Even though I’m a doctor, I thought the stress of pregnancy would end after giving birth. A week later, I was back in the hospital. With blood pressures approaching the danger zone, I was diagnosed with a pregnancy disorder putting women at risk for seizure, stroke, or death.
The day after giving birth to my son, I was medically cleared by the doctor who delivered me. I ended up staying two nights, grateful for the postpartum nurses who helped soothe and bathe our baby after the exhaustion of a long labor. When I was ready to leave, paperwork in hand, the nurse checked my blood pressure.
The cuff squeezed my arm and deflated. I was impatient and highly attuned, the way new mothers can be. “What’s the number?” I asked, for no reason except that the machine was turned away from me and I felt an urge to know. “135/70,” my nurse said. “Not bad.”
“Hmm,” I made a noise. “That’s a lot higher than I’ve been so far.” The doctor in me couldn’t help but notice an aberration to the trend.
“Would you like me to let the OB know?”
“Sure,” I said wearily. But my doctor never came to my bedside. Through the nurse, he recommended that I check my blood pressure when I go home and ordered a cuff for me. My insurance didn’t cover it, so then he suggested some blood tests which I declined because by that point, I was ready to go home and didn’t want to stick around for tests that were only being ordered because of something I’d pointed out.
“Don’t worry about the cuff,” I told my nurse. “I’ll get one. I’ll check.”
No one told me how soon to check my blood pressure, how often, or what other symptoms to look out for.
Back home, I forgot about his passing remark, busy figuring out how to breastfeed, worrying about jaundice, marveling at my baby’s fingers and toes, trying to nap when he did. On my fifth day postpartum, my father brought me his blood pressure cuff and reminded me of what the doctor had said. He held the baby while I went to another room to check. The numbers were alarming: 190/95. I rechecked on the other arm: 185/100. I hoped these were falsely elevated.
That night I slept fitfully and checked again in the morning. I felt no symptoms—or none that I could identify through the haze of tiredness. A person without a medical background may not even have known to worry, or to recheck. As a doctor, I realized that these numbers could indicate severe pre-eclampsia. But as a mom who wanted to focus on her new baby, I was in denial.
A fellow doctor-mom friend sternly talked me into messaging the on-call obstetrician. The OB called back right away and admitted me to the hospital, telling me not to delay and asking me to text her when I arrived at the unit. Behind the cool liquid of her voice, I could detect panic. She put me on a continuous infusion of IV magnesium—to prevent seizures or neurological complications—as well as high, frequent doses of blood pressure medications. The side effects of the magnesium were awful. I felt dizzy and weak, with a dry mouth and blurry vision. But I was grateful to be admitted, knowing that severe preeclampsia could lead to seizures, strokes, even death.
While most cases of preeclampsia arise in pregnancy, it turns out my experience of having a healthy pregnancy with normal blood pressures and being diagnosed after delivery is not uncommon: at least 10 to 20 percent of preeclampsia cases happen afterwomen give birth, like mine did. And yet, while pregnancy is accompanied by frequent doctors’ visits and the injunction to take care of your body, the period after birth is a medical abyss. Take for example the six-week checkup, which comes far too late after giving birth, and feels cursory and optional. Two in five moms don’t even make it to the appointment.
Experiencing this complication terrified me and interrupted my bonding with my seven-day-old son. But most of all made me angry. With skyrocketing maternal mortality in this country, and more than eighty percent of cases of maternal deaths preventable, we need to do better. Preeclampsia affects one in 25 pregnancies in the U.S. and is the second most common cause of maternal death worldwide, after bleeding.
About half of maternal deaths occur within the first year after delivery, and the first few days may be the most critical. The situation is even more alarming for minority women. Maternal mortality in this country disproportionately affects Black women. A study of pregnancy-induced high blood pressure found that Black women have higher rates of preeclampsia and higher maternal mortality; and Asian/Pacific Islander women with high blood pressure have an increased risk of cardiovascular complications during delivery.
It’s time to get back to the basics. Counseling after giving birth on potential risks and precautions. Monitoring for higher-risk moms by visiting nurses or midwives. Empowering moms to care for themselves by having better community or state-based programs for postpartum support and newborn help—such as a recent study showing that when new moms were supported by having an appointment with their primary care provider (PCP) made for them, this increased their rate of seeing doctors from 22 percent to 40 percent. What is more, the moms who saw their PCP postpartum were less likely to be readmitted to the hospital (1.7 percent vs 5.8 percent). This is a great solution, but not all reproductive-age women have PCPs (due in part to a massive shortage in primary carein this country).
One way to go even further is to follow the lead of The Netherlands, where a maternity nurse is provided in the first week postpartum. Studies show that home visiting programs have positive outcomes, like reducing child maltreatment and emergency medical care. To be sure, home-based healthcare is expensive, and there may not be one approach to postpartum recovery that fits every mother. But we can stratify and provide such services to higher-risk mothers—whether due to medical complexity or social needs—and have it pay dividends.
It is time for healthcare and social services to provide more care for mothers after birth. Otherwise, our country’s maternal health outcomes will continue to plummet, and more moms will suffer from preventable complications. When moms struggle, so do their babies, families, workplaces, and communities. In short: all of us.
About the Author: Amrapali Maitra is a Clinical Assistant Professor of Hospital Medicine at Stanford University, a Paul and Daisy Soros Fellow, and a Public Voices Fellow of the OpEd Project.
