Hypertension in Pregnancy | Preeclampsia and HELLP

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Hypertension in pregnancy and its related complications, such as Preeclampsia, can have significant implications in the health and safety of birthing individuals and their babies. Prior to 2007, these conditions were more rare in otherwise healthy pregnancies. Studies have shown, though, that Chronic Hypertension in Pregnancy doubled between 2007-2021 (source). 

Understanding what these conditions are, how they are diagnosed, and what symptoms to watch for is key to early detection and effective treatment. With early intervention and treatment, pregnancy outcomes have a high probability to be positive even after diagnosis. In this post, we will explore hypertension in pregnancy and preeclampsia including symptoms, how these conditions are diagnosed, and variations or other related diagnoses.

A doctor takes the blood pressure of a pregnant patient in their office.

Hypertension in Pregnancy

What is Chronic Hypertension in Pregnancy?

Chronic hypertension in pregnancy is defined as high blood pressure that either exists prior to pregnancy, is diagnosed within the first 20 weeks of pregnancy, or does not resolve by the 12-week postpartum checkup. According to this article, Chronic Hypertension affects at estimated 5% of pregnancies.

What is Gestational Hypertension in Pregnancy?

The main difference between Chronic Hypertension and Gestational Hypertension in pregnancy is that Gestational Hypertension (formerly known as Pregnancy-Induced Hypertension or PIH) is new Hypertension that is diagnosed after 20 weeks of pregnancy. This condition is unique in that it is diagnosed after birth if you don’t develop preeclampsia and your blood pressure returns to normal after 12 weeks postpartum.

While this makes it sound less severe than Preeclampsia, it’s of note that if this condition progresses from mild to severe Gestational Hypertension the treatment is very similar to severe Preeclampsia. Both conditions are important to monitor and intervene if necessary.

Unlike Preeclampsia, Chronic and Gestational Hypertension may not always present with symptoms. However, regular monitoring of blood pressure is essential to ensure early detection. 

What Symptoms Should You Watch for?

Pregnant individuals who experience high blood pressure readings (140/90 mmHg or higher), headaches, visual disturbances, or swelling of the face, hands, or feet should discuss with their healthcare provider if further testing is needed.

How are Chronic and Gestational Hypertension Diagnosed?

Both Chronic and Gestational Hypertension are diagnosed via blood pressure measurement, urine analysis, and blood tests. Blood pressure tests are always the first line of defense as they’re taken at each routine visit. Urine analysis is also routine however they’ll do a more intensive analysis to rule out Preeclampsia. Blood tests may also be taken to check on organ function.

How Common is Hypertension in Pregnancy?

Hypertension occurs in about 10% of pregnancies in the United States. Chronic Hypertension affects about 1-5% of pregnancies, while Gestational Hypertension affects approximately 6-8%.

Pregnant individual takes their own blood pressure at home to monitor for hypertension, preeclampsia, and hellp in pregnancy

Preeclampsia

What is Preeclampsia?

Preeclampsia is a serious condition that typically develops after the 20th week of pregnancy. It is characterized by high blood pressure and damage to organs, most commonly the liver and kidneys. This condition can progress rapidly and pose significant risks to both the pregnant person and the baby. It can potentially lead to complications like preterm birth or placental abruption and can even be fatal if left untreated.

What Symptoms Should You Watch for?

The symptoms of Preeclampsia can range from mild to severe. It’s important that individuals share their symptoms with their healthcare provider no matter the level of intensity. It is possible, however, to have Preeclampsia without these symptoms which is why routine prenatal appointments are important! Just like with Hypertension in Pregnancy, persistent high blood pressure (140/90 mmHg or higher), headaches, visual disturbances, and swelling of face, feet, or hands are common. 

Other things to watch for include:

  • Excess protein in the urine (proteinuria)
  • Upper abdominal pain, particularly under the ribs on the right side
  • Nausea or vomiting
  • Sudden weight gain
  • Shortness of breath

How is Preeclampsia Diagnosed?

If Preeclampsia is suspected, the first step will typically be to get a reading on blood pressure followed by a urine analysis. When readings are consistently at 140/90 mmHg or higher and there is protein present in the urine, healthcare providers will typically move forward with a blood test to check on liver and kidney function and platelet counts as well as an ultrasound and non-stress test (NST) to monitor the baby’s growth as restricted fetal development can be common in Preeclampsia.

How Common is Preeclampsia?

