As an educator, doula, nurse, or lactation professional, how many times have you heard that birth cures preeclampsia? Is this true?
A cure is “a complete or permanent solution or remedy; a recovery or relief from disease” (Merriam-Webster, 2013, para 1). As the following quote details, preeclampsia does not always just disappear with the birth of the baby (and placenta). “Delivery does not eliminate the risk for preeclampsia and its complications. Efforts should be directed at the continued monitoring, reporting, and evaluating of the symptoms of preeclampsia during the postpartum period” (Matthys, et al., 2004, p. 1464).
So what are the risk factors?
Risk factors of postpartum preeclampsia (PPPE) include preeclampsia during pregnancy, cesarean delivery (in the most recent birth), gestational hypertension, pre-existing hypertension, a family history of preeclampsia, obesity, teen pregnancy, or advanced maternal age (Preeclampsia Foundation, 2013). Although pregnancy preeclampsia is a risk factor, many women (greater than 60%) do not have symptoms during pregnancy (Al-Safi, et al., 2011). In addition, Sibai’s article (2012) specifies that medications such as Ergotomine, ephedrine, ibuprophen and other NSAIDs, plus large volumes of fluid, can push women into a hypertensive/preeclamptic state after delivery. It is especially true when woman have had large or frequent doses.
When women take some of the over-the-counter medicines listed above to alleviate symptoms (such as headache or abdominal pain), they may unknowingly exacerbate the problem. So what are the symptoms? The most common symptom (69%) for PPPE is headache (Al-Safi, et al., 2011). Symptoms of postpartum preeclampsia include headache, change in vision, dizziness, high blood pressure, protein in the urine and decreased urination, upper abdominal pain, weight gain, and swelling (Mayo Clinic, 2012; Yancey, et al., 2011). The symptoms in the postpartum period are not always the quartet of classic symptoms, exaggerated reflexes, high blood pressure, swelling, and protein in the urine, seen during pregnancy, but they tend to be headache, vision changes, high blood pressure, and seizure (Yancey, et al., 2011).
When symptoms go unnoticed and severe preeclampsia is left untreated, it can progress into eclampsia, HELLP, stroke, disseminated intravascular coagulation, organ failure, or death. Of the deaths that occur because of preeclampsia, 80% occur in the postpartum period (Preeclampsia Foundation, 2013). Researchers believe that the higher mortality stems from lack of education, the amount of time between postpartum visits, sleep deprivation, post-partum depression, and focus on the newborn, which leads to missing the presenting symptoms (Preeclampsia Foundation, 2013; Simbai, 2012).
While it seems that preeclampsia during pregnancy is decreasing, postpartum preeclampsia is increasing (Lim and Steinberg, 2013). Postpartum hypertension and preeclampsia rates range from 0.3-27.5% (Sibai, 2012). Most PPPE cases happen within one week of delivery (Al-Safi, et al., 2011). Normally it occurs within the first 48 hours after birth, but late postpartum preeclampsia can occur up to 6 weeks after birth (Mayo Clinic, 2012). Women with preeclampsia during pregnancy can have a reoccurrence at around 3-6 days or 4 weeks (Sibai, 2012). Simbai (2012) points out that it is hard to track the exact prevalence because new mothers rarely have their blood pressures checked between birth and their first postpartum visits. Also, postpartum women with presenting symptoms may be seen in the emergency room.
What can childbirth professionals do?
If you work with women prenatally as a childbirth educator, educate women and their support people to report symptoms to their care providers. Numerous studies have pointed out that education is important so that women identify their symptoms and get prompt attention. So what can you do if you work with postpartum women? Know the symptoms and educate new parents as well. If any of your new moms experience symptoms, have them call their care providers right away. Inform moms to tell their providers about all of their symptoms and medications they are taking (over-the-counter, as well as herbal). If a mother had preeclampsia during pregnancy, teach her (and her partner/family) to be aware of any postpartum symptoms. Be aware of the resources available. If a mom needs in-hospital treatment, what resources are available? What about her new baby, what about her other children, can she breastfeed? Postpartum doulas have to be acutely aware of PPPE because of their extended contact with postpartum women.
The cure for preeclampsia, as reinforced by the Preeclampsia Foundation, starts with birth.
Postpartum symptoms must be identified and quickly addressed. For the woman to return to health, care-providers must follow her closely in the postpartum period. Because many CAPPA members work closely with postpartum women, they have an opportunity to help women to identify and recover from postpartum preeclampsia.
By Brenda Bach, CCCE
Copyright CAPPA 2015
-Al-Safi, Z., Imudia, A., Filetti, L., Hobson, D., Bahado-Singh, R. & Awonuga, A. (2011). Delayed postpartum preeclampsia and eclampsia demographics, clinical course and complications. Obstetrics & Gynecology 2011; 118: 1102-1107.
-Lim, K. & Steinberg, G. (May 2013). Preeclampsia. Retrieved 6/4/13 from http://emedicine.medscape.com/article/1476919-overview.
-Matthys, L., Coppage, K., Lambers, D., Barton, J. & Simbai, B. (2004). Delayed postpartum preeclampsia: An experience of 151 cases. American Journal of Obstetrics and Gynecology. 190 (5), 1464-6.
-Merriam-Webster. (2013). Cure. Retrieved 6/4/13 from http://www.merriam-webster.com/dictionary/cure
-Mayo Clinic. (2012, May 26). Postpartum preeclampsia. Retrieved 6/4/13 from Mayoclinic.com. http://www.mayoclinic.com/health/postpartum-preeclampsia/DS01199/DSECTION=symptoms
-Munjuluri, N. (2005). Postpartum eclampsia of late onset. British Medical Journal. 331, 1070.
-Preeclampsia Foundation. (2013). FAQ’s. Retrieved 6/4/13 from http://www.preeclampsia.org/health-information/faq#eleven
-Simbai, B. (2012). Etiology and management of postpartum hypertension- preeclampsia. American Journal of Obstetrics & Gynecology. 206 (6), 470-75. Retrieved 6/4/13 from http://www.ajog.org/article/S0002-9378(11)01155-0/fulltext
-Yancey, L., Withers, E., Bakes, K., & Abbott, J. (2011). Postpartum preeclampsia: Emergency department presentation and management. Journal of Emergency Medicine. 40(4), 380-4.