When a Dream Birth is Followed by the Nightmare of Postpartum Preeclampsia

Ever since my medically questionable induction resulting in a grueling 72-hour labor and a slew of complications nearly seven years ago, I’ve been dreaming of a different kind of birth, free of interminably beeping monitors, unconsented to pelvic exams, and the cumbersome tangle of IV drips. So you can imagine my fear and devastation when just days after achieving exactly this (birthing with my giant gold hoops on! under a glowing evil eye sign! slurping on watermelon!), I was diagnosed with Postpartum Preeclampsia, a serious hypertensive disorder occurring within the first 48 hours after birth through six weeks postpartum, and one of the leading causes of maternal death. 

The labor and birth itself was fast and furious, literally. After a few days of bopping between the chiropractor and acupuncture with light cramping and a lost mucus plug, things ramped up on the couch during an episode of Mr & Mrs. Smith and a few bites of Erewhon spicy tuna. Two hours later, my waters burst on the toilet at home and I nearly pushed out my baby while squatting barefoot in the front seat of my husband’s truck gushing amniotic fluid all over the Carharrt seat covers I’d gifted him for Christmas as we raced toward the birth center at midnight in the pouring rain.

The birth of my third baby had unfolded as primally as I could have hoped — so swiftly and simply that neither my birth photographer nor doula made it. But just three days later, during a routine postpartum home visit, my midwife and OBGYN discovered that my blood pressure was elevated and climbing. After unsuccessful efforts to control it at home, it was time to conquer my fear of the hospital and do what needed to be done for my safety. Off to labor & delivery we went for an intravenously administered Magnesium Sulfate drip that made me feel like a tranquilized rhinoceros in diapers but helped to prevent seizures, also known as eclampsia (serious complication of Preeclampsia).

My hospital stay was only 24 hours, but the emotional and physical effects have lingered far beyond. My intimate bubble of rest and newborn snuggles abruptly popped, my natural oxytocin-high tainted by fear of leaving behind my family and becoming a statistic, my trust and confidence in my body a little bit shaken. After all, I walked five miles a day during pregnancy, took baby aspirin (per the latest research, but more on that later), carefully selected a care team that believed in and protected the physiology of birth. I guess what I’m saying is — Preeclampsia just wasn’t on my bingo card, nor in my birth plan.

So What is Postpartum Preeclampsia, Anyway

Postpartum Preeclampsia, like its more popular and equally devious cousin Preeclampsia, is a serious hypertensive disorder characterized by high blood pressure and excess protein in the urine after birth. Unlike Preeclampsia, which affects women during pregnancy, Postpartum Preeclampsia commonly presents within the first 48 hours after giving birth, but can appear up to six weeks postpartum (known as late postpartum preeclampsia). 

Though less common than its prenatal counterpart, Postpartum Preeclampsia can be equally — if not more — dangerous, as most new moms are no longer being regularly monitored by a provider during this critical time due to a gap in care between hospital discharge and the standard six week postpartum appointment, and have not been educated on the telltale signs and symptoms to lookout for. Though far from a household name – according to March of Dimes, one in five families, and one in four Black families, has never heard of it – Preeclampsia is one of the leading causes of maternal mortality nationwide and a top cause of maternal death among Black women.

Postpartum Preeclampsia Symptoms

This lesser known condition is characterized by high blood pressure, signs of damage to other organs such as the liver and kidneys, and excess protein levels in urine (Proteinuria). The symptoms of postpartum preeclampsia are similar to those of preeclampsia during pregnancy and may include:

1. High blood pressure (hypertension)
2. Swelling of the hands and face, especially around the eyes
3. Severe headaches
4. Vision changes, such as blurred vision or seeing spots
5. Upper abdominal pain, usually under the ribs on the right side
6. Nausea or vomiting
7. Decreased urine output
8. Shortness of breath

Amidst the delirium and chaos of early postpartum, it can be easy to miss the signs and slip through the cracks. Sleep deprivation, postpartum depression, a laser-focus on counting baby poops and mastering the swaddle, and a general lack of familiarity with normal postpartum experiences can conceal symptoms and cause new mothers and those around them to overlook indicators of a problem. In my case, I did have a headache, but figured it was just because I’d had my first glass of wine in nine months and was now responsible for the survival (not to mention playdate and doctor appointment scheduling) of three children. This is why education, early detection, and prompt treatment are so important.

