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HELPP syndrome postpartum preeclampsia

Two Cesarean Births, Postpartum Preeclampsia, HELPP Syndrome, and Advocating for Yourself Postpartum

Katy’s 1st Birth

Katy’s first pregnancy occurred after 18 months of trying to conceive. She and her husband had just started exploration into fertility troubleshooting when they became pregnant. The pregnancy was initially normal and healthy, and Katy stayed very active throughout, walking regularly and attending ballet class once a week. So, Katy was surprised to learn she had gestational diabetes which could not be controlled through diet, despite very strict adherence to a conservative meal plan. When the doctor explained that gestational diabetes is impacted by the placenta, Katy’s sweets-loving husband started calling the organ the “candy cane placenta”. Indeed, there were no candy canes for Katy as she took her Metformin and tested her blood sugar throughout the holiday season. 

Due to her son’s large measured size, as well as her age and the GD, the doctors decided to induce Katy at 39 weeks. Katy’s labor was not as physical as she had hoped for – due to the GD, she had to stay hooked to monitors, and at one point had six liquid drips in her body. However, the hospital staff was incredibly supportive, and she received immense, kind attention. Katy labored for 30 hours, including 18 hours unmedicated (it was a birth hour podcast episode that helped her decide to get an epidural!). Katy pushed for three hours, but her son’s 98th percentile head couldn’t make it past her pelvic bone, so she agreed to a C-section. While this result was disappointing, it was made better by the doctor agreeing to let both Katy’s husband and her sister be in the operating room when her son was born. 

After the delivery, Katy was exhausted and very anxious. She had a hard time sleeping and struggled with feelings of failure when her son had a hard time latching and her milk supply was insufficient. She was also very swollen after all the liquids pumped into her body.

After returning home, Katy mentioned to her husband another birth hour podcast she remembered where a woman had postpartum preeclampsia. This prompted her husband to go out and get a blood pressure monitor, through which they discovered that Katy was, in fact, developing high blood pressure. Per her doctor’s instructions, she returned to the emergency room when her blood pressure got too high, and was readmitted for postpartum preeclampsia. Katy stayed in the hospital several more days for treatment with  magnesium drip and water pills until the issue cleared. She had no lasting health effects and was able to pump and send milk to her son during the treatment, who gobbled it down along with a massive amount of formula for the rest of his babyhood. That same baby boy is now a very healthy and active six year old (whose head is still in the 90th percentile!).

Katy’s 2nd Birth

Katy’s second pregnancy conception came more readily than the first one, likely due to the more relaxed environment of being on furlough from work and living the largely home-focused life of 2020. While the world was experiencing a very uncertain and unprecedented time, Katy enjoyed the silver lining of being able to navigate the first trimester largely from her couch, with a supportive husband around full-time to care for their toddler aged son. Katy was recalled to full-time, in person work at the start of her second trimester, thankfully never contracting any illness. Because of her history, Katy took the three hour Gestational Diabetes test as soon as she was able. Katy’s doctors warned her that a second occurrence of gestational diabetes was likely, but Katy was delighted to learn that her glucose was normal! (Though largely craving vegetables throughout the pregnancy, Katy celebrated on that day by baking a pie and eating the entire thing over the span of a week.)

The rest of the pregnancy proceeded along beautifully, with Katy receiving check ups by MFM due to her age. Though her baby girl was measuring much smaller than her son, Katy ultimately elected to do a repeat C-section instead of try for a VBAC. Her doctor suggested her participation in an ERAS (Enhanced Recovery After Surgery) program, which was in trials at her hospital. Katy glided into surgery well rested and photo ready, delivering a sweet and sleepy baby girl (who nursed right away as the doctors closed after surgery).

The ERAS protocol worked beautifully, and for the first two days after surgery, Katy felt strong, healthy, and continued to sleep well. However, on day 3, Katy noticed swelling in her thighs that was making her skin feel tight. She also noticed that she was beginning to get some lower back pain and was feeling nauseous. And most importantly, her blood pressure was starting to increase. She spoke with the discharging doctor – the one provider from her practice she did not care for – and he explained that they look at the ankles and calves for swelling and that her thigh swelling was considered normal. He also said her blood pressure was within healthy limits and she shouldn’t be concerned, and discharged her that afternoon.

Katy continued to monitor her blood pressure at home, returning to the hospital that evening when it spiked to dangerous levels. The same doctor, still on duty, reviewed her labs and suggested she just needed some rest and a postpartum anxiety support group and sent her home again. Katy spent the rest of the weekend unable to sleep or keep food down due to nausea and a growing sense of panic. She called her OBGYN practice first thing Monday morning and after a brief afternoon visit, was sent back to the ER. By this point, she was so swollen, it was difficult to take her blood to confirm postpartum preeclampsia, but her primary delivering doctor was back on duty and admitted her and ordered a magnesium drip while the blood work was finally being run. Shortly after Katy started the magnesium drip, the doctor urgently entered the room and ordered it stopped. He explained to an increasingly delirious Katy that she in fact had complications due to HELLP, was in kidney and liver disfunction, and he called rapid response. Katy was transported to the ICU, where she remained for five days while doctors attempted to stop the issues with her circulatory system and get her levels back in order. She eventually recovered enough to be transferred to a PCU, and received special permission to see her daughter, who had been kept at home due to Covid protocols. She was shocked that after so much time, her daughter still readily wanted to nurse. Katy was discharged shortly afterward and miraculously made a full recovery from her issues. She filed a formal complaint against the doctor who sent her home twice and actively advises pregnant mothers to listen to their gut and advocate for themselves, even in their most vulnerable moments. After navigating some standard tongue tie revisions and speech therapy to improve latch, her daughter nursed exclusively until she was two and now is a petite, delightful, feisty 3 and 1/2 year old. 

Katy Thomas Slack Bio

Katy is an engineer, manager, wife, and mother of two living in Orlando, Florida. She enjoys dancing, singing, helping in her community, going to the beach, and traveling (especially to her home state of Texas!). Most of all, she loves spending time with her family watching her two children blossom and grow. Katy is the cofounder of a small but mighty moms’ support group specifically for Moms in engineering, and is passionate about supporting young mothers in technical fields. Katy is passionate about women having safe and practical access to reproductive care as well as control of their choices regarding unplanned pregnancy, as she now knows a third pregnancy would be fatal for her.

Resources

Motif Medical

This episode was sponsored by Motif Medical. Motif designs insurance-eligible products for busy moms. With a focus on innovation and empowerment, Motif’s line of breast pumps and maternity compression garments are sophisticated, yet discreet, and made to support mothers as they navigate new motherhood. Discover why moms are reporting more milk in less time with Motif’s Luna breast pump, AND how Motif’s Aura Glow wearable pump can give you flexibility in your pumping routine. Plus, see how you can get your pump covered through insurance at motifmedical.com/birthhour

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