… I didn’t have it.

Magnesium

When you are in the hospital being induced for pre-eclampia, they put you on this IV medication called magnesium. This is what is going to prevent you from having a seizure and helps protect the babies brain. It however makes you have hot flashes, but what’s worse is it makes everything very fussy. Like you cannot concentrate, your eyes can’t focus. I remember trying to watch Wimbledon and I could only focus on the tennis ball for 0.5 of a second before my eyes would just close.

Strict monitoring of your input and output also becomes important when you are on magnesium. Nurses have to make sure your kidneys are still working correctly and you are peeing at least 30ml of fluid an hour. Monitoring this means you have to pee in a hat and in most cases have a urine catheter.

Magnesium doesn’t stop when you deliver the baby… nope. In fact, women are prone to having seizures up to 24 hours AFTER delivery so be prepared to continue this medication… and the catheter for another 24 hours after having your baby.

Delivery

My body was NOT ready at 32 weeks to deliver a baby, which meant I needed to be given a few different medications to get that cervix to dilate. I was lucky to be at a hospital with a NICU so once I did deliver my baby would stay in that hospital with me. It also meant that I would have to deliver in the operating room which has a pass-through window to the NICU. I didn’t need to have a c-section, but was moved to the operating room just for proximity to the NICU.

3rd baby also meant once I was in labor… my body knew what to do. From the time my water broke and I was 3 1/2cm to the time Harper was delivered was 52 minutes.

Within a few minutes we were wheeling down the hall.  My hands were clenching the bed in pain and as we pulled my bed into the OR.  The anesthesiologist ripped my epidural from my back and said “lets just do a spinal” and started setting things up.  I yelled back, “Mike! How long is it gonna take?”  He said two minutes and I said, nope, lets just have a baby.  Dr. Parrett quickly set up her stuff and within 30 seconds another contraction came and she was out a push and a half later.  Covered in blood because my placenta has abrupted, Dr. Parrett quickly adjusted her hands around the very floppy and still Harper to discover she was indeed a little girl!  We quickly passed her through the window to the NICU and were out of the operating room within a couple of minutes.

Things kind of add up and cause more complications. My body dilated/transitioned quickly, so my pain became intense. A lot of pain means high blood pressure, high blood pressure led to a placental abruption (which means my placenta tore away from the lining of my uterus causing a lot of bleeding and also no oxygen going to the baby… a quick delivery became necessary).

What I would have could have done differently.

There isn’t a way to stop pre-eclampsia from happening, but I do think that there are lifestyle choices I made that contributed to the progression of my illness.

Eat Healthy

I told myself going into this pregnancy that I was going to eat healthy, exercise, do all the things I’m “supposed to do,” but when you feel tired, morning sickness sets in, stress, and anxiety it is VERY HARD to eat healthy. So I didn’t. I ate like garbage. All the processed foods would immediately give me a headache. The headache would debilitate me and made it so I was a very temperamental mother of two toddlers.

Meditate & Yoga

I have never, ever had an issue with anxiety in my life… until this pregnancy. There were several moments I would break down in tears because I just couldn’t do it any longer. I met with my doctor and contemplated being put on an anti anxiety medication but was extremely hesitant because as a nurse… seeing babies delivered on SSRI’s was frightening. The baby is so relaxed that they come out not wanting to breath or cry. So instead of medication I turned to an app called headspace and meditated daily. I also went to yoga twice a week and these REALLY REALLY helped! I strongly recommend it to anyone who is pregnant even if you aren’t struggling with anxiety.

Throw your birth plan out the window

I didn’t necessarily have a birth plan… but as a labor nurse I see so many moms come into the hospital with a very very specific birth plan and when complications arise their stress and anxiety levels go through the roof because it isn’t their perfect plan. As a nurse my plan for myself and my plan for all my patients is HEALTHY MOM. HEALTHY BABY. Whatever we have to do to get there doesn’t matter.

Don’t be afraid to ask for help.

Throughout this 3rd pregnancy I was required to be at the hospital 3-4 days a week for 13 weeks straight… and then had a baby in the NICU for another 4 weeks all while having a 2 1/2 year old and 3 1/2 year old at home. There was extreme mom guilt and I needed help. My neighbors stepped up and were honestly my angels through this very difficult time. They watched my kids for all of these appointments and medical visits. They brought my family dinner a few times a week for months. I honestly wouldn’t have survived without them. Don’t be afraid to ask neighbors, friends, family to help you.

Part 2 will go over how to survive having a NICU baby with other kids at home. Stay tuned!!

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