I want to talk today about what good care looks like. We have all heard horror stories about patients whose symptoms were missed or ignored. Some of us have even been those cases. I myself was nearly killed by my doctor’s negligence, and he did kill someone a few months later, my good friend’s sister.
So I know what bad care looks like, and I know how triggering it can be when I see someone else’s case and question whether her doctor is taking her seriously. As an Admin, I have had to work hard to separate my own trauma from other people’s stories, to be able to see their cases more clearly and give appropriate advice. And our team moderates posts closely to see when someone really needs to advocate, or when trauma and fear are taking over in the comments section.
So what is good care? First of all, there is no treatment for preeclampsia except delivery. I want to repeat this because it is important to understand. There is NO treatment for preeclampsia except delivery, and even then it can sometimes get worse before it gets better. There are treatments that can manage some of the symptoms, but they will not stop or slow the progression of the underlying process. There is nothing a doctor can do to stop you from getting worse, or even slow it down.
What doctors can do is evaluate you and baby through regular prenatal screenings and whenever there are new or worsening symptoms. They watch you closely to be able to answer the Big Question: Can you safely stay pregnant a little longer, or is it time to deliver? And the next question: Do you need any supportive treatment in the meantime, blood pressure medication, magnesium sulfate, blood transfusion, etc?
So what do regular prenatal screenings look like?
blood pressure checks
questions about common symptoms
possibly a urine dip test, although some offices are moving away from these
They may also do things like:
Non-stress tests (NST)
Biophysical profiles (BPP)
Blood and urine labs
How often you have these checkups and tests will depend on your circumstances. What were your previous pregnancies like, and when did you deliver? What symptoms are you experiencing in this current pregnancy?
In between these regular prenatal checks, you should watch for any new or worsening symptom and report them to your doctor. Ideally, all doctors should tell you what to watch for, what is worth calling for, and what should send you straight to the hospital. We know many do not, so we encourage pregnant women to ask for specifics:
At what blood pressure level should I call or go in? (Different women will have different call-in levels depending on their circumstances.)
What other symptoms should I watch for?
What is the after-hours phone number for nights and weekends?
So what do you do if you notice symptoms you are supposed to call or go in for? You call or go in. And what should your doctor do? They should evaluate. They may ask you some questions:
How high is your blood pressure?
Do you have any other symptoms?
How long have you had these symptoms?
Have you tried any self care treatments, and did they help?
Over the phone, they may suggest some self care and tell you to call back if things do not improve, or they may ask you to come in. At the hospital, they may decide to run some tests. Which ones will depend on what symptoms you are having. These may include:
24 hour urine or protein-creatinine ratio
reflexes and clonus (tap your knee and push your foot back against your ankle)
And then they will either deliver you, admit you for closer monitoring, or send you home.
If they send you home, does that mean you are getting bad care? Or if you call and they decide not to have you come in, is that bad care? Not necessarily. If they have evaluated you properly, run the right tests, asked the right questions, and decided you can safely stay pregnant a little longer, that is good care. It is also good news!
I want to address one more thing. Going through an experience like preeclampsia is traumatic. Anxiety is especially high when you are pregnant again and back in the same situation where everything went bad last time. Preeclampsia is a BIG DEAL, rightfully so, and it is easy to feel like you are doomed, a disaster waiting to happen, and to feel freaked out. And it is easy to expect everyone else to be equally freaked out. So when a doctor calmly and properly evaluates you and decides you are still fine, it can feel like they are not taking it seriously enough, because if they were, they would be freaked out like you!
I know I sound like a broken record because I say this all the time, but it is so important. Anxiety is a normal, natural response to a trauma like preeclampsia. But that does not mean you have to suffer with it. There are treatment options available. If you find that anxiety is overwhelming you, please reach out for help. Therapy and/or medication really can do wonders. Nothing will completely take away the fear, but it can be managed.