Preeclampsia affects about 5-8% of pregnancies in the U.S. It is most common in first-time pregnancies, but risk factors include being pregnant with multiples (twins or more) and a history of hypertension or kidney disease.

How Common is Postpartum Preeclampsia?

Postpartum Preeclampsia is rare, occurring in about 0.3-0.7% of pregnancies. It can occur in individuals who had Preeclampsia during pregnancy, but it may also develop in individuals with no prior related history. The symptoms remain the same during pregnancy and after delivery. Postpartum Preeclampsia can develop after a baby has been delivered. The highest risk is 48 hours after delivery but it’s important to pay attention to symptoms that develop once you’ve arrived home and seek care immediately if something appears to be off.

Are There Other Conditions I Need to be Aware of?

The other main hypertension-related condition to be aware of is HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome. HELLP previously was thought to be its own classification. It is now thought to fall under the hypertension umbrella as a variation of Preeclampsia. This condition can be more difficult to diagnose because the early symptoms present just like Preeclampsia symptoms. This is why it’s important to know the symptoms, attend your routine prenatal appointments, and intervene early. Preeclampsia.org estimates that of the 5-8% of pregnancies that develop Preeclampsia, 15% of these people develop HELLP (source).

Hypertension and its related conditions are significant health concerns for pregnant and postpartum individuals. These conditions, while statistically more rare, are still important to pay attention to and know the symptoms of.

During pregnancy it is important to attend routine appointments for a whole host of reasons! Early detection of conditions like Hypertension is just one. Remember, even if a pregnant individual develops one of the conditions we’ve noted here, treatment is possible! Outcomes are greatly impacted by early intervention.

Struggling with one or more of the symptoms above? We want to encourage you to reach out to your doula and healthcare provider immediately. Chances are you’re okay (statistically speaking!) but the peace of mind from double checking is invaluable.

An Interview with Emily and Debbie | 10 Years of DOB

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In honor of a decade of DOB, we thought an interview was in order! Our Marketing Director, Mallory, sat down with Emily and Debbie to chat with them about the last ten years, what lessons they’ve learned along the way, and what’s coming for the future.

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When you first launched, what was your biggest challenge?

We both began our doula journeys as solo practitioners—Emily in 2003 and Debbie in 2014.

Emily: The biggest challenge was transitioning from being a solo doula and childbirth educator to running an agency that brought on trusted doulas to represent the business. With so many word-of-mouth referrals coming directly to me, it was a learning curve to shift to the mindset of, “This person is trusted by me and therefore should be trusted by you.”

What would you say was the best part of the early days?

Interestingly, that challenge also turned out to be the best part. While it felt daunting, it opened the door to supporting many more families and doing much more postpartum work than I could ever manage alone.

What was your first big win?

Emily: The first time I ran payroll for our team was a milestone! But my biggest win was bringing Debbie on as my business partner. To say that Debbie saved Doulas of Baltimore (and me in the process) would not be an understatement. She jumped in with both feet to keep the agency functioning during an overwhelmingly difficult time in my life. Not everyone would do that. Yet, in true doula style, she faced the challenge head-on, rather than shying away. In the last six years, we’ve accomplished so much together! More than that, her partnership meant I was no longer isolated as a small business owner; I had someone to share wins with, listen to me, and challenge me to always bring my best. I often think about how much harder the last several years would have been without her!

Debbie: A more recent win has been adding support staff. What a relief it is not to wear every hat as a business owner! We now have two dynamic marketing associates and an office assistant. Next up is bringing on an administrative assistant and 1-2 doula team leaders. Exciting times ahead!

What would you say your biggest inspiration for DOB has been during this last decade?

Emily: My inspiration has always been the desire to make a difference in the lives of babies and young children. The years from birth to three are crucial for childhood development. Supported parents enter their parenting journey more positively. Solid, non-judgmental support helps parents engage, care for, and communicate with their babies confidently. When cared for by connected, attentive parents, children thrive.

Debbie: It may sound cliché, but my inspiration is Emily. She single-handedly created DOB, evolving from her solo doula business to the first iteration, Baltimore Family Beginnings, and eventually to the Doulas of Baltimore we know today. DOB is Emily. Every day, I strive to ensure that my interactions with our team, clients, and colleagues reflect her incredible legacy in the Baltimore birth community.

Did you envision being where you are right now? What has changed?

Debbie: Never in a million years would I have believed that my doula trainer would become my business partner and one of my best friends!

