March 20, 2023 By Samantha Carlin Willis
I went into my first OBGYN appointment of pregnancy with the details of my twin sister Ilana’s experience and her OB’s advice for me at the ready. My OB listened, but she explained that we would monitor it as we went, that every pregnancy and body is different, and that baby aspirin doesn’t always work for preventing preeclampsia. I liked my OB, she was attentive, sensitive, we shared an alma mater, and this was a large, renowned NYC hospital - so I trusted her.
Once I got through the first trimester of morning sickness and hating food and everything smelling disgusting, I felt great! Everything was proceeding perfectly and I was healthy. I got pregnant in late 2020 - still very much pandemic times - and we got a Peloton - so I worked out almost every day. At my OB appointments, my blood pressure readings were healthy and normal.
My OB went out on maternity leave herself during my second trimester, so my care changed to rotating through anyone else in the practice who could see me. I talked to each provider I saw in the practice about Ilana’s preeclampsia, and each of them said the same thing - every pregnancy is different, every body is different, we’ll monitor you. At the doctors’ advice, I started taking my blood pressure almost every day in my third trimester (though I had monitored it earlier), and sending a weekly log. All of my at-home readings were healthy; I’m looking back at the log now as I write this – at 33 weeks, 34 weeks, 35 weeks…they were numbers like 115/64. True, my feet were swelling to a painful proportion, but it was late May and early June in New York City, it was hot!
Things changed at and after my 37 week appointment. My blood pressure was high, but the doctor chalked it up to that we’d probably rushed there and that fighting through all the Manhattan traffic was the culprit. He sent me on my way saying they’d see me in a week. My husband Matt and I were halfway up the block when the doctor called me; he’d thought about it and wanted me to come back and check it again. When I went back and he checked it again, it was lower this time, a number he was satisfied with, and sent me home. But the next day, a Friday, the doctor called - there was protein in my urine - I should come back on Monday to get the supplies for a 24 hour urine test. Immediately I was talking with my sisters about it. My older sister, who had been induced for preeclampsia, said I should be prepared to deliver in the next week, since I was 37 weeks and they might want to wait a few more days.
Over the weekend, I checked my blood pressure daily, and the numbers were higher than they’d been, but not alarming…126/81, 137/74, 123/77… however, I also wasn’t feeling totally right. I had an ache in my side, and just felt generally unwell. I spent way too much time Googling the symptoms and was scared that the pain on my side was a warning sign. That Sunday, we went to my parents’ for Father’s Day, and had a nice time, but I still wasn’t totally certain I was feeling my best.
Then on Monday, June 21, 2021, I told my colleagues I had to go to the doctor and might have to deliver early, maybe at the end of the week, and then went to the OB’s office to get the test kit. But, I still really wasn’t feeling well, I couldn’t quite explain it but since I’d been feeling great for most of my pregnancy, I knew it was different. I told the nurse this and said I wanted to see a doctor. I don’t remember exactly how it all transpired, but I remember having to ask a couple of times to be seen, and finally they “made me an appointment” so I could be seen by a doctor. Matt had dropped me off and was looking for a parking spot, so it was just me in the office.
A different doctor (who I’d seen before in my rotating OB care) saw me. She took a urine sample, and checked my blood pressure.
“Yeaaah,” she said, “your pressure is high and there’s protein in your urine. We’re going to induce you.”
I was 37 weeks, 4 days - we still had things to do at home! I was supposed to deliver in July! It was June 21st!
“When”? I asked.
“Now.” She said.
So much happened from there - the explanation of being induced, telling my husband on the phone that we are having the baby right now and how to find me at the hospital, calling my mom, texting my boss, admittance, epidural, pitocin, delivery…it was a whirlwind.
I delivered a healthy baby girl (without magnesium), Melody Claire, on June 22nd, and my blood pressure got better and stabilized after delivery. Everyone thought they’d caught it in time, everything was ok. I was relieved, but also holding my breath anticipating that what happened to Ilana would happen to me. They found that Melody had elevated bilirubin, so we would have to stay in the hospital for longer for her to stay under the lights. She also had a couple of other things that needed to be checked out. Her time under the lights, it turned out, was the exact amount of time my body needed, just like Ilana’s, to develop postpartum hypertension/preeclampsia.
