Sara McGinnis was pregnant together with her second child and something was flawed. Her body was swollen. She was drained and dizzy.
Her husband, Bradley McGinnis, said she told her doctor and nurses about her symptoms and even went to the emergency room once they worsened. But Bradley said his wife's response was, 'It's summer and also you're pregnant.' That haunts me.”
Two days later, Sara suffered a massive stroke, followed by a seizure. It happened on the way to the hospital, where she had to go again because of a severe headache.
Sara, of Kalispell, Montana, never met her son Owen, who survived an emergency birth and has oval eyes and thick dark hair. She died the day after he was born.
Sara suffered from eclampsia, a sometimes fatal pregnancy complication caused by persistent high blood pressure, also called hypertension. High blood pressure causes the heart to work at full speed, which can lead to organ damage.
Sara died in 2018. These days, more and more pregnant people are being diagnosed with dangerously high blood pressure, a finding that could save their lives. Current studies show the rates of newly developed And chronic maternal hypertension have roughly doubled since 2007. Researchers say the increase in cases is likely due in part to more testing to detect the diseases.
But that's not the whole story. Data shows that the Total maternal mortality rate The number is also increasing in the USA, with high blood pressure being one of the main causes.
Medical experts are trying to stem the tide. In 2022, the American College of Obstetricians and Gynecologists the threshold lowered in case doctors should treat pregnant and postpartum patients for high blood pressure. And federal agencies provide training on best practices for screening and care. Federal data shows that maternal mortality from hypertension decreased in Alaska and West Virginia after implementation of these policies. But translating these standards into daily care takes time, and hospitals are still working to implement practices that could have saved Sara's life.
In Montana, which last year became one of 35 states to implement federal patient safety guidelines, more than two-thirds of hospitals provided timely care to patients, it said Annie Glovera senior research scientist at the Montana Perinatal Quality Collaborative. As of 2022, just over half of hospitals met this threshold.
“In a hospital, it just takes time to implement change,” Glover said.
High blood pressure can damage an individual's eyes, lungs, kidneys or heart, with consequences long after pregnancy. Preeclampsia – persistently hypertension while pregnant – can even result in a heart attack. The problem can arise from hereditary or lifestyle aspects: for instance, being obese results in a predisposition to hypertension. This also applies to age, and increasingly more persons are having children later in life.
Black and Indigenous persons are way more more likely to develop and die from hypertension while pregnant than the overall population.
“Pregnancy is a natural stress test,” said Natalie Cameron, a physician and epidemiologist at Northwestern University Feinberg School of Medicine who has studied the rise in hypertension diagnoses. “It’s about exposing this risk that has existed all along.”
But pregnant women who don't fit the standard risk profile also get sick, and Cameron said more research is required to know why.
Mary Collins, 31, of Helena, Montana, developed hypertension during her pregnancy this yr. Midway through her pregnancy, Collins was still climbing and taking strength training classes. Still, she felt sluggish and gained weight too quickly, while her baby's growth slowed dramatically.
Collins said she was diagnosed with preeclampsia after asking an obstetrician about her symptoms. Shortly before, she said, the doctor said the whole lot was going well when he checked on her baby's development.
“He checked my blood pressure, did a physical exam and just looked at me,” Collins said. “He was like, ‘Actually, I take back what I said. I can absolutely guarantee that you will be diagnosed with preeclampsia during this pregnancy and you should purchase airline life insurance.'”
In fact, Collins was flown to Missoula, Montana to give birth and her daughter Rory was born two months early. The baby spent 45 days in a neonatal intensive care unit. Both Rory, now about 3 months old, and Collins are still recovering.
The typical cure for preeclampsia is delivery of the child. Medications can help prevent seizures and accelerate the baby's growth to shorten the pregnancy if the health of the mother or fetus warrants premature birth. In rare cases, preeclampsia can develop shortly after delivery, a condition that researchers still don't fully understand.
Wanda NicholsonChairman of the US Preventive Services Task Force, an independent panel of experts on disease prevention, said continued monitoring during and after pregnancy is needed to truly protect patients. Blood pressure “can change within a few days or within 24 hours,” Nicholson said.
And the symptoms are not always clear.
That was the case with Emma Trotter. Days after giving birth to her first child in San Francisco in 2020, she felt her heartbeat slowing. Trotter said she called her doctor and the nurse hotline and both told her she could go to the emergency room if she was worried, but told her that wasn't necessary. So she stayed at home.
In 2022, about four days after the birth of her second child, her heart rate slowed again. This time, the care team checked her vitals at her new home in Missoula. Her blood pressure was so high that the nurse thought the monitor was broken.
“'You could have a stroke at any second,'” Trotter recalled her midwife telling her before sending her to the hospital.
Trotter was due to have her third child in September and her doctors planned to send her and the newborn home with a blood pressure monitor.
Stephanie LeonardAn epidemiologist at Stanford University School of Medicine who studies high blood pressure in pregnancy said greater surveillance could help with complex maternal health problems.
“Blood pressure is a component that we could really influence,” she said. “It’s measurable. It’s treatable.”
More surveillance has long been the goal. In 2015, the federal Health Resources and Services Administration worked with the American College of Obstetricians and Gynecologists to introduce best practices to make childbirth safer, including a particular guide for the evaluation and treatment of hypertension. Last yr, the federal government increased funding for such efforts to expand implementation of those guidelines.
“The inequality in this area is largely due to the fact that women’s voices are not heard,” he said Carole JohnsonHead of Health Resources Agency.
The Montana Perinatal Quality Collaborative spent a year providing this hypertension training in hospitals across the state. Meanwhile, Melissa Wolf, director of women's services at Bozeman Health, said her hospital system learned that doctors' use of the high blood pressure treatment plan in pregnancy was “a godsend.” Even the best way nurses checked pregnant patients' blood pressure varied.
“We just assumed that everyone knew how to measure blood pressure,” Wolf said.
Now, Bozeman Health is pursuing treatment with the goal of ensuring that each pregnant person with hypertension receives appropriate care inside an hour. Posters with warning signs of preeclampsia hang on hospital partitions and loo doors. Patients are discharged with a listing of warning signs to look out for.
Katlin Tonkin is certainly one of the nurses training medical providers in Montana on make childbirth safer. She knows from experience how vital it’s: In 2018, Tonkin was diagnosed with severe preeclampsia at 36 weeks of pregnancy, weeks after she developed symptoms. Her emergency birth was late and her son Dawson, who didn’t get enough oxygen, died shortly after his birth.
Tonkin has since had two more sons, each of whom were born healthy, and she or he keeps photos of Dawson taken during his short life throughout her family home.
“I wish I knew then what I know now,” Tonkin said. “We have the current evidence-based practices. We just need to make sure they’re there.”
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