Episode 75 SN: A Late Visit from a Preeclampsia Diagnosis: Joy’s Story, Part I

P: Hi, thanks so much for coming on the show. Can you introduce yourself and tell us where you’re from?

 

J : My name is Joy, and I live in Austin, Texas.

 

P  Excellent, Thanks so much for coming. Joy. So here we are. We’re going to talk about the family that you feel that you have right now. And sometimes the family you have is a reflection of the family that you’re from. Let’s just talk briefly about the family that you have come from.Do you have siblings? 

 

J: I have one younger brother. He’s six years younger than me and he lives in the northern suburbs of Austin and round.

 

P: Oh, nice to boost age. Yeah, we’re close by and did growing up with a sibling make you think I want kids or not really.

 

J: Being six years younger, there was enough of an age gap. You never really want to play together, that sort of thing. And then by the time I was in high school, I did my own thing.So no, I

wouldn’t say how did you know at some point that you want a family?

 

J: I met my husband after a few years that we were together. We talked about it a lot. But we were also very hesitant about the state of the world at the time, which now seems depressing.

 

P: Quaint?

 

J:  Yeah, exactly. And I had a lot going on in my own personal life with my mother’s health, which definitely derailed me for a few years as well. And so yeah, it was it’s not the kind of decision that the two of us would ever make lightly. It’s something we’ve put a lot of just like any major decision,

 

P when you go to get pregnant is easy to get pregnant. 

J: Yeah, it was pretty easy to get pregnant. I think it took like four or five months. Kind of trying, you know, but not like being very serious. didn’t need any help with it. 

 

P: Okay, good. And what’s the first trimester like

 

J : the first trimester was really pretty easy. I did not have any morning sickness, which is sometimes can be a bad sign. Because it’s an indication of all like the hormones and all the things that are changing in the body.

 

P : So this is a good question. Does morning sickness have a deeper meaning? Does it mean that pregnancy is doing well or poorly? It looks like in general the answer to this is no. Lack of morning sickness doesn’t imply that pregnancy is on the wrong path. There was an article in 2016 in an important medical journal that found that for women who had one or two previous miscarriages, morning sickness was associated with reduced risk of pregnancy loss. But this finding is limited to people who have previously experienced miscarriage.

 

J And I really didn’t have too much of that. I don’t even remember being all that tired when that I hear no quite calm. So it really wasn’t that bad first trimester.

 

P  Okay, good. Did you have I should have asked this before, but did you have a concept of what pregnancy would be like before you stepped into it?

 

J  Yes, I have been a health reporter in New York City at that point for a long time. For a while I had worked in White Plains, New York, which is a suburban community north of New York, and it’s very wealthy. And really the health concerns there are dramatically different than the health concerns where I grew up in Corpus Christi. And I had met women who were debating things and looking at the science journals, and interventions in birth, and really, they really approached it from this very privileged standpoint of like there’s too many interventions in birth. And that kind of influence my view, by the time I got ready, I really was like, Oh, my gosh, the C section is that should not be happening to me and I tried to go for very, quote, natural childbirth as much as I could, you know, it’s about that was sort of the background approach.

 

P  So does that mean you went to like midwifery instead of a traditional OB

 

J  Yes, I went to my OB. When I got pregnant. She didn’t have privileges or whatever at a one hospital in Manhattan that had a birth center, which was at the time the sequence was about and so I switched to a mid wave clinic and have more midwives because they I had a birthing center at the hospital that I liked that it was within a hospital if anything went wrong. I was already there.

 

P  Yeah. That seems like the right kind of insurance. 

 

J: Yeah, exactly. Yeah. So we’re, we toured the birth center in those early days and yeah, and it seemed like a good setup.

 

P  So does that mean that your your care is more kind of gentle and sporadic throughout your pregnancy?

 

J I wouldn’t say sporadic I think you have just as many appointments as you would. I mean, I don’t know for sure, as you would have been OB and you have those sonograms you know starting at the regular schedule, and you have a lot of visits. And so I think the I don’t know what the big difference would be there might have been less testing and you know, bloodwork, maybe I’m not sure, but I remember having that doing the glucose test, all that sort of stuff.

