I need to tackle nutrition. I know I need to, but I don't know where to start. There's so much that goes into it, so much research to wade through. And then there's the emotion that goes along with it, in particular a certain diet with false promises that has led to pain for people I know. It's a topic where my two roles--PE advocate and natural birth advocate--collide, and it's not pretty. I want to present the facts without the stain of emotion, but at the same time, the emotional impact must be made clear.
Sigh.
So I'm taking a few more days to work on it. Tomorrow's post is a Survivor Saturday, so that buys me some time. And for tonight, I'll present some fundraiser tips. Really, just one.
Use regular mail.
I've found I get very little response from e-mails, Facebook, blogging. I've heard a lot of fundraising experts talk about "tapping into the resources of social media", but I don't think it works out as well as they think it will. It's too easy to see a request in your feed, think, "Oh, I should send them something," and move right on to what someone ate for dinner or the funny thing their kid did.
But an actual letter? In the actual mail? It sits on their desk, calling to them. When they sit down to pay the bills, they might just add a check for your cause. And if you include a self addressed stamped envelope to mail it in, well, they can't let that stamp go to waste, can they?
I am blessed to be a part of a very generous family, church family, and social circle. I sent out 200 letters last week, and I'm already more than 40% to my goal (though I don't need to stop at $5000). I am so thankful for everyone who has donated and is considering donating.
This week, the online support group at the Preeclampsia Foundation saw a woman welcome her baby after a very scary few weeks. We were all praying for them both. We also welcomed a woman who just lost her sister to eclampsia and is wondering how to help her brother-in-law raise a motherless baby, and a grandmother whose daughter lost a baby and nearly died herself, and is now pregnant again and having panic attacks. My hope is that my children will not need to spend their pregnancies waiting for a ticking timebomb to go off, that my grandchildren will not be growth restricted or born too soon. And every dollar brings us closer to that goal.
I'm too tired to write the post I had planned, so I'll give a little update on my fundraising efforts. I sent out 200 letters last week. So far, I've raised $1590 of my $5000 goal. If this keeps up, I may have to raise my goal! Thanks to everyone who has contributed so far, and to all who are considering it. If you'd like to help, click on the "What AM I Running For" link at the top of the page.
Yesterday, we explored the research on bedrest. Today, we're going in the opposite direction: exercise. Much like bedrest, it has been recommended for years that healthy pregnant women exercise 30 minutes a day. The primary reason for this recommendation is to prevent complications like preeclampsia and gestational diabetes. The reasoning is that, since exercise can have a positive effect on chronic hypertension outside pregnancy, it would have a similar effect within pregnancy.
The problem with this assumption is that the mechanism behind preeclampsia is completely different from chronic hypertension. In fact, high blood pressure is not the primary problem, only a symptom of that problem. So how does daily exercise as a prevention hold up in actual research?
Most of the research showed a small benefit to exercise before and/or during pregnancy as a prevention for PE, according to this review. It also showed no harm with regard to preterm delivery or low birth weight.
Then we come to this study, one of the largest ever done on exercise and PE. It looked specifically at exercise in the first trimester, categorized women on how long they exercised weekly, and looked both at mild and severe PE. The results were rather astonishing. After adjusting for certain risk factors, researchers found NO benefit to exercise on the rate of PE, and women who exercised the most (270 minutes per week or more) had higher rates of severe PE.
There needs to be more research done to confirm or discount this study. While exercise is an important part of healthy living, and it's especially important to be healthy while pregnant so you and baby have the best chance of surviving any complication that may come up, it doesn't appear to prevent PE. While light exercise isn't harmful, I would be careful not to overdo it.
Disclaimer: I am not a doctor. This is provided for information only. As always, consult your medical professional before starting or stopping a treatment plan (or exercise regimen) in pregnancy.
While recent research into the causes and mechanisms of preeclampsia has been very exciting and informative, finding a treatment has been painfully slow. No one wants to be responsible for harming unborn babies, so developing new medications is done very cautiously if at all. Instead, the focus has been on fairly innocuous treatments like low dose aspirin, dietary supplements, and lifestyle changes. I plan to feature these over the next few days. Keep in mind, I am not a doctor. This is provided for information only. Please consult your health care provider before starting or stopping any treatment plan.
Bedrest has been the go-to advice for many pregnancy complications including preeclampsia since the 1950s, a time when there was little else to be done to control high blood pressure in pregnancy, when there was no way to monitor the baby for adverse effects like growth restriction, and when there was a poor outlook for any baby born before 36 weeks.
Today, there are ways to manage high blood pressure with medication, the baby can be monitored with regular ultrasound, and preemies are much more likely to survive. However, bedrest remains a common recommendation for women with preeclampsia. There was little evidence to support it in the '50s, and little quality research has been done since then.
This 2005 review of four studies found no reduction in the perinatal death rate (the death of a baby before, during, or shortly after birth) and no improvement in low birth weights for women on bedrest for PE. Two of the reviewed studies did show improved outcomes for mothers with severe hypertension. One study found no difference in outcomes between partial bedrest or full bedrest, although it doesn't explain what is meant by partial bedrest. Two studies found a small improvement in the rates of severe hypertension among women who had no protein in the urine, and a marginal improvement in preterm birth among the same population.
This review also pointed out the cost of bedrest: loss of income for mothers previously working, increased risk of blood clots, muscle atrophy and bone demineralization, general inconvenience. Based on this review, it appears the costs of bedrest outweigh the benefits.
