Welcome to the world Baby R! I am writing my reflections on my pregnancy and the birth of my daughter both for my own reflection and memory, and as a piece on my lived experience with gestational hypertension for anyone who may be experiencing this condition during their pregnancy, that it may serve to inform and reassure or affirm their experiences.
The first thing I want to acknowledge is that my pregnancy with Bub was the most beautiful thing I’ve ever experienced, right up to the end. My first and second trimesters were largely uneventful and easy following an intuitive conception, and while I worked through some of the usual early morning sickness and fatigue, I found my changing body to be the most beautiful thing in the world. My various symptoms were largely easily managed, and all positive signs of a healthy pregnancy and a growing baby. I will always miss being pregnant. I loved the early flutters, the kicks that grew more distinct, and watching my belly grow. As I rounded my second trimester, and the insomnia and crazy dreams came back, so too emerged some of the more challenging aspects of growing a tiny human – transient hip pain, disturbed sleep, and the big one – gestational hypertension (GH).
Prior to having Bub, I had always skirted at the ‘high end of average’ in regards to my blood pressure, however had never required medication to manage. There may be a genetic component to hypertension within my family as various family members are currently medicated for high blood pressure. My blood pressure was monitored by my obstetrician throughout my pregnancy and while it remained at this ‘slightly higher end of normal’ range for the first and second trimesters, it was not particularly on my or my husbands radar as a condition that would escalate during my third trimester. In fact, I had expected that another pre-pregnancy condition (total thyroidectomy requiring full thyroid hormone replacement) would be more difficult to manage during pregnancy – turns out, other than a few minor dose adjustments to my thyroid medication, my former thyroid issues were not a cause for concern or much attention at all during my pregnancy.
As I entered my third trimester, my blood pressure was monitored at my fortnightly obstetrician appointments. We discovered that it was consistently on the rise. My obstetrician would take both automatic and manual readings over multiple times during my appointment, with my blood pressure reading ranging within 130-135 systolic, and 85-95 diastolic. Due to these readings, I was diagnosed with gestational hypertension. It is here that I would like to share the most frustrating aspect of living with gestational hypertension – that I never experienced any symptoms whatsoever. I was completely asymptomatic of traditional hypertensive symptoms. No blurred vision, no headaches, no dizziness, no tight head, no pounding heart. The only complaint I had from 28 weeks pregnant was a significant fatigue. I put this down to normal third trimester symptoms (and still feel that a lot of the fatigue was normal pregnancy-related fatigue) but during this time I also started to notice an increase in fluid retention in my face and legs, which was possibly the start of my body letting me know that my blood pressure was on the rise. I had purchased an at-home blood pressure monitor and took readings daily. I could see that my levels were consistently elevated. I had planned to work up to 36 weeks but knew that medical clearance would be required to work beyond 34 weeks.
At my 33 week obstetrician appointment, my blood pressure read 150/100. My obstetrician requested I attend hospital to be monitored, and on arrival to hospital, I was immediately attended to within the pregnancy assessment unit. Over the next several hours, the baby and I were monitored, and my blood pressure escalated further. I was loaded with oral and intravenous antihypertensive medication in quick succession, and following several hours and a MET call later, my blood pressure reduced to an acceptable level. I was admitted to hospital for three days and commenced on regular Labetalol – now medicated for the first time in my life, and instructed to start maternity leave effective immediately. In hindsight, this was a timely blessing given Bub would arrive 3 weeks early. Over the next three weeks, my blood pressure was monitored at my weekly obstetrician appointments and remained elevated but not dangerous. I also continued to monitor it at home. Blood and urine samples indicated I was not in the realm of pre-eclampsia but a scan of Bub at 35 weeks showed she was likely to be born as a smaller birth weight and options around delivery were discussed. Induction and epidural was recommended to deliver bub prior to 40 weeks in the setting of hypertension, and I was advised that an epidural would likely assist with reducing blood pressure during labour. I was open to all scenarios for delivery with a focus on the safety of the baby and myself.