 

P  Okay, so that sounds familiar. And maybe a birthing center that is situated inside a hospital is slightly different than a birthing center on its own, because it’s just 

 

J: yeah, 

 

P: by proximity and selection and all these other things. And so second trimester still doing well.

 

J : Yeah, doing pretty well. I remember we traveled to Costa Rica and it was a good trip. And yeah, second, second trimester. I think they’re, you know, looking back in hindsight, if there was a little bit of an indication the baby’s growth wasn’t like it’s starting to slow down near the end of the second trimester, the belly measurements, you know, towards towards that end of the second trimester. I remember seeing them like, okay, and I didn’t look super pregnant by the end of the second trimester. I remember people saying I looked less pregnant than I was. People don’t hold back with their opinions. 

 

P: Yes, yeah. Pregnant women seem to be public property. I do remember having to like fend off paws that were coming my way. To touch the pregnant belly, which I don’t remember selling tickets. You are not in line. Don’t. Don’t touch me that way. So the baby’s baby going a little bit slower, but no one’s upset about that. 

 

J: No,no, and I you know, I don’t even remember, I went through a process of looking exhaustively, looking through my medical records after the fact. And it’s hard to say if at the time I was really thinking about it, I definitely remember looking at the record. Oh, there might have been some signs here.

 

P Yeah, I mean, it’s interesting when you look after the facts, right that things look a little bit different, but we’ll get to that because I read your story in cosmopolitan, which is, I’m glad that it’s published because it is important and kind of shocking. As shocking as it was to experience it’s it is shocking to read. 

 

J: Yeah. 

 

P: So we’ll get we’ll get to that. So third trimester rolls around and what’s that like?

 

J That’s really hard, really hard. And I remember what to say around like week 33-34 My hands started. It was like a burning sensation. It started hurting, hurting to write which I was a writer and a reporter and you know, using my pen taking notes in a meeting or whatever, my hands would just start hurting and they were kind of bright red. They weren’t really swollen like with edema, but they hurt. And I started developing an upper gastric pain of pain on my right side up towards the top and I went to my midwife, I complained about it and in my chart, it said, you know, suggested ice packs for hands and she called the belly pain. The ligament pain like the 

 

P: round ligament?

 

J: round ligament like yes, yeah, that was written in my chart. It was actually my liver but that was you know, was written in my chart. And then I also had a couple of times where I went in with high blood pressure. And I remember distinctly going in there once and the midwife you’d see different midwives each time, which I think was not a good thing that there were that was not consistent way of getting care, and they were also had way too many patients. I mean, the waiting room waiting was atrocious, sit out there for a really long time to see your midwife. Um, you know, in hindsight, it just was not a good experience. 

 

But one of the times that I was having my blood pressure measured, it was high. She’s like she’s she Shepherd shuffled me over to a second room that was dark and heavy lay down on my side, I retook my measurement, and that’s what ended up in my chart. And at the time, I don’t know what was going through my mind. I knew I kind of you know, was vaguely aware of what preeclampsia was but I also had this attitude that that that wouldn’t happen to me. I don’t know why. But you know, that was really dangerous but she did. And that was probably week 36,37. When when stuff like that was happening, and I was definitely just miserable those last few weeks not feeling good. And I went all the way to 41st week. 

 

P: Wow.

 

J: Yeah. 

 

P: So So let’s talk a little bit about that third trimester no one’s running tests to check stuff. 

 

J: No, no, I didn’t get any bloodwork done. And I you know, I’m really curious now, if that would have shown anything with the liver enzymes. Yeah, just the regular go in, take your blood pressure. Take your vitals, measure the belly. Again. The belly growth was a week or two behind what you would see normally.

 

P And are you worried or you’re you’re trusting entirely the midwives?

