Promise Me You’ll Come Back In, Ok?

October 30, 2023 By Emily Wallace

Promise Me You’ll Come Back In, Ok?

I had a pretty healthy, run of the mill pregnancy. Some morning sickness, heartburn…nothing worrisome. That is, until my 39 week appointment when I got sent immediately to Labor & Delivery for protein in my urine and a blood pressure of 166/106.

We stopped at home to grab my hospital bag, and I had a bit of a cry. I wasn’t expecting things to end this way. When we got to L&D they did an NST, blood draw, urine test, and put me on the cardiac monitor. Aside from my blood pressure, everything was looking good. My labs were fine, and baby was doing great. They have me some nifedipine and labetalol, booked an induction for that Saturday, and sent me home. On our way out, I passed my nurse at her computer and she put her hand on my shoulder and looked me in the eyes. “Emily, promise me you’ll come back in if you feel badly, ok? I need you to promise." I’ll never forget that.

We had only been home for about an hour when I developed a bad headache. This isn’t unusual for me - I get severe migraines - but hadn’t had one in 9 months. I ended up vomiting as well. Part of me felt silly for going back to the hospital so soon, but I thought of what my nurse said as we were leaving, and I knew I needed to get checked out again. Sure enough, not only was my blood pressure high again, this time my platelets had dropped. Of course, they were worried about HELLP syndrome - and being a nurse myself, I was too. The nurse came in and told me that we were going to start the induction today, instead of waiting until Saturday. The plan was to put in the foley and then do repeat blood work at midnight. If everything was good, we’d proceed with the induction but if my platelets dropped any lower, it would be an emergency c-section. “Either way, you’re not leaving here without a baby”.

Thankfully, no one whisked me off for emergency surgery in the middle of the night, so I can only assume my platelets were stable. They broke my water, started pitocin, took 4 tries to get a working epidural, and started pushing around 2:15. After about an hour, my BP spiked and baby became tachycardic with late decels, so they did a vacuum assisted delivery. She was small for gestational age, at 6 lbs 3 oz and her first APGAR was only 2. But once she stabilized, we were both okay - I didn’t need any more BP medications in hospital, and my labs were all improving, too. We were discharged 36 hours later, with a prescription to take labetalol.

The next few days I felt pretty tired and weak. It’s hard to say if it was normal postpartum recovery, or the preeclampsia. But on my 6th day post delivery, I checked my blood pressure and it was 176/116, so we headed into the ER. On our way, I developed a headache and spots in my vision, which I knew wasn’t a good sign. In the ER, the triage nurse brought me straight into the Red Zone. The doctor, a former colleague, was there within minutes, congratulating me on my baby, assessing my reflexes and checking my vision, and for any abdominal pain. That night was awful. Being away from my baby was bad enough, but somehow, after receiving multiple doses of IV labetalol, magnesium sulphate, and hydralazine, my blood pressure was still in the 160’s. I don’t know who was more frustrated - me or the doctor. I was scared. The only saving grace is that my labs were all fine: no concerns with my kidneys, platelets, or liver. Thankfully they found a single room so that my husband and baby could stay with me. It only took a day or so to find the right mix of nifedipine and labetalol to get things under control, before the doctor felt comfortable sending me home with parameters for how to adjust my medications based on my readings.

It’s now two weeks later, and we are just starting to taper down my medications. I am hopeful that I’ll be able to come off of them completely but only time will tell. I am grateful to my care team - thanks to their knowledge and compassionate care, baby and I are well and I am on my way to recovery.