The Ordinary Doula Podcast

E93: Understanding Preeclampsia: Warning Signs, Risks, and Real Stories

• Angie Rosier • Episode 93

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Preeclampsia can appear without warning and reshape a birth plan overnight. We explain the signs, risks, and care decisions with real stories from the hospital and straightforward steps to lower risk and catch problems early.

• what preeclampsia is and why it matters
• common and less obvious warning signs
• who is at higher risk and why risk shifts
• how diagnosis works in real prenatal care
• dangers for mother and baby if untreated
• treatment options, induction and cesarean decisions
• postpartum risks and long-term health impacts
• prevention basics: aspirin, calcium, nutrition, exercise
• real cases: risking out of home birth, NICU realities
• self-advocacy, listening to your body, asking for help

Your listens mean so much to us. I want you to try and make a human connection today. If you can reach out, touch someone, whether that's virtually eye contact, really grab hold of someone with your own hands, give them a hug.


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Show Credits

Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker

SPEAKER_00:

Welcome to the Ordinary Doula Podcast with Angie Roger, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.

SPEAKER_01:

So this is an episode I have pondered on and thought about for a long time. Something I've wanted to address because I see it a lot. I see it as I work in hospitals, I see it as a doula, see it as a lactation consultant, seen it for years. Um it's a serious topic, it's um a little bit of a mysterious topic, and that is preclampsia. So you may have heard of preclampsia. That is simply a pregnancy complication that is involving high blood pressure and stress on the mom's organs, usually happens after about 20 weeks. So um I want you to kind of think of pregnancy kind of like a journey, right? Like a you're going on a road trip. I don't know if you guys like road trips. I love road trips. I just got back a couple weeks ago from a 6,800-mile awesome road trip and had a great time. So when I'm going on a road trip that long, um, I prepare for and I hope everything will be well. Uh that's not always gonna be the case, obviously, but I get the car ready, I think ahead, what are our stops? Um, we're obviously gonna need to refuel, we're gonna need some brakes. Um, you know, that's just the traveling part of it. Then there's the fun part to all the activities we're gonna do along the way, what our different destinations will be. And every time I do a long road trip, and I've done several across the whole United States, um, like it's a miracle if it goes well. It seems like. So this last road trip was 6,800 miles, and I was about 2,000 miles in um when the air pressure on one of my cars was like totally going down. Or sorry, one of the tires, the air pressure was going down. I'm like, oh dang it, I've got so much longer to go. Went in, got it checked out, sure enough, and we went to a wouldn't you know it, in um, where somewhere in the middle of Ohio. There was a 24-hour car place, this little hole in the wall shop in the back of nowhere, which is awesome. I was so glad they were open at 10:30 at night. Sure enough, there's a hole in my tire. I bought a new tire and got on the road again. So pregnancy is kind of like a road trip. Most of the time, things are gonna be smooth, there's gonna be bumps, but you can keep moving forward. So proclampsia is a little bit like a little hiccup in a road trip, right? Maybe it's the engine overheating. That's actually a great um thing. Like the engine has just been working hard, and with the engine overheating, the car just can't go on very well, right? Pressure builds up, the temperature gauges are going up. Um, if you catch it and work with it, you know, we we can kind of cool the car down and and take good care of it, change what needs to be changed. But that if we don't do anything about it, that pressure is going to kind of build, could damage the engine, so you're not able to go on further in the journey, in your your quote unquote journey or your road trip. So preclampsia is a lot like that. A lot of times you're just cruising along through pregnancy, feeling fine, and then one week, it's quite sudden sometimes, um, you're facing dangerous blood pressure issues. Okay, so this affects about five to eight percent of pregnancies worldwide. I have seen, I haven't pulled data on this, but anecdotally, I have seen this, and I have I've I know I've talked to other providers in many hospitals, they're seeing, feeling, having the effects of this kind of creeping up. Um, so it's one of the leading causes globally of maternal and neonatal illness or death. Um, and we'll talk about a little bit about why. So increased risk factors, it increases the risk factors per premature birth, which increases NICU stays. Um so babies struggle. If they have to be born early, they struggle, right? It increases complications within the organ systems of the mom's body, can lead to strokes, seizures, and organ damage. It could be permanent. So talking about who's at risk, like basically everyone could be at risk, which is so