 

J I’m not worried. Yeah, I’m miserable. And I’m in because I did go and I told them, you know, I’m having these issues, and they said it was these other things. You know, I just was like, Okay, I guess, I guess this is how it’s supposed to be. I also had really bad insomnia, because I was so uncomfortable. And I just remember like, being up all night, like trying to find a comfortable position to lay in and just not getting any sleep and I thought, okay, I guess that’s normal too. You just it’s hard to know what’s normal and what’s not and tell you a full range of like Swelling is normal, your ankles swell, you know, that sort of stuff.

 

P It is it is interesting, and I’m completely and fervently of two minds about all this which is on the one hand, so little is known about pregnancy. And all these complications that you easily could be in that bin of nothing serious going on here. And preeclampsia it while it’s significant issue is not super common. It’s not like 30% of the people have preeclampsia; at the same time. We need to be screening everyone in the fall. It’s not serious then to make sure they’re in the right bit. Right. 

 

J: Yeah, yeah. And you’re reminding me of an important thing that happened one way that my case was different, you know, they were doing the urine checks. Every time I go in my urine was always normal throughout the entire thing. My kidneys were always fine. I never had protein in my urine and but I did have elevated liver enzymes, quite high and right around around November after I gave birth about six or seven months after ACOG. The American College of Obstetrics and Gynecology changed their guidelines to say we should not rely solely on protein in the urine and high blood pressure. You should just be high blood pressure at that point you need to do the full battery of tests because protein can be some women go into this variant of the liver versus the kidney and that that was me and I think that might have been one of the ways I was felt they were thrown off by me.

 

P  What year is this? 

 

J : this is 2013

 

P: And how old are you? 

J: I was 36 Mine delivered. 

 

P: Okay, so the definition of preeclampsia has changed over time to become

 

J I haven’t Yes, I haven’t looked into it really since then. I got very involved with it. And three years after I gave birth in terms of I know I was on the Patient Advisory Council for the preeclampsia Foundation, wrote that article and since then, it may have changed. But I do remember that year they updated those guidelines because they knew they were missing. They knew they weren’t missing people by being that narrow.

 

P  12:47  

Yeah, it continues to evolve that now for sure they say it does not require protein in the urine to be defined as preeclampsia. I brought this question of the definition of preeclampsia to two experts.

 

Today we’re lucky to have not one but two amazing scientist/ physicians who research issues around preeclampsia on the show. The first is Dr. Suzanne Oparil. Who if I introduce Dr. Oparil, with all the professional designations that follow her name, the society she’s a part of and the groundbreaking work she’s done. we’d be here all day. So I’m going to I’m going to summarize here. I’ll say that she’s a cardiologist at the University of Alabama Medical School of Birmingham, who was interested in the fundamental mechanisms of cardiovascular disease. She’s authored tons of work on preeclampsia, among other things, and is on the Medical Advisory Board of the preeclampsia Foundation. And we’ll talk about one of the groundbreaking clinical studies that she’s a part of a little bit later. And I also want to introduce Dr. Rachel Sinkey, who’s an Assistant Professor of Obstetrics and Gynaecology, in the Division of Maternal Fetal Medicine at the University of Alabama medical school, who has also authored just a zillion papers on hypertension in pregnancy and preeclampsia. Doctors this feels like a dream team. So thank you so much for spending some time with us this morning.

 

Dr. Oparil: You’re welcome. It’s an honor to work with Rachel who taught him 90% Of what I know about preeclampsia. 

 

Dr. Sinkey: That’s so not true but it’s an honor to be on your show today with Dr. Oparil

 

P: Well we’re glad to have you both. We’re gonna start off with what I’m hoping is a softball. Can you tell us what is preeclampsia.

 

Dr. Oparil: go fot it.

 

Dr. Sinkey: Absolutely And since this is my bread and butter, we see this so often. It’s just so important to teach our trainees but basically it is either new onset hypertension in a patient who didn’t previously have hypertension, plus either protein in the patient’s urine or other signs of end organ damage. Or the patient has a history of hypertension, then it can be associated with worsening hypertension. Worsening proteinuria and potentially end organ damage.