What Causes Postpartum Preeclampsia

The exact cause of postpartum preeclampsia is not fully understood, but it’s thought to be related to factors such as abnormal placental development during pregnancy and underlying vascular issues. While anyone can get postpartum preeclampsia, regardless of age, race, or health status, some risk factors for developing postpartum preeclampsia include:

1. History of preeclampsia: Women who had preeclampsia during a previous pregnancy are at higher risk of developing postpartum preeclampsia in subsequent pregnancies.
2. Age: Women who are younger than 20 or older than 35 are at increased risk of developing preeclampsia, including postpartum preeclampsia.
3. Obesity: Women with a body mass index (BMI) of 30 or higher are at increased risk of developing preeclampsia and postpartum preeclampsia.
4. Multiple gestations: Women carrying twins, triplets, or higher-order multiples have a higher risk of developing preeclampsia and postpartum preeclampsia compared to those carrying a single fetus.
5. Pre-existing medical conditions: Certain medical conditions, such as chronic hypertension, diabetes, kidney disease, and autoimmune disorders, can increase the risk of developing preeclampsia and postpartum preeclampsia.
6. History of high blood pressure: Women with a history of high blood pressure or a family history of hypertension are at increased risk of developing postpartum preeclampsia.
7. History of gestational hypertension: Women who had gestational hypertension (high blood pressure that develops after 20 weeks of pregnancy) in a previous pregnancy are at higher risk of developing postpartum preeclampsia.
8. Placental abnormalities: Certain placental abnormalities, such as placental insufficiency or abruption, can increase the risk of developing preeclampsia and postpartum preeclampsia.
9. Assisted reproductive technologies: Women who conceive through assisted reproductive technologies, such as in vitro fertilization (IVF), have a higher risk of developing preeclampsia and postpartum preeclampsia compared to those who conceive without it.

How to Prevent Postpartum Preeclampsia 

While it’s not yet possible to prevent postpartum preeclampsia entirely (until they, and by that we mean Elon Musk and friends, start investing in women’s health instead of space hotels), there are steps you can take to understand and mitigate your risk. 

Talking to your doctor or midwife about your personal risk factors, being diligent about attending prenatal appointments (where your blood pressure and urine will be regularly checked), and monitoring your own blood pressure at home in early postpartum can facilitate early detection (you can buy a blood pressure cuff, or book a blood pressure check at your local CVS). 

If you have one or more risk factors, consult with your midwife or OBGYN about taking a low dose aspirin beginning at 12 weeks of pregnancy, which new studies have found to reduce the risk of pre-eclampsia by as much as 15 percent.

Postpartum Preeclampsia Treatment

Unlike preeclampsia in pregnancy, which is commonly resolved by delivery of the baby and placenta, the treatment for postpartum preeclampsia involves close monitoring of the mother, sometimes in a hospital setting, and prescription medications like labetalol or nifedipine to lower blood pressure. In more severe cases (such as my own, as luck would have it) the medication Magnesium Sulfate is administered intravenously to prevent seizures known as eclampsia — a critical complication of preeclampsia. Magnesium sulfate, or “mag” as it is colloquially referred to, requires close monitoring in a hospital as it can affect breathing and other bodily functions.

Does Postpartum Preeclampsia Go Away?

Once the acute phase (the period of time where blood pressure and symptoms are severe) has been addressed, monitoring and follow-up care with your provider are essential to safeguarding long term health and ensuring blood pressure remains stable. Most cases of postpartum preeclampsia will resolve with proper care and treatment, and many are able to wean off of blood pressure medication by twelve weeks after birth.

Preeclampsia Awareness Month

And on that note, May marks the end of my fourth trimester, and the start of Preeclampsia Awareness Month, an annual campaign to raise awareness around this potentially fatal condition. This year, maternal and child health organization March of Dimes has partnered with Olympic athlete and outspoken Preeclampsia survivor Allyson Felix to amplify its mission and educate providers and pregnant people on the benefits of over-the-counter, low dose aspirin as a potential solution to this growing crisis.

In a country with one of the highest maternal death rates (disproportionately impacting Black women), and where 72% of women report experiencing medical gaslighting, I’m painfully aware that — even with my privilege as a white woman with access to private midwifery care — this could have turned out differently. As for me, I’m still on blood pressure medication, and managing my anxiety in the aftermath of this unexpected diagnosis. I hope that by sharing my story, I can help even one more family be prepared if blindsided by Preeclampsia in postpartum.

Please note that this story is a personal story, it is not intended to be medical advice of any kind. If you have questions/concerns regarding your health or health situation, we urge you to speak with your own doctor.