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.

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!

Postpartum Planning Guide | What, How, and Why?

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Most people are familiar with birth planning but what happens when you bring your new baby home? As professionals that walk through the journey of birth with clients every day, we believe Postpartum Planning for expectant parents is equally important as birth planning. Who will walk the dog? Who will prepare dinner? Getting this in line before birth creates a sense of security and peace after baby arrives. Need a hand? Check out our Postpartum Planning Guide below!

What is Postpartum Planning?

Creating a plan for after the baby has arrived covers many different aspects of your life. A good Postpartum Plan should include discussion with your partner and anyone who will be with you for an extended period of time immediately after birth. The plan is meant to facilitate communication between you and your support team, whoever that includes.

What should I consider for my Postpartum Planning Guide?

There are many aspects to running your home and life and planning for all of them can get overwhelming. We recommend that you break everything down into categories. If you like guides, you can download our Postpartum Planning Guide here (for Free!).

Multi page preview of Postpartum Planning Guide from Doulas of Baltimore

Before Pregnancy

We suggest covering topics like parental leave, childcare preferences, birth providers and birth locations and parenting topics.

Early Pregnancy

During your first trimester it’s a great time to discuss things like childcare options, where the baby will sleep in your home, announcing your pregnancy, and care providers for your birth and postpartum.

Mid-Pregnancy

Around your second trimester is a great time to begin hiring support for birth and postpartum, creating your baby registry, planning a Babymoon, and getting to any large house projects like renovations or upgrades.

Late Pregnancy

Your third trimester will feel both long and very short! It’s time to start tying up loose ends like setting up your home to welcome your baby, outline lists of who does what around the house and who can help with those tasks while the birthing parent is healing, and creating a resource list full of providers such as your OBGYN/Midwife, your doula, and your Lactation Consultant.

Easing the Transition

We also recommend considering how you will ease the transition for you, your baby, the baby’s siblings, your fur babies, and your extended family. How will you structure your day? How will you ensure everyone’s needs are met? What boundaries will you put in place to ensure visiting family offers support and not more burdens?

Who should help with my Postpartum Planning Guide?

The best people to help with your postpartum plan fall into two categories. One is the people who will be directly involved in caring for you after you give birth. This could include a partner, siblings, parents, or other loved ones who step up. The other category is the professionals you’ve added to your support team. This could include a chat with your birth doula or a session with your postpartum doula.

 

The best place to begin? In our opinion, our Free Postpartum Planning Guide!

 

Professionals for Your Postpartum Recovery

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You are going to have a baby, and then you are going to have to heal from having a baby. The massive unknown in that equation is all the experiences you will smooch together in your brain and label it: My Birth Story. Your postpartum recovery is a unique and important part of that story.

The birth story of your child starts when every you want it to start, and it ends when you say it ends. Most stories include the moments you thought you were labor, and have a tiny baby being held – by someone – at the end.

But regardless of the events, feelings, and choices of your birth, you will need to recover.

In our experience, the postpartum body and mind are neglected and underserved in the US. There are exceptions, and we have hopes of change. But most families are responsible for making arrangements for their mental and physical needs, all the while also learning and caring for a new person whom they just met.

The following professionals are presented for consideration with full knowledge that seeing all of these professionals may in itself become a difficult task, and therefore may also be a type of harm. So please, know that we know taking it a day at a time is a perfectly reasonable approach to your new life with your new baby. Let this short list be available to you, if and when you are at a place where you are seeking options for extended care outside of the walls of your home.  

Who to include in your postpartum recovery

1. Chiropractor, at a family-friendly office

You can start chiropractic care during pregnancy for aches and pains, and even for help if your baby is presenting breach (or head up). But chiropractic care after delivery may be viewed as a luxury. The baby is born – why keep going?

Once you spend hours and hours, sitting, swaying, rocking, feeding, and not sleeping, your body – while recovering internally from birth – is being used in many ways that are out of the ordinary. Having the care of a chiropractor can help ease your body back into the world where you aren’t carrying a small life inside you, but instead, have a car seat draped over your elbow.

And why a family-friendly office? Because you may have your child with you. And knowing you have the time to be tended to, without needing to worry if anyone has eyes on your babe can mean the world of difference. Ask them if they are prepared to help new moms make their appointments. We’ve seen strollers get pushed back and forth, pacifiers get placed back in a mouth that has just learned to pop it out, and quite a few chins dabbed when a bit of spit up slips out. Ask.