 

P  Okay, so it sounds like in that definition, you have essentially told us how it’s usually diagnosed. You’re looking for those markers. 

 

Dr. Sinkey: Exactly. 

 

P: Today, we’re here to talk about Joy’s experience. She had a new onset of high blood pressure and heightened liver enzymes. But wasn’t diagnosed as ill after delivery. So I’m guessing there’s something tricky about making a diagnosis of preeclampsia on someone is that consistent with your experience?

 

Dr. Sinkey: You’re exactly right all it and the thing is it’s very tricky is that if you are diagnosed before delivery of the infant, then you still have circulating hormones in your body even after delivery and for some women, yes, most women are delivered diagnosed prior to delivery. However, there are some women that aren’t diagnosed until after delivery. And so trying to explain to explain it to families is really challenging and it can it can be a tricky diagnosis.

 

P  Do we know what causes preeclampsia?

 

Dr. Sinkey : We blame the placenta. We are still investigating the underlying causes and I think not having an exact clear understanding of the underlying pathophysiology of preeclampsia also may help to explain why we don’t have treatment yet. So I hope that over the coming decades as our huge appreciation and respect for our basic scientists, colleagues who study this on a daily basis, hopefully as we learn more about the underlying causes, we can also develop therapeutics to prevent it and anti trade.

 

Dr. Oparil: I would guess though there are going to be multiple underlying cause it’s not going to be one thing, one molecule probably.

 

P : Okay, so now you’re not feeling great. It seems like maybe it’s normal because everyone’s telling you it’s normal. That’s another thing that’s like a dissonance right where you’re like, Okay, so this terrible feeling is what everyone does, like, yeah, that doesn’t seem like the marketing I hear around pregnancy. And so what you’re imagining like a birth with an epidural or what’s your picture?

 

J : right, I would that’s what I was. That a was you know, just as few intervention as possible. If I could make it without it. I wasn’t opposed to an epidural but if I can make it without it, I wanted to try it. I come from this like stock of women. That so my grandparents my my grandmother was a twin and she was one of 13 siblings. My great grandmother had 13 children in a log cabin by herself. Yeah. And I had that. There was a newspaper article written about her. She was like so anachronistic. Even in the 60s, she wore a bonnet and had a log cabin and I had a newspaper clipping off her when the headline mentioned that their teen children in the Log cabin I was like give an event living can do it then you know I can do that sort of attitude. And you know, I did not inherit those genetics apparently. Yeah, I definitely changed my mind on the pain control pretty quickly.

 

P  Well, it is an interesting thing. I remember being terrified of birth, like once I was seven months pregnant. Yeah, kind of that idea that this baby that you’re growing is gonna have to exit your body somehow. Yeah. And how’s that going to work? 

 

J: Right. 

 

P: And I too, took stock of like this has happened for eons. Yeah, we’ve been having giving birth in fields by themselves. But unlike you, I thought I’m not one of those women. Yeah, that’s in the field. That’s not me. But so I like your your spirit and your and the mindset that you’re going in with but at least it feels like empowering to think I can do this. My body can do this.

 

J  Yeah. Yeah. But I, you know, if I could go back in time, I think I would have never seen a midwife I would have stayed with an OB. And yeah, I would have been more open minded to everything. I think my biggest lesson was like don’t have a birth plan. The baby has a birth plan, you know,

 

P : it’s hard not to get attached to some form of control, which I think is what that birth plan is because you’re walking into the unknown. So it makes sense to me that people would want a little something to cling to but But you’re right, that doesn’t always land. 

 

J Right. Exactly

 

P: So now you how do you get past your due date? You just do. There’s nothing going on. 

 

J: You know those days are a little hazy because I was definitely feeling really bad but I remember I made it to my final week appointment. And, and then yeah, a few days after that. I started having contractions. But yeah, those last few days are definitely blurry.

 

P : So so how do we get to the hospital? Does your water break or like what take us to the day?

