Postpartum Hypertension: A silent menace

Mrs. S had an uneventful journey of pregnancy and a joyous childbirth experience. She became the mother to a healthy baby girl M. She was discharged home on third day.

Like any new mom, she took a while to settle into the routine with her baby and herself. This was a hectic phase although she was surrounded by a loving and supportive family. A few days into being at home she started feeling weak and exhausted. This was considered a normal part of a new mom’s journey. She was asked to rest and ignore it. She also noticed increasing swelling of her legs.

On the seventh day post delivery she started having a niggly headache. Tiredness, weakness, headache, low mood: all normal she was told. Home remedies, the occasional paracetamol was the solution.

By day 10 her headache was relentless and she was weeping in agony. Her husband requested a doctor neighbor- friend to come and take a look at her. By the time the doctor came to their house, Mrs. S was writhing in agony, she was unable to move her right arm and leg. The BP at that point was 180/110. She was taken to hospital. The diagnosis: severe hypertension, intracerebral bleed (bleeding in the brain) and a stroke.

The journey after this was a very very long one for Mrs. S and her family. Although she recovered her physical health due to excellent medical teamwork, she took a beating to her mental health. Inability to bond with baby, breastfeed, constant sessions of physio and rehab: all of this took a toll on her confidence and self-esteem.

What should have been a wonderful and exciting time in her life was ravaged by postpartum hypertension. Which is easily preventable.

Majority of us have heard about the perils of hypertension and pre-eclampsia in pregnancy. Blood pressure checks are a routine part of pregnancy care. They are done diligently at visit and interpreted meticulously. There are well established clinical protocols to prevent, early detection, management of hypertension in pregnancy.

However, there are serious gaps in postpartum preeclampsia care and education. Like in many other issues postpartum: A most neglected phase of a woman’s life. About one in ten women are at risk of developing hypertension post-delivery. Several factors can contribute to the development of postpartum preeclampsia women without a prior history of hypertension.

This can be silent, insidious or mimic what seem to be normal post delivery recovery challenges (as in the case of Mrs. S). Failure to recognize this early can lead to devastating consequences. On the other hand, early detection leads to excellent outcomes.

Severe hypertension, particularly in the postpartum period, often goes unrecognized and untreated because women are not being educated about how to take care of their health post-delivery. The focus is entirely on the baby, breastfeeding and how a mother’s life should revolve around these two issues.

Monitoring mom’s blood pressure is an important part of self-care. And for the family: As you spend this special time with your newborn, make sure you are also taking care of mom and she is being given enough space and time to take care of herself.

Here is a personal discharge instructions to all new moms: