Lamaze discovers pre-eclampsia

two women watching horror movie

In the wake of a Downton Abbey episode in which a main character lost her life to eclampsia, Lamaze has suddenly discovered it.

The recent episode of “Downton Abbey” brought much needed attention to the maternal health issue of pre-eclampsia. Why is it we rely on fiction for permission to get real? … How do we encourage each other and the next generation of maternal health advocates to harness the undeniable power of media but not become part of a social construction of maternal mortality as not real?

Why do we rely on fiction? Because organizations like Lamaze refuse to discuss pregnancy complications.

According to The Pre-eclampsia Foundation:

Thousands of women and babies die or get very sick each year from a dangerous condition called preeclampsia, a life-threatening disorder that occurs only during pregnancy and the postpartum period. Preeclampsia and related disorders such as HELLP syndrome and eclampsia are most often characterized by a rapid rise in blood pressure that can lead to seizure, stroke, multiple organ failure and death of the mother and/or baby.

Pre-eclampsia can come on silently. That’s because the leading symptom is high blood pressure and most women have no idea their blood pressure is high unless it is measured. Other signs include swelling, protein in the urine and hyperreflexia (exaggerated reflexes in response to testing with a reflex hammer). Complications of pre-eclampsia include seizures (which means that the dsease has progressed to eclampsia), stroke, liver abnormalities, destruction of red blood cells and lack of platelets.

Pre-eclampsia is more common in first pregnancies, but can happen in any pregnancy. Since the disease is extremely serious, relatively common, and poses a risk to all pregnant women, you would think that any organization or author purporting to advise women on healthy pregnancy and childbirth would mention and then emphasize the signs and symptoms of pre-eclampsia. You would be wrong.

Consider Lamaze International. On their entire website, I could find not a single page devoted to one of the major killers of women and babies. Indeed, rather than educating women about pregnancy complications, Lamaze downplays complications into invisibility.

An evolving body of research repeatedly shows the danger of interfering without a valid reason in the natural processes of pregnancy, birth, and breastfeeding. Any intervention, no matter how simple it seems, may disrupt the normal process and create problems that, in turn, must be managed with more interventions. All interventions have side effects that can be risky for both mothers and babies.

Actually, they go further than that by giving the back of the hand to the majority of prenatal tests.

Many of these newer tests were created to diagnose problems in high-risk pregnancies. But with the increased medicalization of pregnancy, they have become routine for healthy women with no known risks. This does not mean that every test is right for everyone, however, or that they are risk-free themselves. There may be a problem that prenatal testing doesn’t show, or a problem may not exist even if the test suggests it does. Results that are unclear or even misleading can plague your peace of mind and decrease your confidence. The barrage of tests can also make you feel like your health-care provider knows everything there is to know about your pregnancy, which is not the case.

Lamaze is not alone. Henci Goer wrote a 500 page book entitled Optimal Care in Childbirth. How many pages did she devote to pre-eclampsia and eclampsia. Zero!

In both cases, the neglect of pre-eclampsia is inexcusable, but it could be worse. Many natural childbirth and homebirth advocacy books and website peddle the lie that pre-eclampsia can be prevented with diet? There is not a shred of scientific evidence that diet has any impact on pre-eclampsia but that doesn’t stop NCB and homebirth advocates from blaring dangerous falsehoods.

Why won’t NCB organizations and authors even mention pre-eclampsia until forced to do so by a fictional television program. I suspect three reasons:

1. There is no money to be made by midwives, doulas and childbirth educators from women who have pregnancy complications. All three ignore anyone who isn’t likely to pay them.

2. Natural childbirth rests on the bedrock lie that childbirth is inherently safe. Childbirth is actually inherently dangerous and pre-eclampsia/eclampsia is one of the reasons why; therefore, it must be ignored.

3. NCB advocates fetishize process over outcome. The ultimate birth for an NCB advocate is one that involves no interventions, not one that results in a healthy baby. Pre-eclampsia “ruins” NCB perfection; better to pretend that it doesn’t exist.