 

J Yeah, I had two trips to the hospital. So the first was around. I had been laboring all day and calling into the clinic and reporting to them on timing and contractions. I had your back contractions I had a lot of pain in that in the back. Just I just know hammering is the way I refer to it. I remember sitting on the first of all, my husband kind of pressing on my back and I was just, you know, at that point, you’re starting to realize like this is this is just the beginning.

 

P  You and You knew this was a contraction. 

 

J: Yeah, yes. Because it was coming in. It was coming in, wakes up and it would go away and then it would come back. And we were timing them and I think they got to five minutes. Although I don’t remember that precisely. But we went in, I wanted to go in and it was like when in the morning went into the hospital went into the triage of labor and delivery and I was only dilated to one centimeter. And so they sent me home but I also have high blood pressure I had it’s like 145 over 90, and I had a racing heartbeat. And I remember the midwife it was a different one this time asking my husband like, Oh, does she have anxiety? Does she get anxious easily? And I think he said, You know, I think he was sort of like well, you know, I guess like he didn’t quite know how to answer that. What you think would have come up before I’m in triage. And so they sent me home at one inches dilated and say you know, you know, keep in touch and call us and I can’t remember exactly what the designation was to call back in. So we go home, and things continue like that for a while but I start feeling worse and worse. And again, it’s so hard to know like, is this labor or is this something else? 

 

P: you feel worse means that you’re getting a headache now

 

J: I have I was kind of like a flu type feeling like a general just generalized fatigue and anxiety. My heart was elevated probably for a month really. But you know, this sense of like impending doom, which is my favorite experience and then at a certain point I call it and I think I felt lightheaded. And I called him to the midwife and I was like I don’t feel good. And so she said, Oh, you’re probably dehydrated. So Brendan my husband ran out and got some power rate. And then I drink that power away and I proceeded to vomit all over the kitchen. And as I’m throwing up, my water breaks. 

 

P: Wow….no shade for your husband, but Powerade sounds vile.

 

J : I happen to like the red one. Reason Yeah, when it’s really cold, the red one kind of spot. I don’t drink it often. But you know, we were trying to I didn’t have much of an appetite and if she you know she wanted me to stay hydrated. So 

 

P: okay absolved…sounds like he did the right thing

 

J:  Yeah, yeah, exactly. Yeah, well, eventually, but it did get all over the kitchen. And yeah, and then the water breaking was like this. You know, just these two things. Two things happening physically at once was insane. And even then I have been learning a birth class. But sometimes when we get to the transition phase of labor, they grow up or they feel nauseated. And so I told Brendan I was like, I think this is normal, like you know, to be growing up and have your water break and things just feel like they’re accelerating. So at that point, my biggest concern is that I’m about to have a baby. And so we go into the I call the midwife and she says come in right away when I when I said that I’ve just been throwing up

 

P  let me ask you a question this transition is like seven centimeters dilated right so yes yeah,

 

J but this one had been like 12 hours on a triage so I you know, I could 

 

P: okay totally legit Yeah, okay. 

 

J: Yeah. And it’s, it’s kind of you know, with the, for me, you know that’s a bad thing to be just just handle your decisions on how much the dilation is happening and keeping you at home as long as possible. In my situation where I’m already having all these vital sign issues and stuff, who cares when I’m dilated? I need to be in a hospital. 

 

P: agreed

 

J: But that was missed. You know that that wasn’t caught and so ended up getting very sick at home. And I remember taking we’ll take a cab into the city and there’s a lot of traffic was lunchtime, just like driving around the west side of Manhattan feeling like shit covered in vomit at that point. 

 

P: So, so how does this feels a little bit like a TV movie here?I know the cab drivers happy to take you or where you’re going to get back from the cab or 

 

J: I don’t remember. I really don’t remember I remember like looking at all the like fancy shops in Midtown. And we’re just kind of crawling along. Yeah. And then I get to the hospital and the midwife meets us down in the lobby and she’s like Where were you? Really we were in traffic, you know, like, drive as fast as we can. And then she like escorted us up to triage. 

 

P: Are you feeling scared now? Or what are we now we have anxiety? Yes, yeah, exactly. Right.

