Published on February 19th, 2014 | by Erika Kleinman0
Erika Kleinman on PREECLAMPSIA
At our four-month prenatal appointment, our midwife took my blood pressure and sat back, her eyes wide. “Whoa,” she said. “That is really high for you.” For the rest of my pregnancy, it slowly climbed. My midwife eyed us warily each time she saw the numbers. “I hope you don’t go over your due date,” she said, furrowing her brow. “I don’t like that blood pressure.” Were we eating well? Yes, perfectly. Exercising every day? Taking prenatal vitamins? Yes, yes. She ordered me to track my blood pressure at home, and to start the Brewer diet, a high-protein diet which is supposed to prevent preeclampsia – pregnancy-induced hypertension. She gave me the name of her acupuncturist. I went once per week, at eighty bucks a session. Yet every week, my numbers continued to creep up. 140/76. 150/80. Higher and higher they climbed.
“It’s because she’s fucking stressing you out,” my husband said. I was at the computer, fretting over the numbers. “I mean, you’re taking your blood pressure on that damn cuff every two seconds. How is that not stressful?” I shrugged, entering the numbers into an Excel spreadsheet.
“I have a few that are normal,” I said, pointing at the ones highlighted in green.
We stared at the screen, hopeful.
Preeclampsia only happens during pregnancy, or shortly after pregnancy. High blood pressure is usually the first symptom. This happens because the blood vessels are constricted, reducing blood flow throughout the body. Tiny capillaries in the kidneys leak from the stress, and protein shows up in the urine. Other capillaries leak fluids, which cause the swelling of the hands and face. Because blood flow is reduced everywhere in the body, the baby isn’t getting as much blood from the placenta. The only cure is delivery.
No one knows why it happens. Theories, theories everywhere, all readily available on the internet. There is plenty of research, most of it confusing and inconclusive. Some researchers say it is because the fetus is unable to get all of the nutrients it needs from the placenta, so it starts siphoning off of the mother’s organs. Kidney failure and liver failure can occur in severe cases. If it develops into eclampsia, then seizures can dislodge the placenta and kill the baby. Or the mother can stop breathing. Just like Sybil in Downton Abbey.
They used to call it toxemia, because they thought it was from a toxin in the mother’s blood. Then they called it preeclampsia. Now they call it pregnancy-induced hypertension. They are always trying to get on the same page about it.
There are certain enzymes that appear elevated in women with severe cases. These enzymes come with names made of letters and numbers. Certain letters and numbers have the same researchers. The incidence of preeclampsia in Mumbai may be affected by the monsoon season. Preeclampsia almost always happens during the mother’s first pregnancy. Most women who have another baby do not develop the disease again. Women who have never given birth are called nulliparas. A woman who has given birth once is called a primipara. None of this information helps, but I’m anxious. It’s a whirlwind of information, a dust devil swirling leaves around my body.
Sometimes I go on the preeclampsia website and look through the stories, my heart racing. The Personal Stories are organized by outcome: Mother lived/Baby lived, Mother lived/Baby died, Mother died/Baby lived. I can only look at the ones with happy endings. I know there are others and that is enough.
In order to have a homebirth, the birth needed to be low-risk. Pre-eclampsia means automatic hospital transfer. We wanted to have the baby at home and use our own towels and sheets and hold her in our arms right away. We wanted to put her on my chest and let her get to know us right away. We wanted her dad to catch her. Strange that we felt so certain it was a girl. We couldn’t even pick a name for a boy.
My midwife suggested exercise to lower my blood pressure. She’s been a midwife for thirty years. I dutifully went to the Y every Monday, Wednesday, and Thursday. I recited positive affirmations in my head while I swam:
“The baby knows just how and when to come out.”
“My baby and I are strong and ready for the work we must do.”
“I am doing everything I can to lower my blood pressure, and I am doing a great job.”
My favorite was the breaststroke. I liked being all the way underwater, weightless. I liked the rhythm. My daughter swam while I swam, turning and kicking in my belly. It had to be good for us.
One night, about a week before the due date, I was making a banner out of construction paper that said, “You Are Safe.” I wanted to look at it during the birth. I got the idea from a Miranda July website. It said to make a banner with a message to yourself. I was following the website’s instructions of gluing letters made out of construction paper onto other pieces of construction paper in contrasting colors. Pink on blue. Red on black. Yellow on green. Taped onto a long piece of twine. I wanted the banner to be beautiful, and I wanted it to help me through my labor. I needed a talisman. When I glued the last letter, I felt a dull pain in my side that radiated to my shoulder. Like I’d been running for a long time, after a long break. A stitch in my side. It got worse when I inhaled deeply. I felt worried, but I didn’t want to wake up my husband. I had woken him up a few days earlier when I thought I was leaking fluid and it turned out to be nothing, and it was hard for him to fall back asleep.
I called our midwife and told her about the pain. “It feels like someone snapped my bra strap really hard.” I laughed. I wanted to make light of the situation. She hesitated slightly. “Go back to sleep,” she said. “I’m sure it’s nothing. We’ll talk in the morning.” Her voice sounded so calming, and I was flooded with relief. I took some Tylenol. I decided to hang the banner in the morning.
The next morning at seven o’clock, we woke up to loud banging on the door. The kind of knock the police might use, hands on their guns. We opened the door. Our midwife looked panicked and said, “I’ve given this a lot of thought. It’s time to figure out exactly what’s going on.” She handed me a cup. “Here, pee in this.” She tested my urine with a strip of plastic with little pastel-colored squares on it. She held up the paper and looked at it. She shook her head. “That’s plus four. You’ve turned the corner, hon. I want you to eat a huge breakfast and then pack up. We’re going to the hospital.” She put her hands on my shoulders and looked at my face. “Yep, your face is swollen.” She sighed. “I’m very serious about eating a big breakfast. They’re going to make you wait forever and they won’t let you eat. Eat some yogurt and some fruit, some eggs and toast. As much as you can get in your belly.” Her keys jingled as she stood up to leave. “It’s great that you got that much more sleep. You’ll need it.”
