Joined by her mother and oldest daughter, Monica Colflesh was headed to what she anticipated would be a routine, 36-week prenatal checkup with her Doylestown Health certified nurse midwife, JoAnne Ruth, CNM.
"Other than some swelling in my feet and legs, I felt fine," says Monica. "We planned to go shopping after the appointment. My blood pressure had been normal, but this time it was elevated. JoAnne had me lie down and checked again, but it was still high," recalls Monica.
"Monica was showing signs of preeclampsia, a pregnancy-related spike in blood pressure," explains JoAnne, noting that Monica's twin pregnancy put her at higher risk. The treatment for preeclampsia is to deliver the babies as soon as possible.
Personalized, Coordinated Care
Evaluating Monica's condition, JoAnne knew that her patient might need an emergency Cesarean section. Midwives do not perform surgical deliveries, so JoAnne consulted with her colleague, Doylestown Health obstetrician/gynecologist Scott Dinesen, DO.
"I was really hoping I didn't have preeclampsia, but they were talking about admitting me to the hospital," says Monica. "I just wanted to go home, and I didn't want a C-section."
"JoAnne gave me a hug and she and Dr. Dinesen addressed my concerns. JoAnne is very professional and warm. I never felt like I was just a number, and that personal connection carried through with Dr. Dinesen," says Monica. "They talked with me about my condition, Cesarean delivery and vaginal birth after a C-section (VBAC) as an option for future pregnancies. And, they agreed I could go home for the weekend, with Dr. Dinesen on call, just in case."
A Safe Delivery
On Monday morning, Monica received news she did not want to hear. Test results showed her preeclampsia was progressing. The babies needed to be delivered right away.
Monica and her husband rushed to Doylestown Hospital where JoAnne greeted them. "Dr. Dinesen performed the C-section with JoAnne assisting. She stayed by my side the entire time," says Monica.
Monica and her husband welcomed identical twin girls into the world that day. The girls are now 9 years old and since then, Monica has had another girl and two boys with VBAC and no preeclampsia. Earlier this year, the Colflesh family welcomed their newest member, a baby boy.
Preeclampsia is high blood pressure in a pregnant woman who has not had high blood pressure before.
"Developing after 20 weeks of pregnancy, usually closer to the due date, preeclampsia can be mild or severe," says JoAnne. "Most women with preeclampsia have healthy babies, but the condition can be life threatening. The treatment is to deliver the babies as soon as possible." JoAnne continues, "It's a disorder of the placenta that causes an inflammatory response. This can limit blood flow to the fetus, interfering with oxygen and nutrients."
The mother's blood vessels narrow, triggering high blood pressure.Untreated preeclampsia can lead to stroke, pregnancy loss and kidney, eye, brain or liver damage. It can progress to eclampsia, which causes seizures and coma.
Some women develop preeclampsia after delivery.
Risk factors for Preeclampsia
- First baby
- Preeclampsia with previous pregnancy
- Age over 35
- Family history
- Preexisting high blood pressure
- Multiple birth
- Weight gain
- In vitro fertilization
Symptoms of Preeclampsia
- High blood pressure
- Protein in the urine
- Changes in liver function
"Every prenatal visit includes a blood pressure check," explains JoAnne. "We screen urine for protein, ask about headaches and blurry vision and counsel patients about weight gain and swelling." If preeclampsia is suspected, additional tests are done to evaluate the condition of the woman and fetus.
Delivering the baby is the most effective treatment. Blood pressure usually returns to normal within days or weeks after delivery.
Timing of Delivery
"In mild cases, we monitor the mother and baby for risk factors and the baby is delivered by the due date," says JoAnne. "When preeclampsia is severe, it's time to have the baby. Inducing labor may be an option, but if not likely to occur in a timely manner, a C-section may be necessary." A baby is considered premature if he or she is born before 37 weeks, but severe issues occur when a baby is born earlier than 32 weeks.
Medications for preeclampsia
- Blood pressure-reducing medications
- Magnesium sulfate to help prevent seizures
- Steroid medications to help baby's lungs develop for premature delivery
"It isn't possible to predict who will develop preeclampsia, but a preconception visit is a good way to identify risk factors," says JoAnne. "Women who have had preeclampsia in the past may benefit from a medically-managed plan of low-dose aspirin. We suggest limiting pregnancy weight gain to 25 to 35 pounds."
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About Doylestown Health's VIA Maternity Center
Doylestown Health's VIA Maternity Center is rated among the best in the region for maternity care with services available for every stage of pregnancy through the birth experience. The VIA Maternity Center features a 32-bed maternity unit that includes 9 labor, delivery & recovery rooms, 22 private post-partum rooms, and a Level II NICU staffed by CHOP neonatologists.