I’m feeling scared for you. And obviously I know how this turns out but you still worried about the high blood pressure and the fast heart rate and, and a fast heart rate. The thing that’s bad about that as opposed to high blood pressure is most people say you can’t feel high blood pressure necessarily. Right. But the fast heart rate is a freaky thing to feel.

 

J  Yeah, it is. Yeah. And it’s and it feels exactly like anxiety. So yeah, and so there was this this, I was definitely anxious. And at that point, one weird thing that happened to me. And I don’t and I’ll never know if this was anxiety or if this was the high blood pressure or both. I started hearing like an ocean sound kind of a shot like that. He was holding shells up to my ear. And I went into some sort of other space at that point where I was listening to the sound. I was very calm. And I didn’t say anything to anybody, but like hearing the sound. I don’t think I was really aware of it. In that sense. Like I should say, thing was just like intense. I think it was just the intensity, everything. And in triage, I get a cervical exam and meconium spills out, which is the baby’s first bowel movement. And if it happens in utero, it’s usually a sign of distress, and the baby can accidentally aspirate or swallow it and then get very sick and so once they saw that I think I still wasn’t dilated enough technically to whatever be admitted, but at that point didn’t take me to the hospital because of the meconium. And I said right away I want an epidural men so 

 

P: I’m gonna pause you right there though for a second to say the thing that gets you in as a sign of distress for the baby. All these things have happened to you. You don’t sound entirely lucid once you have the shell sound right, which is a little disconcerting in a way that you can’t access or communicates. None of that none of that gets you access. To the room. Right? That’s a problem. That’s what I remember. 

 

J: You know, it’s t’s because it is such a chaotic situation. That that that is what I remember being the like, being almost relieved, you know that. There’s no way they’re gonna send me home. I don’t have to go do this by myself. Yeah.

 

P  Crazy. So they put you in a room and and what happens then

 

J :I get the epidural pretty quickly. And then they give me Pitocin very quick. The you know, depending on what hospital on what OB I might have had, I think a lot of situations they probably would have given me a few sections that the employee but they chose to continue with labor, vaginal labor, and so I had the idea of getting the Pitocin and then the epidural, it actually can lower your blood pressure and and women who have normal blood pressure, it can go into too low. In my case, it just made it look normal. Basically, I’d have to look back at the charts at what it was reading at but it was a high or low and that can be a side effect of getting an epidural anesthesia.

 

P:  How does an epidural lower blood pressure so epidural block affects nerve fibers that control muscle contractions inside the blood vessels. This can cause blood vessels to relax lowering blood pressure. This doesn’t happen for all women who use an epidural but does affect a significant share of women.

 

J  So that might have been another situation where that threw them off like once they got me in. And I had midwife looking at my case at that point, not an OB yet and so an OB might have been like well, she came in with high blood pressure and when she got the epidural and drop, this might be preeclampsia. You know that connection wasn’t as far as I knew, they might have been. It didn’t stay in my chart around that time like watch BP closely. So I think they were aware of something was going on. Like there’s a diagnosis.

 

P  Well, this is all a little scary. How’s your husband faring since he’s present? 

 

J: Yeah,he seems to be doing okay. Like it’s we both felt relieved once I was in the room and had the fetal monitor on me and had the the constant attention of a nurse and all that sort of stuff. And I was so much calmer once I had the epidural and I was laying down and can focus a little bit more. I didn’t feel great, but I you know, again, I’m like, How are you supposed to feel? And it took a long time still, though even with all the Pitocin for things to speed up enough to get to the pushing stage of things. 

 

P: so even though they’re worried about the meconium for the baby, this is not a rush situation.

 

J  : I went in and went in the afternoon, that’s like a time and then I delivered at like 130 in the morning. 

 

P: Okay. And so what’s what’s delivery like with you feeling so awful? 