Emily: I can’t say I envisioned being where we are now. The pandemic prompted a necessary reevaluation of our business. It forced us to rethink our emotional investments, boundaries, and how to sustain growth. We had to pull back and be intentional about what we wanted moving forward. Before the pandemic, we laid down significant boundaries, which gave us the space to focus on what truly mattered. We spent about nine months in 2021 refining our systems, ensuring we were ready when business picked up again.

What’s next? What can we expect to see in the coming years?

Debbie: We identified a need for a more expansive newborn care offering, and our clients have responded enthusiastically. We now have more people taking our four-week Essential Newborn series than our previously most popular class, Baby 101. This makes me wonder if there’s something else we need to develop that we just don’t know about yet—our clients haven’t told us!

Emily: Looking ahead, I want to continue nurturing sustainable growth while integrating systems and support staff to lighten the load. We’re focused on adapting our services based on the needs of the families we serve. Ultimately, we want to build a community that supports our clients, helping them connect with local resources and each other. We’ve long wanted to host parenting support groups, especially for working parents and non-judgmental feeding support. Having our new office has been a game-changer, providing the intimate space we need to create these offerings. I’m excited about what’s next!

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The future of DOB looks bright and we cannot thank Baltimore enough for 10 beautiful years of supporting families. Here’s to 10 more!

New Parents | Planning for Your New Normal

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New Parents, your life will never be normal again.

Ok, that’s not entirely true. You will settle into a new normal but when a baby is born, life as you know it comes to an end. That can sound daunting! How will you make sure your new baby is cared for, your home is tended to, your work keeps going? When new parents are settling into a new normal it will take work. With some skilled planning and a willingness to shift when needed, you’ll find yourself in a groove before too long.

 

End of New Parents Leave

Usually once a baby has arrived one or both parents will get some amount of leave from their job. Circumstances look different for each employer. Explore what options you and/or your partner have for parental leave once your baby has arrived. How long can you take? When preparing to return to work, consider what will make it easiest including a hybrid or virtual work schedule for a period of time or even permanently. Explore these options and what they will look like with your employer.

New Caregiver

New parents transitioning to a new caregiver will take some effort but with planning it can be as smooth as possible. Ensure your new caregiver has adequate bottles and pumped milk or formula available to feed the baby. Pack their bag well with extra diapers, wipes, outfits, and anything else they may need. Discuss any circumstances unique to your family that your new caregiver may need to understand (is your baby on medication? Do they need to be fed a certain way? etc.) Communication is key to make transitioning to a new caregiver as easy as possible.

Balancing Home/Work

A new baby will always change the dynamics in a house. Consider how to make the transition easier for yourself as new parents, your pets, big siblings, and extended family members. Identify how your household tasks are currently split. Who takes out the trash? What about cooking meals? Who does the dishes? Consider a chart or writing out a schedule for when these things occur and think about planning to prepare food ahead of time while you ease into your new routine.

 

Babies change your life in the blink of an eye and it can feel overwhelming going through all the changes that you will face. With an open mind, lots of communication, and a plan ready, going back to work will feel challenging but not impossible. 

 

Need some extra help? Check out our Free Ultimate Postpartum Planning Guide!

Frederick, Maryland | Day Trip Idea!

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A perfect day in Frederick, Maryland is just a short drive away! About an hour outside of Baltimore, Frederick is the perfect place to take a day trip. Here’s how we would spend a perfect day.

Start your day off with one of our Frederick-based birth or parenting classes. Our one-day classes begin at 9AM and are a perfect way to kick off your trip enjoying connection, fun, and education with one of our incredible instructors.

Next stop, take a quick stroll down by Carroll Creek. A beautiful waterway that meanders through downtown, you’ll enjoy the soothing sounds of water and a calm stroll past the park.

After your stroll, wander through one of the many shops downtown! We’ve already written about our top shops in Frederick, but we have a few great suggestions for this day specifically. 

Stop in at Dancing Bear and find a toy for your sweet baby or their older sibling! Pop over to Curious Iguana (owned by the same people!) and expand your little one’s library with a new book. Stop into The Urban Cottage for a beautiful piece of jewelry or new candle. End your shopping with Relish Decor for a new centerpiece or some new items to make prepping postpartum food a breeze.

Of course you’ll need dinner after your big day! We have a few spots. Stop into Isabella’s Taverna & Tapas Bar for a slice of Spain. To experience local beef and a restaurant committed to the environment, check out The Wine Kitchen. Swing by South Mountain Creamery for a sweet treat to finish off your meal.