interesting. Um, and we'll talk a little bit more about that in a minute. But first pregnancy is actually kind of um more at risk. A history of preclampsia, um, carrying multiples, chronic hypertension, diabetes, having kidney disease or autoimmune disorders, or if a history, if you have a history of pre-clampsia with moms, sisters, or anything that can contribute to risk factors, it could happen in people over age 35 a little more frequently, people who are um have a higher BMI. So everyone is at risk, but there are certain factors that can make it a little more common for sure. So some signs and symptoms to watch for. And um, you get asked these questions quite a lot in pregnancy at your visits. You might not know exactly why they're asking and what they're looking for, but um high blood pressure. So when you go in for regular prenatal check, it's kind of boring, right? You pee in a cup, they take your blood pressure, um, they're measuring fundal height, there's not a whole lot to do, but that's actually very important bits of care because one of the indicators of preclampsia is high blood pressure, often picked up at prenatal visits. Um peeing on the stick, right? You put a little stick there looking for protein in the urine. That's another sign of stress on the kidneys, could be a sign of preclampsia, swelling. Have they asked about your swelling? If it gets um really quickly, if it goes up, if um, you know, sometimes you're dehydrated, you're hot. It's summertime. People swell, but um, it's one that doesn't go away, especially in the face or hands. It can be a sign of preclampsy, an early sign, sudden weight gain from fluid or tension, headaches. Here it asked about like are you seeing spots or any blurriness? How's your vision doing? Are you getting headaches? It could be pain, like upper belly pain, which is near the liver. That's what we're looking at is liver dysfunction. And sometimes there's absolutely no symptoms, which is interesting. There's no, not even the blood pressure is reading high, but there's absolutely no symptoms when all of a sudden this is occurring. So it's diagnosed with blood pressure checks, urine uh tests for protein, which are pretty standard and regular, um, and then blood tests if needed. This isn't a super regular test at prenatal visits, but if needed, they will um do a blood test for liver, kidney function, platelet counts, um, maybe ultrasounds to moder baby's growth. If there's sometimes preclampsia, then the baby's not growing as well. So some dangers, a lot of the dangers here lie in the health of the body of the mom. So her organs can be in danger. This would be um her kidneys, her liver, and the function of those. She's at risk for developing e-clampsia. So there's pre-clampsia, pre-eclampsia, and then eclampsia. We'll talk about the difference in a minute, which can lead to stroke, help syndrome, and organ failure. Big stuff, like big scary stuff. The risks for the baby are growth restriction, like if the mom's body is just, you know, if that engine is overheating or your tire is deflating all the time, it's going to be hard to continue on with this pregnancy in a very effective way. Um, preterm birth, so that leads to NICU stays, babies who have challenges with that. Um, and in severe cases, very uncommon, but could lead to stillbirth. Most of the risks lie with the mom. Um, and while serious, it's treatable with early care, early detection in care. Um, so the first things if if we're suspecting that is just closer monitoring. It may we may use blood pressure medications. Um, bed rest is no longer recommended. It used to be, but turns out that's not the best thing for us is to hold still all the time. Um, in severe cases, hospitalization, I've seen people hospitalized for weeks, weeks, weeks at a time to manage their preclampsia, waiting for that baby to get big enough so that it'll be a little bit easier for the baby and taking very good care and taking a close keeping a close eye on the mom. Magnesium sulfate. So if you heard the mom that's on mag, um, she's getting magnesium sulfate to prevent seizures. Um, and that is not a fun feeling. Um, mag kind of makes you feel pretty yucky. Um the best cure is delivery of baby and placenta. That's like when we're like, all right, things are at a tipping point, we need to get this baby out. Um, sometimes it's done by cesarean, sometimes induction. It kind of depends on the severity of things and the designational age of the babies. Um, and still, even after delivery, moms are still at risk for preclamtic symptoms and problems. So the blood pressure may take days or weeks to kind of normalize and will still be watched pretty closely by a provider. So it's important to let people know, right? Talk about it, say let people know how you're feeling um before, during, and after. And they're going to be keeping pretty close tabs on people who are um experiencing these. So prevention is um in the second trimester, and this is something you would work on with a provider. It's not something you really choose to do yourself, but work closely with a provider. Low dose aspirin for at-risk pregnancies, regular prenatal care, obviously, to check the early signs. Um, and then one thing you can do prior to even becoming