At my antenatal visit at 37 weeks, my blood pressure was 150/100 despite 600 mg daily of Labetalol. My pathology results also showed that I had entered into pre-eclampsia. A decision was made to proceed with induction that evening and I was admitted to hospital. The following morning, my waters were broken, and I was induced into a 7.5 hour labour, complicated by a partially ineffective epidural (I had breakthrough pain on my left side). My blood pressure remained elevated throughout labour, and after Bubs trace showed that her heart rate was slower to recover following contractions, a decision was made for emergency Caesarean. In the half hour that followed, and the whirlwind of emotions and physical interventions that ensued, our daughter was safely and happily delivered into this world. After our skin on skin time, my husband and Baby R went to recovery, while I was finishing in surgery. Through the combination of surgery and medication, my blood pressure took a nose dive whilst I was on the operating table, and I become very ill which persisted for a few hours beyond delivery. As is the nature with hypertensive disorders of pregnancy, later that evening, approximately 5 hours after delivery, my blood pressure soared once more, requiring another MET call, and a high load of oral antihypertensives in quick succession. Due to this load of medication, the following morning saw me unable to sit up in bed as my blood pressure plummeted too low. This yoyo of pressures would persist for days after giving birth. Our daughter had been transferred to special care for management of low blood sugar due to her small birth weight, and being unable to visit her due to feeling so ill was one of my greatest challenges.
At the point of discharging from hospital, I remained on both Labetalol and Enalapril. As I write this 3 weeks after giving birth, I remain on Enalapril, hoping to wean from it within 3-4 more weeks. My blood pressure has started to stabilise slowly, sometimes taking a plummet to the point of being too low, whilst my medications are adjusted. Pre-eclampsia can persist beyond giving birth and persistent blood pressure issues do make recovery from childbirth more of a challenge.
When I was pregnant, I found only one good blog post written from a personal perspective on living with gestational hypertension. I want to share my story in the hope that it may inform and encourage other women with GH. The truth of it is – I never felt sick during my pregnancy. I felt alive, full of joy, full of hope, and generally well. I have had people tell me I was sick. This was not my experience. On paper, I had gestational hypertension. I am all too aware of the severity and nature of very serious complications for mother and baby as a result of this condition, and I was one of the luckier ones. But I was not discouraged, nor overcome with symptoms or the condition itself. With excellent medical management and so much support from my wonderful husband I carried a healthy baby girl to term and am in awe of what my body did for us both – I considered myself otherwise to have had a healthy pregnancy, and would do it again in a heartbeat. My pregnancy was a glorious chapter in my life and my memory of it will be one of connection to my baby and my own abilities, and a body that was able to achieve so much.
I write this because I feel there is a scarcity of information out there about lived experiences with GH. There are also a heck of a lot of misconceptions about what causes or contributes to a woman developing hypertension in pregnancy. Common sense tells us that poor diet, lifestyle and excessive stress aren’t good for anyone and naturally increase the risk of a person developing a hypertensive disorder at any point in life. There are genetic, medical and individual risk factors for the development and progression of GH and pre-eclampsia and I am not a medical professional, however, I know a few things about my experience for certain. Stress did not induce my GH. Being told to keep calm, while well-intentioned, was one of the least useful things anyone could say to me. There were sometimes implications that I had more control over my hypertension than I did, and I found this a real challenge to shake off. It can be a very isolating experience to be told you have a medical condition that requires medical support, while you look and feel otherwise very well, and for you to do everything in your power to take care of yourself (including in my case eating well, eliminating caffeine and consciously choosing a low-stress and slow lifestyle) whilst people are telling you to ‘just stress less’. GH is not something we have control over. We can positively influence our outcomes through good choices but we can’t get rid of it or fix it. We can’t bring our blood pressure down with a few deep breaths or happy thoughts. GH is a pervasive condition which can only be optimally managed. And following the advice of your medical professional is paramount. As is taking your medication, getting your blood and urine workups done in a timely way, and monitoring your symptoms and as appropriate your blood pressure at home (I used an Omron HEM-7600T device which syncs to an app on your phone). Ultimately, gestational hypertension is not the fault of the woman, but does make for an opportunity for an empowered pregnancy and delivery.
Looking ahead, I hope to wean from my blood pressure medication when the time is right. I feel supported and empowered to enter into any future pregnancies, if my husband and I decide to go down that path, with the knowledge of my predisposition to gestational hypertension and pre-eclampsia, and strategies to actively manage this for the same good outcomes I was able to enjoy for this pregnancy. I look forward to supporting other women facing similar challenges and hope that even one other person can take encouragement from my story if they are facing a diagnosis of gestational hypertension. At the end of the day, you are capable of far more than you think.