She finally called the OB on-call at her practice and he had her go to the hospital immediately.

Phew.

Then he sent her home! No 24 hour urine collection! No blood draw for a HELLP panel!

I am freaking out. Not happy at all with the practice. Trying not to go insane trying to micro-manage her medical care from a distance.

The Unspeakable

I realize that I am a traumatized, over-informed, very anxious person when I find out that someone I love is pregnant and starting to experience the early signs of preeclampsia.

I can't help it. I have looked into the eyes of women who have lost their babies, aging parents who have lost their daughters and are raising their young grandchildren, men who are partnerless and childless, doctors who have lost patients and sweat they'll never let another woman die. Women and babies are still dying from preeclampsia all over the world, and in this country. I am not crazy to worry about the unspeakable.

My sister reluctantly told me today that her blood pressure has continued to be elevated since her OB appointment two days ago. It's not a fluke. She is continuing to have headaches and dizziness, as well as just feeling sort of crappy, otherwise known as "general malaise." I know she is tired of being the little sister getting bossed around by her older sister, but I can't help but plead with her to call her OB or go to the emergency room for testing.

I am angry that the nurse practitioner she saw on Wednesday didn't give her a jug for a 24 hour urine collection, or do a blood draw. She is at a higher risk for preeclampsia than the typical pregnant woman, thanks to me. :( I just feel like they're not taking this seriously enough, and I have heard way too many tragic stories not to step in.

I sent my sister and brother-in-law this email (and remember I am not a medical professional, so this advice is not official medical advice):

I am sending this email because most healthcare providers are not aware of the cutting edge research and recommendations regarding the treatment of pre-e and women have to self-advocate for good care. There is NO diagnostic test for preeclapmsia. It is a vague set of symptoms that often vary from woman-to-woman with some common threads, so often "diagnosis" is murky and confusing and the symptoms are hard for OBs to put their fingers on. The common thread of symptoms often includes:

• hypertension (140/90)
• higher than usual blood pressure
• headaches
• dizziness
• seeing small white spots
• swelling or retaining water, usually more noticeable in your feet and face
• tingling of your extremities
• general malaise, or just feeling sorta crappy but not sick
• nausea and/or vomiting after your first trimester
• ongoing diarrhea
• upper abdominal pain, sometimes in the right quadrant, sometimes in the middle
• back pain
• any "lap band pain" that is not super low in your belly
• shoulder cramps and/or pain, especially in the right side - kind of like a running cramp
• proteinuria (kidneys spilling protein - important to note that the standard urine tests at the OB's office will only pick up MAJOR protein dumping, so you need both a 24 hour urine collection asap and a uric acid test - see below)
• eyes start to look funny
• weight gain that is unusual, ie more than a pound a week, at any point during pregnancy

First, my immediate recommendations for TODAY, other than relaxing on your left side and drinking tons of water and dandelion root tea:

• If you take your bp and it is above 140 systolic OR 90 diastolic, please page your OB immediately and let her know that you've be "trending hypertensive since Wednesday and having other preeclamptic symptoms, including headaches, dizziness and swelling." Ask her for admittance to thehospital for 24 hour observation of urine/protein and blood draws for liver function, platelet count and anemia.
• If you're staying just under 140/90, stay on your left side and take your bp 1x every 4 hours. If it continues to trend into the hypertensive range with EITHER top or bottom number, follow the instructions in the first bullet. 
• If bp stays just under hypertensive range, note a change in any other symptoms and if you have any additional symptoms, page your OB and follow bullet point #1.
• If you are still home tomorrow, please call your OB's office and ask for a 24 hour protein collection pitcher. If you have a Qwest lab (or other lab) open on a Sunday, you can go and get an orange collection tub from them. If you know which lab your OB uses, go there and get one and start your collection with your first pee AFTER your initial morning pee. You need to get this urine collected Monday, turned in to the lab by Tuesday late morning, and results by Wednesday afternoon. But keep in mind that any other pre-e symptoms, such as hypertensive BP trumps the urine collection and you go back to bullet point #1.
• Also you should probably go ahead with a blood draw tomorrow at your OB's office for liver function, platelet count and anemia. 
• If your OB does not agree to test your 24 urine count or draw your blood TOMORROW, please go to the ER or call another practice. This is not time to worry about the emotional, relational part of your OB experience. This is a matter of life and death. If I could do it over again, I'd have had Brian take me to the ER the night I was having liver spasms and my midwife just told me to rest and come in to her office in the morning. 
• Make sure your hospital bag is packed, and have the very basics for the baby ready at home (4 swaddling blankets, 5 of your smallest onesies, baby hats, nursing pillow and a place to lay the baby down) They'll give you preemie diapers at the hospital so you don't need those right away, and the cloth ones we gave you are preemie/NB sized too.
• Call us if anything happens at any time of day/night and we'll help you with next steps related to thehospital, such as the magnesium sulfate issue, c-section stuff, etc. 
• Dave, you need to watch a c-section video on babycenter just in case she needs an emergency c-section otherwise they will not let you in the OR. She will need you. There is a small chance they'll give her the mag and induce her with pitocin and she'll be able to birth vaginally, but it's important to start to understand the c-section issues preemptively.

For other wonderful, comprehensive info, please visit http://www.preeclampsia.org/

I also recommend reading birth stories on this site.

The Story Begins

Today my sister called and told me her blood pressure was 140/75.


We both silently weighed the gravity of that information. 


I paced nervously around the house, probably twirling my hair, thoughts spinning very quickly into the worst case scenario. Thinking back to it, I imagine my sister was lying down on the couch when she told me, a hand reassuringly cradling her pregnant belly, the worry lines in her forehead more pronounced than in her usual serious expression. 


I could imagine the thoughts and feelings flooding her .. Is the baby ok? Is this really happening? Did the nurse make a mistake when she took my blood pressure?


And I could imagine the question that she hadn't yet allowed.. Is there any way that what happened to my sister is going to happen to me too?

I could imagine this scene and its swirling thoughts and feelings because I'd had many of them exactly 4 years ago when I was pregnant for the first time and slowly beginning the descent into severe preeclampsia and HELLP syndrome. 

There are things you are supposed to share with your sister. Jeans, first cars, favorite bands, stories we'll never tell our parents. But not this. Not preeclampsia.