 

J: Yeah, it was it was scary because they knew that, you know, they knew that she had the meconium so they had a neonatologist from the ICU standing in the room. And I have brought in like the little or big kind of almost looks like an x ray table where they examine the baby. She was standing in the corner like watching my birth, the last like hour took a long time. And I hope that she was watching the heart rate monitor and the fetal signs. They don’t know. I just remember being like I don’t know who this woman is, and she’s standing there. And so yeah Adela is born and very quickly, they rush over to table and the neonatologist takes a tube and aspirates her so my first look at Adela is her with a tube down her throat having fluids suctioned out and so that was just like, you know, you’re just terrified. Hoping she Okay? don’t really understand what’s going on.

 

P:  And my guess is there’s no crying because they don’t want her to cry because their afraid she’ll aspirate

 

J: Right, exactly. There’s no crying and then they do hand her to me. But it’s brief and I can see that she’s not breathing normally she’s like that panting 

 

P: Yeah. 

 

J: And so basically, you know, you can hold her for a few minutes but we need to take her to the NICU and meanwhile they’re stitching me up I have like an internal tear and an external tear. Can’t feel it but you know, the midwife has done our stitching me up and then they take her to the NICU. And then yeah, the next like three days are just absolute hell for me

 

P: This already sounds like way too much. Delivery where their silence is terrifying. Right, right. When she when she exits her body and you cannot hear Yeah, I wish we’ve all been trying to listen for sound scary on it’s own. Not feeling well. Then they’re gonna take her away again.

 

J: Yeah, Her birthday was six, six pounds, nine ounces, and considering the gestational age being at like 41 weeks she was small. She was like at 10% or eight to 10% of what’s normal and that, to me, it was like that’s the sign of growth restriction. She was like getting the nutrition from my placenta that she should have been no one. No one ever discussed that with me though. But when I saw the numbers, I was like, wow, she’s I thought she’s going to be huge based on everything that happened. 

 

P: Yeah, yes. So now they have moved you into recovery. I’m assuming and, and baby Adela is in the NICU? 

 

J: Yeah, she’s in the NICU and I moved to this flip the floor or an area of the hospital. We’re just NICU moms, which I didn’t know was a thing. Either, but I’m sharing a room which I really hated with another woman who had had twins, and I think she was having twins have been there a little bit longer, and they immediately want me to start pumping, because I have a breast pump. And though again, like the sleep was such at that point, I was so sleep deprived going into it. And then it’s like 130 in the morning and they’re really wanting me to try to use the breast pump. And then I remember sharing, it’s just like a curtain between us. 

 

P: Yeah, 

 

J: she’s a twin mom and she is using the breast pump constantly. It’s right by my head and I just cannot sleep I brought earplugs and like an iPod you know, trying to drown out the sound and she’d have family coming in and out. You know, it was just like, you know, so noisy and, you know, just hazy. And I think I think I made one visit to Adela before we started to get more concerned about me. You know, I didn’t feel good. The like 12 hours after I gave birth and it kept me on the IV pole for a while. I guess I was on the IV pole for a really long time but they hadn’t taken out the Pitocin they had I don’t know I guess they keep it in after delivery  to continue to shrink the uterus But my nurse at that point it was really the the that RN who picked up and she was like your blood pressure is high. Your blood pressure is high. And she kept telling me this. I was like, you know, I don’t know what it was I don’t know how to respond. I was like, you know, and you know, and she just like she’d come in and she was just concerned. She was concerned. She was the surgeon and so she called the midwife and the midwife came in. And she told me Oh, I think we might you might have preeclampsia and at that point I started crying

 

P:I’m going to stop my conversation with Joy here, and we’ll pick up the rest of the conversation next Friday. For now I’ll say that this experience of medical care is harrowing to hear about, so I can’t imagine what it was like to experience it. I appreciate that Joy shared it with us, because as hard as it must be to talk about it, it’s important to examine and understand how this is happening to someone at one of the most vulnerable times of her life. Birth is one of those experiences that stays with you for the rest of your life…which doesn’t mean it should be perfect, but to the degree we can keep it from being traumatic, that should very much be our goal. I find Joy’s ability to analyze and relate her experience a real testament to her strength and resilience and it’s inspiring to hear how she used that experience to help other women who ran into preeclampsia