pregnant, um, have balanced nutrition and good physical activity and healthy weight management. Those are going to be some efforts that you can make previous to um even getting pregnant that can help with that. And I have honestly seen, um, because this can come up so quickly, I have seen this happen in professional athletes. I've had clients who are Olympians and they have experienced preclampsia. And so these are individuals who are incredibly fit and incredibly healthy. So it's not all, like I said, everyone's at risk for preclampsia, everyone and anyone. And the mystery to me now is why do the rates seem to be going up? And I know in within our industry, they're kind of taking a look at that, seeing what we can do because it's pretty um, pretty dangerous and pretty costly to the systems and obviously to people's lives, incredibly disruptive and makes and it's and scary, right? It's pretty scary. So after someone has preclampsia, they do have a higher risk of heart disease, stroke, and blood pressure, high blood pressure later on in life, and it may um include be their risk of getting it in a future pregnancy goes up by about 20%. Um, so kind of the the take-home message here is it's common and it's serious, but with watchful care, lives can be saved. I've had a couple of clients this year who are planning um home births, like they're planning a home birth, they were low risk, they low risk categories in every way, and which you have to be for home birth, and they risked out of home birth like in like week 20 um to 27 because they're they were starting to detect some creeping up blood pressures. Um, and one mom had to be had to have a very fast section upon arrival when she was experiencing a lot of symptoms at um the hospital. Another one had to be admitted to the hospital, transfer out of home birth care, and she was in the hospital about a week before she she delivered vaginally, but they kind of watched to see a safe time. We've got that baby as old as we could and as big as we could before um choosing to induce labor. And that baby was in the NICU for a while. He came home not too long ago, and um, so that was a different journey, obviously, than that that family was planning on taking. So this, you know, is something to be aware of. And I want to talk a little bit about um some preventative things. It cannot always be prevented, and sometimes it just pops up without any clear warning signs at all. But there are things that anyone can do to lower the risk and or to catch it early. One of them is prenatal care, just get real good prenatal care. Some people like, ah, I'm feeling great, I'm healthy, I'm young, I've done this before, whatever the case may be. But prenatal care um is uh like regular prenatal care is going to be helpful to um detect any early signs. Work with your provider to see if you have certain risk factors, if low-dose aspirin, that's an easy little easy fix. And it's not a fix, it's an easy help, right? Um, that lowers the risk of developing pre-clampsia. Um, entering pregnancy at a healthy weight and gaining an appropriate amount of weight during pregnancy, right? So that comes with um, and then you know, we all start pregnancy in different places for sure, but going into a healthy can impact um healthy outcomes or unhealthy outcomes. So having a diet balanced and rich fruit, you know, fruits, vegetables, proteins, whole grains, all of our whole foods are going to be helpful, limiting processed foods, limiting excess salt, limiting sugar, um, kind of like anyone would do to eat for healthy blood pressure. And then managing chronic conditions. If you have any chronic conditions, hypertension, diabetes, autoimmune disorders, right? That if you're going into pregnancy, um, make sure those are pretty well under control. There was one client I had uh a few years ago, and she probably the earliest and one of the most interesting and perhaps severe cases, she got preclamtic symptoms at week 17. So kind of early as they said we can't even diagnose you with this, although she had crazy high blood pressures at week 17. Um, we can't diagnose you with this until after week 20. Sure enough, after week 20, she had these high blood pressures. They monitored her very closely throughout her entire pregnancy and watched carefully to see when would be the best time to deliver her baby. So her baby was delivered a little bit early, but not too much. Um, so that was her second pregnancy. And then a couple years later, um, well, she actually uh, you know, as she knew the risks throughout her life, um, she contemplated whether she should have another pregnancy, first of all. Um, but what she did was change some lifestyle things and got into really good shape. Um, she did a lot of diet changes and exercising. She and her partner ran like a half marathon together. She trained for some triathlons between. I'm not saying you need to do that, but she made some pretty good changes in her life and she was in really, really good shape when a couple years later she did indeed decide to have another pregnancy. And as luck would have it, she became pregnant with twins. Total surprise. I remember they called me um the day, well, the day after the day that they found out they called me after their doctor's appointment. And they're like, guess what? You were never gonna guess. Um, but they had twins, they were having twins, they were in shock for a while, as you can imagine, and the risk for clampsia goes up with multiples. She was working with a fabulous MFM, an amazing doctor, who helped her throughout this next pregnancy. And you know what? Twins. Um, she was obviously a little bit older, she wasn't in an old category by any means. I think she was in her early 30s by this point. Um, that was the healthiest pregnancy of her three pregnancies, and she delivered healthy baby girl twins, um, much closer to their due date than um we had first anticipated. So pretty exciting, like success story there, which is awesome. So manage those conditions. Regular, moderate physical exercise, like walking, swimming, prenatal yoga can just help keep blood pressure steady. Um, so go into pregnancy if you are able to and in a good healthy state, healthy for you. Um, and obviously work with the provider to know if it's safe to do these things if you're pregnant or have other conditions. Know your family history. Know that like ask questions of your sisters, moms, um, any close relatives who have blood relatives who have had babies and see what their um experience was like. And then in some parts of the world, calcium intake is low. So supplements have been shown. Um, calcium supplements have been shown to reduce the risk of preclampsia. So definitely do that with a doctor as well. So while we can't completely prevent it, we can reduce risk and catch this early. Um, so work very carefully with your healthcare team. That's going to be one of the best protections that you can. So there is some power. There's some powerful ways to reduce the risk of things that are in your control. Um, catching it early is one, but doing best you can to avoid it is important. Um so those with multiples, diabetes, high blood pressure, um, work closely again with your provider. Maybe you use aspirin or calcium supplement that can re reduce risk by up to 20%. Um Wow, pre-clampsia, that's a lot. It's still um a mystery to me, and I think to a lot of people right here right here in our right here, right now, um why this is happening so much. I was at uh birth not too long ago. Um, and we're I was talking to the charge nurse out in the hall. She's like, man, I got so many medicals going on, and all these people with preclampsia. And so that causes inductions, that can be a little bit longer, it can cause little complications at birth with baby. Um, and she's like, honestly, my whole nursing staff is not, um, that's kind of a young staff that's on tonight, and they don't have all um of the deep experience and skills that I wish we had tonight because of what we've got going on. So please do your best to take care of yourself. Um, just as a quick little wrap-up and checklist. Remember, we can't always prevent it, but we can reduce risks. Prenatal visits help us catch it early and then be able to manage it. Know your risk factors, do the best you can to control them um with lowering, lowering those risk factors. Well, try not to have twins. Just kidding, you can have twins if you want to, but and we know that going into having diabetes, type one or type two, um, having high blood pressure, chronic hypertension, carrying multiples, sometimes being over 35, all those can be risk factors. Um, so watch extra careful. Uh, know the warning signs. That's why they ask about headaches, vision changes, sudden swelling or pain. Um, if something feels off, like trust it, trust your gut and and talk to your proprietor about that. Um, know that you can work on this. Um, and your own, you have the power to work on this for yourself and for your health, for your baby's health as well. Um, I mean this is something I'm gonna continue to watch. It's piqued my interest for several years in my career, something I will continue to watch and look at studies and um see what comes out and how uh like it's a little bit of a mystery for us to solve, um, how we can continue to reduce risks because sometimes this one surprises us. It really does, and it has some pretty big effects. Hopefully, this has been helpful to you. Um, if you're in pregnancy or know somebody who is or supporting someone who is, um, help them to manage those risk factors and or support them through the hard times, right? Sometimes when this crops up, um people are surprised. Obviously, they're they're quite quite surprised, and it can be a challenge. So give appropriate support, compassionate support um around the situations that are challenging. Um thank you so much. I want to thank you for being here today with the Ordinary Deal Podcast. Your listens mean so much to us. Um, I want you to try and make a human connection today. If you can reach out, touch someone, whether that's virtually eye contact, really grab hold of someone with your own hands, give them a hug. Um, that it will be important to make that human connection. Uh people need that. We all we all need each other. Hope you have a great day, and we will see you next time on the Ordinary Doula Podcast.

SPEAKER_00:

Episode credits will be in the show notes. Next time, as we continue to explore the many aspects of giving birth.