But - it took me advocating for myself for the nurses to take me seriously. I was nervous about going home given what happened to Ilana, so when Melody was better and they were eager to discharge us (yes, eager, we had been there about 72 hours, we’d overstayed our welcome according to US standards!), I wasn’t ready. My blood pressure had been rising a little bit with each reading. I was feeling tired, and not just from having just given birth. I was worried. I told my nurse to check my blood pressure again. She was dismissive, tried to talk me down, told me they would send me home with instructions about my blood pressure and what to do. But I wouldn’t budge. I was armed with the knowledge of what happened to Ilana. I made her check it again. When she finally did, things changed quickly. Just like Ilana, my blood pressure had gone up to a concerning number. She told me to lie down and called the doctor. The nurse returned with some medication - I took it, and tried to get some sleep. What felt like moments later, the doctor (the same who’d delivered me) burst in to the room and said she was putting me on magnesium.
Through all of this, my husband was a hero. Taking care of me, our newborn, keeping all of our family and closest friends informed. They took Melody to the nursery so Matt could come with me to triage for them to start the magnesium. I was terrified, we were terrified - what would happen to me and our new family? I was also devastated to be separated from my newborn.
Once I was moved out of the “recovery room” to a private room, we asked for Melody to be kept in the nursery overnight so Matt could try to get some rest, since I was on magnesium, he was exhausted. The magnesium was miserable. I was completely out of it, and every time the medicine went in, it was painful. And through it, I was pumping, and sending what little breastmilk I could get at that point to the nursery - it was intensely taxing on my body and mind. The next day, they brought Melody back to be with us. Doctors and residents and interns came in to see me; Matt was texting with Ilana to get the exact information about her medication dosages and what worked for her. I heard him telling the doctors (all while caring for our baby!), this is what happened to her twin sister, this is what they ended up with, this is what worked for her. The doctors did exactly what Ilana’s doctors did the second time around - they took their own course of experimentation and action - despite everything Matt was telling them. He felt like they barely listened to him - like the dad didn’t matter.
I was taken off of magnesium earlier than expected (thankfully), and like Ilana, they switched to trying to find the right combination of medications. And, after a couple of days - yes, days - they finally found something. It was, milligram for milligram, the same exact combination of medications that got Ilana’s blood pressure under control. You could almost laugh about it, but not in a funny way.
Finally, after six days, we went home - again like Ilana, with an arsenal of medications. It was scary, being at home. It didn’t seem to be working. I called the nurse line, I was afraid I had to go back. But they told me to give it some time. After a day or two, my body did adjust. Because of the timing of when they gave the medications at the hospital, at home, I had alarms set in the middle of the night to take labetalol and nifedipine and labetalol again. Plus pumping. Plus caring for our newborn. It was harrowing.
Then, the doctor who’d made the call to induce me, who’d delivered me, who’d ordered the magnesium - called me personally. She wanted to see how I was. She apologized that it all happened that way, she’d thought they caught it in time. While that doesn’t change how hard we had to fight to be heard, it was comforting to hear, and I hope she learned something from the experience she has taken with her to other patients.
Today, Melody is 19 months old and we are all doing well. I’m still on nifedipine, and am not sure when or if I’ll be able to go off of it. I still feel too close in time to all of this to be able to come up with an inspiring moral of the story like Ilana’s, but I know that I’m grateful for the lessons Ilana drilled into me that made me advocate for my care. And, that Melody was born with elevated bilirubin. If she hadn’t been - I would have been home by the time my blood pressure went up, and I don’t even want to think about what could have happened. It’s the same thing that happened to llana - I’m grateful that my first niece Lila was born under five pounds so she had to be in the NICU which meant that Ilana also wasn’t home when her postpartum hypertension hit. In a way, our daughters, and being twins, saved us.
You can read Ilana's story here.