When women tinker with death

Monday September 20 2021
Preg pic
By Lucy Tomeka

The reproduction process is quite an amazing feat to say the least.

Women do belong in a museum for all they go through in creating a person.

Pregnancy, no matter how smooth a sailing it may be for some or rigorous and horrific for others, has a lot of complications and problems that sometimes are easily overlooked or addressed in a laissez faire manner.

Six years ago, I had a smooth sailing during my pregnancy.

A few minor issues here, or there but the most prevailing issue was my constant drop of blood pressure which was expertly managed throughout.

One night, two weeks before my due date, I felt pressure on my bladder, a common thing during pregnancy and thought I needed to visit the bathroom. I rushed and to my dismay, I bled quite heavily.

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Now remembering all the emphasis my gynaecologist put on not bleeding, I decided to give her a call, to which she said I was to rush to the hospital.

I was still pretty calm at this point and when I arrived at the hospital, routine check-ups for any expectant mother were done and my family was informed that I would be put on observation for the night.

At this point, my blood pressure had sky-rocketed beyond anything my body had ever experienced, however, the nurses simply said to me that it was common for blood pressure to rise every now and then and that was why I needed to stay in hospital for.

Half an hour after my family left me, I was then strapped to another machine to monitor the baby and only then did the nurse look a little concerned; turned out the baby’s heartbeat was very faint and I was in labour even though I could not feel any pain.

At this point, everything was in a flurry with one nurse preparing me for a caesarean section and another cutting off all jewellery on me and another sticking in a needle to run an IV and at that point, I began to panic against all the “don’t worry” and “you are in good hands” assurances they gave me.

My doctor met me on the hall way as I was being wheeled to the theatre and seeing as she was the only familiar face present, I chose this moment to ask her to explain. She simply said that I needed to have an emergency cut to take the baby out, which added more to my confusion, fear and panic.

When I came to, she finally explained to me that my placenta had raptured and the baby was not receiving any oxygen.

Of course in my new mom moment, I didn’t think to ask more and all that clouded my mind was relief that we were both fine.

Over the years however, I begun to question just how serious it may have been and seeing as I did not really understand,

I asked fellow moms and learnt that for many, surviving pregnancy ordeals is worn as a badge of pride and never really addressed.

The reality however is that maternal mortality is very high and in developing countries like ours, it is very easy to ignore warning signs that could be managed and in effect save lives.


What went wrong?

Pre-eclampsia, a condition that is all too common during pregnancy had me in the hospital late at night. “It is a condition that causes high blood pressure in pregnant women during the second half of the pregnancy,” explains Dr Isaac Maro of TMH hospital.

“It also causes water retention and protein in the urine. It is a very manageable condition, however not one to be taken lightly as it could lead to eclampsia.”

There are plenty of risk factors where pre-eclampsia is concerned.

Factors such as diabetes, kidney disease, high blood pressure, being a teenager, being over 35-years-old, having a first pregnancy, being pregnant with multiples, having a family history of pre-eclampsia and obesity could lead to one developing this condition during pregnancy.

Symptoms are swelling of the face, hands and feet, headaches, protein in urine.

High blood pressure, blurred vision, upper abdominal pain, vomiting and shortness of breath amongst others.

In the case that your doctor suspects that you have pre-eclampsia, there are certain measures they are obliged to take.


Blood tests: Your doctor will order liver function tests, kidney function tests and also measure your platelets — the cells that help blood clot.


Urine analysis: Your doctor will ask you to collect your urine for 24 hours, for measurement of the amount of protein in your urine.

A single urine sample that measures the ratio of protein to creatinine — a chemical that’s always present in the urine — also may be used to make the diagnosis.


Foetal ultrasound: Your doctor may also recommend close monitoring of your baby’s growth, typically through ultrasound.

The images of your baby created during the ultrasound exam allow your doctor to estimate foetal weight and the amount of fluid in the uterus (amniotic fluid).


Nonstress test or biophysical profile: A nonstress test is a simple procedure that checks how your baby’s heart rate reacts when your baby moves.

A biophysical profile uses an ultrasound to measure your baby’s breathing, muscle tone, movement and the volume of amniotic fluid in your uterus.

“Pre-eclampsia usually goes away quickly after the baby is born. While pre-eclampsia can be serious for both the mother and unborn child, treatment is available and it helps,” says Maro.


Treatment

The most effective treatment for pre-eclampsia is delivery. You’re at increased risk of seizures, placental abruption, stroke and possibly severe bleeding until your blood pressure decreases.

Of course, if it’s too early in your pregnancy, delivery may not be the best thing for your baby.

If you’re diagnosed with pre-eclampsia, your doctor will let you know how often you’ll need to come in for prenatal visits — likely more frequently than what’s typically recommended for pregnancy.

You’ll also need more frequent blood tests, ultrasounds and nonstress tests than would be expected in an uncomplicated pregnancy.

Possible treatment for pre-eclampsia may include:


Medication

Medications to lower blood pressure. These medications, called antihypertensives, are used to lower your blood pressure if it’s dangerously high.

Although there are many different types of antihypertensive medications, a number of them aren’t safe to use during pregnancy.

It is important to discuss with your doctor whether you need to use an antihypertensive medicine in your situation to control your blood pressure.

Anticonvulsant medications. If your pre-eclampsia is severe, your doctor may prescribe an anticonvulsant medication, such as magnesium sulfate, to prevent a first seizure.


Bed rest

Bed rest used to be routinely recommended for women with pre-eclampsia. But research hasn’t shown a benefit from this practice, and it can increase your risk of blood clots, as well as impact your economic and social lives. For most women, bed rest is no longer recommended.


Hospitalization

Severe pre-eclampsia may require that you be hospitalized. In the hospital, your doctor may perform regular nonstress tests or biophysical profiles to monitor your baby’s well-being and measure the volume of amniotic fluid.

A lack of amniotic fluid is a sign of poor blood supply to the baby.


Delivery

If you’re diagnosed with pre-eclampsia near the end of your pregnancy, your doctor may recommend inducing labour right away. The readiness of your cervix — whether it’s beginning to open (dilate), thin (efface) and soften (ripen) — also may be a factor in determining whether or when labour will be induced.

In severe cases, it may not be possible to consider your baby’s gestational age or the readiness of your cervix.

If it’s not possible to wait, your doctor may induce labour or schedule a C-section right away. During delivery, you may be given magnesium sulfate intravenously to prevent seizures.

After delivery, it can take some time before high blood pressure and other pre-eclampsia symptoms resolve.


Advice

Although pre-eclampsia is manageable, doctors advice that you go to the hospital as soon as you can.

In addition to being attentive to your body changes, there are a few bits of advice for every expectant mother to take note of.

• Follow doctor’s instruction: No matter how good you may feel at a time, it is very important to follow every instruction a doctor give you too the letter.

• Stick to a doctor that knows your history: Although it is at times advised that one has a second and third opinion, it is more helpful to have a doctor that knows your medical history from conception to due date.

• Lifestyle changes and health eating: A good diet, rest and change in lifestyle goes a long way in easing pregnancy related stress and more.

Left untreated, pre-eclampsia can lead to serious — even fatal — complications for both you and your baby. If you have pre-eclampsia, the most effective treatment is delivery of your baby.

Even after delivering the baby, it can still take a while for you to get better.