2. Massage Therapist

Your body holds onto events long after they have happened. Are your shoulders tense right now from work, or that conversation yesterday, or because you are thinking about all the things you said you would do?

Now imagine how it will remember the task of moving a child into the world? Your body will be tender, and once you feel comfortable laying on your belly, having care from a professional who can help your body to release the tension it holds will be a world of difference for your mind, as well as your muscles.

You may get weepy on the massage table and not know why. You may miss your baby while in your appointment, and both love it and hate it. Being worked on by your therapist, you might realize, will be the first time in weeks where you are being touched with restorative energy, instead of having to be the one giving stimulation, food, or peace. Massages are not just for birthdays and anniversaries. Your body deserves to have attention be paid to it after doing the critical work of birth.

3. House Cleaner

This last one might be a stretch for you, but we want you to think about hiring a cleaning service to help in your first weeks home with your baby. Your attention will be divided between learning about your new child, grieving the loss of your old life, and being wrecked with an onslaught of hormones and sleep deprivation.

A professional cleaner is not someone you will need to worry yourself over. She or he can reduce your stress if you are frustrated with keeping up with old and new responsibilities, help prevent your space from becoming an isolated cave, and offer peace of mind that you and your baby are not having your immune systems overwhelmed by housework.

If there is a time to invest in supporting your entire family, taking the cleaning stress off of everyone’s plate is a caring way to start your first weeks as new parents.

As always Doulas of Baltimore is honored so many families are choosing our in-home postpartum team to come and help in the postpartum period.  If you would like to talk with us about care options for support inside your home day or night, we want to hear from you. And if you need referrals to some of our favorite local professionals, just let us know!

 

5 Basic Questions to Think About Before Baby Comes Home

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Being pregnant and preparing for birth can feel overwhelming enough without considering what happens when you bring baby home. But postpartum planning before baby arrives can save you a lot of stress when you will want to be resting and recovering from delivery. And, you might have postpartum brain fog that makes thinking about your options (not to mention making decisions) hard. At Doulas of Baltimore, we think of the first three months at home as the fourth trimester. The postpartum period comes with its own challenges and joys. Here are some basic questions to consider before you go into labor that will make your postpartum life easier. 

What will your home look like?

Because nesting is very real, you may have already set up a nursery or room for your baby. But realistically, this isn’t where baby will be spending most of their time. For the first six months, the American Academy of Pediatrics recommends baby sleep in your room. But where does baby sleep during daytime naps? Do you want to have a dedicated changing table, setups in different parts of the house, or a moveable station? Where will be the best place to feed baby during the day and at night? Consider the layout of your living space and the setup of cribs, feeding or pumping stations, and changing tables. 

What does everyday at home look like? 

A baby changes things: we know this. And postpartum planning involves thinking about the details of how things have changed. Who will feed baby when they wake up at night? Who will change baby? Who will cook meals? Who will walk the dog? Who will take big sister to school? Who will go to baby’s appointments? Who will clean and tidy the house? 

Who can you go to for extra support? 

While everyone might want to meet your new baby, that doesn’t necessarily mean they can provide the support you need. Consider which friends and family can provide practical support, like buying groceries, cooking meals, walking the dog, or taking care of siblings if you are at the hospital longer than expected. 

Who are the care providers you need?  

With care providers, there are the basic people you need to have planned out, and others that you may want to think about having lined up. While you’ve been dealing with an OB, midwife, and/or doula before birth, afterward you’ll need a pediatrician. You may also want a postpartum doula or lactation consultant. If you are concerned about postpartum depression or emotions after birth, you may want to find a mental health provider before delivery since they can have Before you leave the hospital, you’ll need a carseat installed, and we recommend having it checked by a Child Passenger Safety Technician (CPST) or “car seat tech”.

What does post-parental leave look like? 

There is unfortunately no standard for parental leave, so consider when parents will be going back to work and what happens then. Do you have a nanny, babysitter, friend, or grandparent who can care for baby? Will you need a daycare? 

 

This is just a short overview of questions that we see new parents considering as they bring their babies home. Over the next months, we will be going more in depth on these questions and providing guidance and advice for the postpartum period.