The Science and Sensibility piece which discovers pre-eclampsia includes an interview with a volunteer at The Pre-eclampsia Foundation. Asked what she would recommend to childbirth educators and doulas, Jennifer Carney answers:

Really, I think it comes down to trusting that the moms you are helping can handle the information that they NEED to know. I was alone. If I had known that these symptoms could mean eclampsia or preeclampsia, I might have been able to save myself from the seizures – which would have also likely saved me from the ARDS and pneumonia. My ICU stay might have not happened. My son was going to be born early – but if I had gone to my doctor or called an ambulance myself, it might not have been so close a call. It’s not my fault that I didn’t know – but it could have been tragic.

Know the signs and symptoms. Know that a woman with severe PE might be having cognitive issues – confusion, and vision problems. Don’t ask her to drive. Don’t downplay distress. And take complaints of headaches, upper quadrant pain, nausea, diarrhea, shoulder pain, visual disturbances, and a general feeling that something is “off” seriously. And if you have a client or patient that experiences something like this, please follow up and ask about mental health issues. Be careful not to ask questions that can be answered with the words: “I’m fine”. Dig deeper.

Pre-eclampsia/eclampsia is a killer of women and babies. It is not uncommon, and it can be easily diagnosed by basic testing. While women cannot diagnose pre-eclampsia themselves, there are signs they can look for and bring to the attention of their providers before pre-eclampsia turns deadly. Of course they can only do that if they know about pre-eclampsia.

It is a damning indictment of NCB organizations like Lamaze that they downplay and ignore common, life threatening pregnancy complications. If you can’t rely on them to provide basic information to save the life of a pregnant woman, you can’t rely on them for accurate information on anything.

  • Elle

    Question – You say that there is not a shred of evidence that diet has any impact on pre-eclampsia, but I have known (and known of) women who were showing symptoms who were told to change their diet to prevent it from getting worse. Why were they told this by their doctors if there is no connection?

    • I can think of a couple of reasons: 1. the doctor was none too bright and a bit casual about pre-e (the latter is not uncommon) 2. It WAS mild, and a better diet wouldn’t do any harm.

      Chapter and verse, please. Did it prevent it getting worse? How long for?

      I got problems at 27 weeks, was admitted to hospital at 29 weeks, bumbled along until 35 weeks. That is fairly unusual – it is more common in late pregnancy, and may well stay unspectacular long enough for a healthy child to be born – if you are lucky, but you would have to be very unwise to trust to luck. My daughter followed a similar pattern; I hung on fairly well, my child suffered. My daughter got quite ill, her child was fine. Maybe my own previously low risk good health was not that great an advantage. Lots of theories – maternal/fetal conflict, over efficient immune response in the early stages, reaction to FATHER’S genes – lots of sophisticated research, because it KILLS PEOPLE. Diet was abandonned as irrelevant quite early, I believe.

      • KarenJJ

        The other thing I can think of is that the poster is confusing pre-eclampsia with gestational diabetes.

        • Elle

          No, I had gestational diabetes and controlled it with diet. I suppose that wasn’t a good question since it’s based on hearsay, and the person I heard it about didn’t have the best diet to begin with, so in her case perhaps it simply inspired her to “get serious” about her eating habits. Perhaps the connection in my mind has to do with blood pressure, as non-pregnant people can lower blood pressure through diet.

          • Victoria

            As you say it is hearsay, it is also just one person. Evidence that pre-e is controlled by diet cannot, as you probably realise, rely on the anecdote of one person whose medical history and symptoms are unknown.

          • Box of Salt

            Elle, “as non-pregnant people can lower blood pressure through diet.”

            Do tell (besides lowering sodium intake).

          • lacrima

            I’ve got chronic hypertension, which is worse now that I’m pregnant and I had pre-eclampsia with my daughter. I’ve always been told not to go nuts with the salt intake and keep my weight within respectable limits, but that’s it. Specific dietary recommendations have been made to a couple of family members, since, unlike myself, their hypertension is complicated by the fact that they are massively overweight, have high cholesterol and one of them is diabetic. My blood pressure seems to be controlled only through meds, unfortunately.

          • Ignorant about most things physiological, I read somewhere that the rise in BP in pre-eclampsia increases the blood flow to the struggling placenta. Does that make any sense?

            I think the line between PIH/underlying hypertension and pre-e may get a bit blurry. I was told I could expect to be hypertensive in middle age – but I am not. BP perfect to low either side of pregnancy.