My Blood Pressure Spike On Postpartum Day 3


By Maria Petty, NP

The headache wasn’t that bad. The fatigue was worse. I had slept about six hours total in the past three days. I was fortunate to have dutiful help from my husband and both grandmas, but I was still exhausted. Between breastfeeding, diaper changes, snuggling, trying to eat and maybe shower, adjusting to being thrust into the most important role in my life, feeling the joy and anxiety as only someone who birthed a child for the first time could feel—of course I had a headache, right?

But my friend had postpartum preeclampsia around five months earlier, and my primary care nurse practitioner’s brain nudged me to ask my husband’s mom to bring her blood pressure cuff over(she planned to visit anyway).

I sat, took a few deep breaths, and thought about my likely overreaction as the cuff squeezed my left arm. 135/90. Right arm 140/92. I called the on-call OB.

“I have a headache, and my BP is 140/92.”

“Did you take any Tylenol?” She sounded annoyed.

Yes, 650 mg a few hours ago.

“Why didn’t you take three Tylenol?”

Trying not to sound hurt and annoyed, I told her, “I don’t know, but I just don’t feel right.”

“Well, you’re saying all the right things,” she huffed. “Come down to triage; I ordered some labs.”

I tried to stay calm, telling myself it was just a precaution. I had never made a formula bottle, and I cried as I tried to find the scoop in the Similac sample (it was buried in the middle of the powder). I was googling formula scoop to tablespoon conversion when my husband reminded me that we should go and that our sweet boy would be fine with his doting grandma.

We get to the hospital, and my blood pressure is 160/90. My breasts became engorged. I had never used a breast pump, and the kind nurse advised me where to place the flanges and to merely increase the suction to my comfort level. Well, anything felt comfortable compared to my own personal baby shark at home. I increased that suction to top power and asked my husband to help hold the flanges in place as the BP monitor automatically squeezed my left arm every few minutes. The nurse encouraged breast massage to help with milk expression, and my husband and I joked that our first romantic evening post-baby involved him massaging my rock-hard breasts in a hospital room.

Our laughter ended when my subsequent blood pressure was 180/120. I knew that reading bought me an admission. I was understandably sad to be without my new baby and family, but I knew this was where I needed to be. They started an IV magnesium bolus (my ears never felt so hot) and then 24 hours of an IV magnesium drip. My blood pressure gradually came down on oral labetalol, and the headaches (and then blurred vision) improved. My liver function tests rose to approximately twice the upper limit of normal but came back down within two weeks. I felt like a new woman after sleeping for six hours in one night. The nurses and doctors were wonderful, and it was great to trade some health care stories. The time in the hospital was also my personal pumping basic training, and I was fortunate to see lactation consultants exclusively for my pumping. The OB reassured me that postpartum preeclampsia could happen to anyone. She let me know I would be placed on aspirin 81mg daily for future pregnancies (and I thankfully did not have any preeclampsia with my second son).

My blood pressure was still high at home, and my labetalol was titrated up to 300 mg TID. Between weeks three and four postpartum, my blood pressure normalized. Thankfully, I had diligent nurses and providers following up with me (and the support at home so I could attend these appointments), so I had guidance in gradually weaning off the labetalol. Yet I still bottom out toward the end of the taper, feeling lightheaded with a blood pressure of 80/50. My husband was home (so grateful I wasn’t alone with our baby) and had compression stockings and the knowledge to increase salt and fluid intake.

I recovered well, but I still think about this episode and what could have been improved. For example, I will be forever grateful for the care from the on-call OB; she could have just been having a bad night, but her terse words stuck with me.

I was also correctly told that the labetalol would make me more tired and depressed. If I have postpartum preeclampsia again, I might stop breastfeeding/pumping immediately and try a different medication. This choice wasn’t offered to me, and while I understand why (especially in considering breastfeeding benefits and formula shortages), I think multiple medication options should be discussed.

Most importantly, I think about my preeclampsia-specific and general knowledge gaps. I could not recall learning about postpartum preeclampsia in my prenatal classes. I wasn’t given any written instructions on what symptoms to expect with my blood pressure returning to normal. My husband and I also would have benefitted from a pumping tutorial (side note: the lactation consultant said not to just power up to top suction) and a quick lesson on making formula bottles. A more empowered mom and family might be less tempted to dismiss a postpartum headache.

I realize hindsight is 20/20, and I could always improve my patient communication. I am optimistic about future developments in preeclampsia care. I registered so further research can be done. I hope to eventually advocate for more inclusive and comprehensive prenatal classes and insurance-covered blood pressure monitors for all mothers. For now, I will be content in telling my story, written as my kids are thankfully asleep.

Maria Petty is a nurse practitioner.


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