After we ate, we packed to leave. My husband asked if I wanted to take the banner. “No,” I said. It looked so inadequate; so sad and childish. We left it folded on the bed.
She was right about the waiting. You have to wait and wait at a hospital. They like to come in and tell you the news and then you’re left to process things your own way. “You’ll need to be induced.” Then off they go. “Your liver enzymes are very high. That pain in your side was your liver. You’re very sick, did you know that?” Seven hours later, after the induction had failed, the doctor came in and sat next to me on the bed. “We’re going to have to go in and get the baby.” At first I didn’t understand. Like, forceps? “No, a C-section.”
“I agree,” said my midwife. “It will be good for you and good for the baby.”
We both cried. We didn’t want to be in a stark white room with doctors and nurses. We didn’t want her to be cut out of my belly. I had no idea how Cesareans even worked. Did they just cut you from the top of the belly down, like a fish? I felt foggy from the magnesium sulfate, a drug given to prevent seizures. The feeling from the drug was worse than any flu I’d ever had. I felt sick and thirsty, like I’d been choked and left for dead in the desert. My brain felt like it was bobbing in hot water against my skull. They wouldn’t let me eat anything, not even ice chips. They were afraid I would aspirate during the surgery. “Give me some motherfucking ice chips,” I hissed at my husband. He wiped sweat from his forehead and looked at me apologetically. “Babe,” he said, squeezing my hand.
The anesthesiologist and my husband stayed close to me while I was on the operating table. I tried very hard to connect with the baby before the surgery, but I was so tired, so hungry, so spent. I tried to visualize sending her a little rainbow of love. I forced myself to focus on the positive things. “Now I get to find out for sure if you’re a boy or a girl!” But I was scared. So many things had not turned out the way we wanted, I was afraid that she wouldn’t be okay.
But she was perfect. The rest of the hospital stay was a blur of holding her, nursing her. My midwife smiled. She looked exhausted. “She’s a good nurser,” she said.
After four days, they said we could go home. I felt like a shell. My body felt wrecked, raw. But they said my numbers were okay. When had it all been reduced to numbers? We were relieved to go home.
During our home visit the next day, our midwife’s assistant took my blood pressure again. It was very high; higher than when I was pregnant. She suggested calling the doctor. She exuded calmness. I was so out of it I didn’t detect anything alarming. I lay in bed while my husband called the doctor. I heard my husband say, “170 over 110.” A pause as he listened to the doctor’s response. My husband asked, “Do you think we need to come to the hospital?”
“I don’t think,” the doctor had said. “I know. You need to get her over here now.”
Even after delivery, it can stay for several weeks postpartum in some cases. I was one of those cases. A special case. The doctor said, “If you wanted to hang out, you should have just called.” I did not laugh. One of the other doctors said, “I wouldn’t skip any of your annuals. It makes no sense for you to have this. You’re a young, healthy woman.” He shook his head. “No reason.” Doctors have a tricky way of trying to make you feel like it’s your fault. I dreamt that it was a snake in my veins, coiled in my womb. I cried when a nurse came to take my blood pressure. “What’s wrong with me?” I was all tears and snot. She had brown eyes filled with warmth and empathy. She told me as much as she knew. She printed out some information from some reputable websites and handed it to me, smiling apologetically. “I’d rather you read this than look around on your own,” she said. “Scary stuff out there. We weren’t made to know every bad story in the world.” Everyone took my blood pressure every two minutes. I couldn’t sleep. My husband cried and stroked our daughter’s face as she slept peacefully. I couldn’t do anything but lie there, tangled in tubes. “Call our friends,” I said. “We need help.”
People showed up with bottled water, coolers full of baby carrots, hummus, yogurt, bags of almonds. They brought summer dresses with matching hats for our daughter. They brought her bibs with cute sayings on them. Mommy loves me. Daddy’s girl. They became wistful about their own children’s births. They cried when they saw her tiny face. They took my husband out for a beer down the street. One friend brought us omelets from our favorite brunch restaurant in the morning. It was the most wonderful, luxurious breakfast in the world. Mine was spinach and mushroom, with provolone cheese. My husband’s was tomato and onions and garlic. It was exactly what we needed. We shared a couple of bites and we ate them together, while our daughter slept in her bassinet, her tiny belly rising and falling like a puppy’s as she breathed.
It’s easy to forget. After a couple of weeks in the hospital, my blood pressure went down and everything was back to normal. A few weeks later when I was home, I couldn’t remember much about the pregnancy. And the birth? Just a few hours out of my day! My body healed quickly, but I chose to spend three weeks with her in bed. I wanted to be with her. I felt we had been robbed, bonding-wise. I planned to take that time back. She slept next to me and I woke up every hour to check her breathing. She made little sucking noises while she dreamt about nursing. My little nursling. We swaddled her and stayed up all night with her while she screamed. We said, “Shh shh shh” while we bounced her to sleep. We figured out the fastest and most painless way to put on a fresh cloth diaper. We argued about how hungry she really was, about who had a right to be more tired. We argued about the correct temperature of her bath. We laughed as we took her picture over and over again. We watched her coo and smile for hours. We talked about how perfect she was, how different everything was now.
My midwife insisted preeclampsia is a first-pregnancy phenomenon. “You’ll be fine for the next one,” she said. “You’re going to have a wonderful home birth.” I believed her and didn’t believe her. I placed the banner under my bed, the Y on top of all of the other colored letters, waiting to be unfolded.