I Had a Seizure After Giving Birth: How Postpartum Preeclampsia Happened to Me

My son was born on a Wednesday. My first words as a mother were, "He is so cute!" His delivery was quick, and he was healthy, so we were soon whisked away to rest and bond in a recovery room.

My mom flew in from halfway across the country on Thursday, eager to meet her new grandson. That day was sweet and warm. A close friend of mine came to visit and was the first outside of our family to hold my son.

By Friday, it was time to go home. Since my mom was staying at our house, my husband left the hospital to pick her up. My son was in the nursery, as was the custom at the time. I was alone and so grateful for a shower. I quietly sat on the edge of the hospital bed, finally clean, finally dressed in my own clothes, waiting for the nurse to bring my son down to me. That was my last memory before the seizure.

I didn't know it then, but I had developed postpartum preeclampsia.

Complications of Postpartum Preeclampsia

According to the Preeclampsia Foundation, postpartum preeclampsia is a serious condition related to high blood pressure that can happen to anyone who just had a baby. It has most of the same features as preeclampsia, and about 15% of postpartum preeclampsia patients will experience a severe aspect of this condition: eclampsia or seizures. After delivering my son, I became a part of that statistic.

According to the Centers for Disease Control and Prevention (CDC), preeclampsia occurs in 1 out of every 25 pregnancies, and of those who are diagnosed with preeclampsia, only around 1% will have seizures.

I Had a Sudden Seizure and Memory Loss

A hospital employee retrieving my breakfast tray saw me seizing and called for help. When my husband and mom returned, I looked at my mother and asked, "What are you doing here?" I also asked where my father was, yet he had passed away three months earlier, and I didn't remember any of it. I didn't even remember having a baby. I would later find out that my mom was deeply troubled that I didn't ask for my son much that day. The doctors reassured my husband that my memory would slowly return.

My first memory after the seizure was my husband showing me pictures on the back of our digital camera. It was 2007 before we had taken the plunge to buy smartphones. I remember staring at the tiny screen on the back of our camera. Pictures of me holding a baby. I had a baby. I had a son. Yes, I had a son. I remember. Slowly, more details flowed back in.

Doctors Were Perplexed By My Case

"Why does my shoulder hurt?" I kept asking. In a bizarre turn, I dislocated my shoulder during the seizure. I must have grabbed the bedrail. We will never know because I had been alone. But I was one of the lucky ones. I was lucky that I was still in the hospital, lucky to have been in bed when I seized, lucky that I wasn't holding my baby, lucky that I wasn't still in the shower as I had been minutes before, and lucky that I didn't have a stroke.

Doctors seemed perplexed by my case as my blood pressure had only gone up to 138, while 140 is the clinical cut-off for concern. A magnesium IV was started to prevent another seizure, and mother-infant bonding took the back seat.

I had carefully chosen this hospital in a large metropolitan area. Yet, this hospital did not have a neurologist or an orthopedist on staff. When a neurologist arrived, I was told my blood pressure had not been high enough to signal a preeclampsia diagnosis; however, my obstetrician said the seizure, protein in my urine, and blood pressure combined made a clear case for postpartum preeclampsia. Since I had not shown symptoms of preeclampsia during my pregnancy, I was told I had new-onset postpartum preeclampsia, which I had never heard of before.

Diagnosing New-Onset Postpartum Preeclampsia

According to Sarosh Rana, M.D., MPH, a professor of obstetrics and gynecology and section chief in Maternal-Fetal Medicine at the University of Chicago, new-onset postpartum preeclampsia is believed to be subclinical preeclampsia before delivery that persists after birth. In other words, preeclampsia existed under the radar because the symptoms were not severe enough to be caught through routine testing and exams. But it can be triggered by a combination of factors such as

• Intravenous fluids
• Loss of pregnancy-related changes in blood vessels
• Mobilization of fluid
• Presence of diabetes
• High BMI
• Use of non-steroidal anti-inflammatory drugs.

"The chance of developing new-onset preeclampsia after birth is lower compared to women who already have diagnosed hypertension or preeclampsia before delivery," she says.

Not much is known about why women will have new-onset preeclampsia after birth, but "At the University of Chicago," says Dr. Rana, "about 90% of women with some sort of hypertension prior to pregnancy end up with elevated blood pressures after delivery in the first few days, while the chances of new-onset hypertension after delivery is close to 10%."

Dr. Rana says this diagnosis can be missed, especially if the providers and patients are not acutely aware of signs and symptoms. She explains that parents under her care are educated on the signs of symptoms of preeclampsia (headache, blurred vision, and other symptoms) and asked to promptly call their doctor for evaluation if they notice any of these symptoms.

Treating and Preventing Postpartum Preeclampsia

One common misconception is that delivery cures preeclampsia. It does not, and Dr. Rana believes we need to do more to educate birthing parents and doctors on the risk of preeclampsia after birth.

"Many providers are not even aware of the risks associated with preeclampsia that persist after delivery," she says. "Risk of postpartum hypertension, stroke, seizures, and lab abnormalities are high within the first several days to weeks after delivery but can persist for up to 12 weeks. The old paradigm that preeclampsia is 'cured' by delivery is wrong. It can persist after delivery or even appear for the first time after delivery. Women are still at risk for short-term and long-term complications such as chronic hypertension, cardiovascular disease, stroke, and kidney disease many years after delivery."

While I was lucky to have received prompt care for my eclampsia because I was still in the hospital, new parents need to be aware of this condition so they can know what warning signs look for. According to the CDC, preeclampsia after birth is usually diagnosed within 48 hours and includes the following symptoms:

• High blood pressure
• Excessive protein in the urine
• Swelling in the face, hands, and feet
• Blurred vision
• Headaches
• Abdominal pain in the upper right-hand side

How Hospitals Can Improve Postpartum Care

When I finally saw my son, my arm had been tightly fastened to my chest with Velcro in a shoulder sling. I could sit up in bed with my son lying on my legs, but I could not hold him. I was not able to nurse. Yet, I was alive because I had access to multiple hospitals and excellent insurance.

Dr. Rana, says it's important for new parents and doctors to know that "African American women have a higher prevalence of hypertensive disorders than white women in the United States; pregnancy-related death is four times greater among non-Hispanic black women, and preeclampsia is a major contributor to this disparity." The risk of postpartum hypertension is also much higher in African American women, she adds.

Dr. Rana is working hard to educate and make postpartum maternal care more comprehensive. A big step is encouraging new parents to attend a postpartum follow-up appointment as early as seven to 10 days after delivery to check their blood pressure.

"At the University of Chicago, under my leadership, we have created a program especially for postpartum women as a form of a bundled approach," says Dr. Rana. "We are calling it systematic treatment and management of postpartum hypertension (STAMPP – HTN). We provide education to all postpartum patients and providers throughout the hospital, creating protocols for management of high blood pressures and preeclampsia before, during, and after delivery. The idea is that we empower patients and their families with knowledge and improve access to care."