We can’t wait for you to enjoy a day of connecting with your partner in beautiful Frederick, Maryland! Don’t forget to register for one of our upcoming classes.

Newborn Classes and Childbirth Education for New Parents

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There isn’t a handbook for pregnancy, birth, or parenthood and that can be overwhelming. If you’re finding yourself with notebooks or spreadsheets full of information to wade through, you’re not alone. We have access to an entire internet full of recommendations, be they current or outdated. Finding reasonable, science-backed answers can feel like an uphill battle and a lonely one at that. Are childbirth classes really necessary? Are newborn care classes worth it?Where can I find newborn classes and childbirth education in Baltimore?

That’s a call only you and your partner can make.

Childbirth Education

What is Childbirth Education?

Childbirth Education Classes are educational programs taught by experienced instructors well versed in the field of Pregnancy, Birth, and Postpartum. Childbirth Education curriculum varies and classes attended are generally chosen based on your preferences. Some focus heavily on a larger, trademarked curriculum such as Evidence Based Birth or Lamaze, while others are completely unique to the instructor such as Doulas of Baltimore’s signature Complete Childbirth Education Series.

Childbirth Education classes can be taught in person, online, in a group setting, or on an individual basis. There are many options and approaches, the bottom line is finding one that someone you trust teaches.

 

What should my class cover?

While there are many different types of curriculum, and the benefits of childbirth education still require more official study, it’s well known that access to education increases positive outcomes. When looking at classes, ensure yours covers these basic topics:

  • Decision making strategies to ensure you remain an active participant in your birth story
  • Tips for staying healthy and comfortable in late pregnancy
  • Physiology and the process of labor and birth
  • Common interventions and medication options
  • How to create and communicate your birth preferences
  • Hands-on coping, comfort and relaxation techniques 
  • Preparing for the postpartum experience

 

Whether you’re planning on going through childbirth without an epidural or are open to medication, understanding these key topics can help you create the birth and postpartum experience that will set you up for success.

 

Doulas of Baltimore is hosting our Spring session of our Complete Childbirth Series on Saturdays beginning April 6th, 2024 in Baltimore and our One Day Baby 101 workshop in Frederick. Our Complete Childbirth Series runs 4 weeks and covers 12 hours of science-backed education in an affirming and open environment. Our Baby 101 workshop is a one day intensive that gives new parents all the essential information they need. Learn more and register here!

Newborn Care Classes

What are Newborn Care Classes?

Newborn Care Classes are educational sessions for anyone who needs updated information on the care and keeping of newborn babies. Experienced teachers lead these classes who have taken professional training and work in the field. There are many different options for taking these classes including Hospital-based programs and more uniquely designed curriculum created by individuals. Ensure the source and how frequently the materials are updated are considered when searching for your classes. Safety standards for newborns and infants change regularly and ensuring you have the latest information ensures you’re able to keep your baby safe and those around your baby updated.

What should my class cover?

All Newborn Care classes should cover the basics of baby care such as feeding and diapering as well as:

  • Preparing your home and family for a newborn
  • Common baby gear and gadgets
  • Normal newborn characteristics
  • Hygiene including diapering, bathing, and dressing
  • Crying and newborn communication
  • Comfort and bonding techniques
  • Newborn sleep patterns and safe sleep
  • Feeding options and techniques
  • Hunger and satiation cues
  • Common feeding obstacles

 

Doulas of Baltimore has an opportunity for Newborn Care Education this Spring. Join us in Baltimore for our 4 Week Essential Newborn Care Series. This class runs 4 weeks and covers 12 hours of science-backed education in an affirming and open environment. Learn more and register here!

 

When considering the question, “What childbirth classes should I take?” consider who is teaching it, what the course covers, and if the curriculum is aligned with your birth wishes. If you’re searching for infant care classes for new parents we recommend ensuring that the course is based in science and has up-to-date information on safety and development for newborn babies. We recommend if you’re searching for Newborn classes and Childbirth Education in Baltimore or Frederick, consider Doulas of Baltimore!

 

We believe education is one of the most important things you can invest in. Above all when we educate ourselves we empower ourselves to make sound decisions, enter any situation with confidence, and create a great environment for a positive experience. Generally taking classes with your birth partner prior to giving birth can deeply connect you to one another creating a sense of safety and support.

Pinterest graphic about classes for new parents to take