More recently, this 2008 study looked at women on hospital bedrest for reasons other than PE (preterm labor, premature rupture of membranes, incompetent cervix, etc) to see how their rates of PE compared to women not on bedrest. The result: a significantly reduced risk of developing PE and a lower risk of intrauterine growth restriction. The conclusion: "When strictly adhered to, bedrest may be an effective measure in the prevention of preeclampsia and early intrauterine growth restriction."
My non-scientist take on this study: these women were on bedrest before any sign of PE showed. Since 90% of women never get PE at all, and most of those who do so get it only in a first pregnancy without any other known risk factors, it would be impractical to put this into practice. How would you know ahead of time which women would benefit? However, for someone like me who has a history of PE more than once, has several known risk factors, and would be at high risk in any future pregnancy, it could be beneficial to start bedrest before any symptoms show. This also may become more relevant in the future when an early detection test is finally developed.
Ultimately, bedrest remains controversial and under-studied as a possible prevention or treatment for PE, though it is a popular recommendation.
Trigger warning: This post includes talk of the loss of a child.The last thing I want to do is add to the pain of bereaved mothers. Please use your own discretion.
One of the hardest things about treating preeclampsia is that it involves two patients, mother and child. The only cure is birth. But what if PE strikes before baby is ready to be born? How do you balance the needs of the mother with the needs of the baby?
If PE strikes after 37 weeks, it's a fairly easy decision. At that point, baby will most likely do fine. But before that point, it becomes a very fine line in staying pregnant long enough to give the baby the best possible chance while not endangering the mother. There comes a point, though, where Mom is sick enough, baby won't be any better off inside than out.
I got just a small taste of that decision. When I was diagnosed in my first pregnancy at 35 weeks, I was already too sick to wait. It was very hard for me to know my baby had to be born prematurely because of me. I would gladly have risked my life for her benefit, but at that point it wouldn't have helped her. My body was shutting down; she would have been oxygen-deprived as my lungs shut down and exposed to the toxins as my liver shut down. Her best chance was birth, just as mine was. Thankfully, at 35 weeks her chances were very good. She did spend time in the NICU, but did really well all things considered.
I had another small taste when I was diagnosed with PIH at 22 weeks with my twins. I knew the average time from diagnosis to delivery is 2 weeks. How does one prepare for the decision to induce labor at an age where only 10% of babies survive? Thank God, I was a slow progresser that time. I carried my twins an astounding 14 weeks after diagnosis, and they were born very healthy. I know how miraculous that is, and I don't take it for granted.
In my time on the Preeclampsia Foundation's forums, I've seen cases of mothers who had to give birth very early, including several who lost their babies. My own experience pales in comparison to these heartbreaking cases. I can only imagine the pain those mothers felt. I've also seen cases where the mother died, their relatives reaching out for help to understand what happened.
That is why I am raising money for the Preeclampsia Foundation, to find a way to end these horrible conditions. No mother should have to say goodbye to her baby. No mother should have to face these kinds of decisions, walking the fine line between giving birth too soon or too late. If you would like to join me, details of my fundraiser are here.
It can be hard to watch someone you care about go through a difficult time. Whether it's a dangerous pregnancy, a traumatic birth experience, the loss of a child before or after birth, you don't want them to feel pain or sadness. You just want to take it away and make them happy again.
Or maybe you don't even understand why they're upset. If you had gone through something like that, you don't think you'd have reacted this way, so why is it so hard for her? Why hasn't she gotten over it yet?
No matter what you say, you can't take away another person's pain. She has the right to feel what she feels. She will work through it in her own time and her own way.
There are, however, at least two things I would recommend against saying.
1. "At least..." At least you have a healthy baby. At least you know you can get pregnant. At least you don't have to get up in the night to take care of your baby (actual quote said to a grieving mother who lost a child!).
Never, ever, say at least. I'm sure it's said with the best of intentions: if only she can look on the bright side, she'll be happy and won't be in pain any more. But what it really sounds like is "The bad thing you went through wasn't *that* bad. If X had happened, then you'd have something to be upset about, but you have no right to feel bad about the not-so-bad thing that happened."
Grief is not a competition. Something bad happened. She has the right to feel what she feels. "It could have been worse" doesn't change that.
Now, if the woman herself wants to look at the bright side, that's great! It's a good sign of healing. But it's not something she can be forced into before she's ready.
2. Any variation of "It's God's Will." God has a plan. God will use it for good. God is teaching you something important.
This may come as a surprise to people who know me in real life, and I may even offend some of them with this. I am a committed Christian. I do believe things happen according to God's plan. I do believe God will use bad things for good. I do believe God can use it to teach us something. I still find it upsetting when someone tells me this.
Again, I'm sure it's said with the best of intention. You can take comfort in knowing good will come from the bad, right? But "It's God's will" sounds like "You aren't allowed to feel bad about the bad thing that happened. How dare you question God?"
Jesus Himself felt sadness. Jesus Himself felt anger. Dare I say, He even felt fear. If the Son of God can feel these things, surely I can, too. Trusting that God has a plan doesn't automatically end those emotions. I can take comfort in trusting God's plan while still feeling and working through my pain.
So what should you say? As I said before, nothing you say will take away the pain. BUT a little empathy can go a long way. "I'm sorry" may sound trite and cliche, but it acknowledges what happened and allows the woman to feel what she feels. "I'm sorry you had to go through that. It must have been hard."
I'm sure there are other things that people found helpful or upsetting. Feel free to comment and share your thoughts.
Today I have the privilege of sharing Nicole's story. I ran 8 miles in her honor today. She told me she wrote this story with tears streaming down her face. The emotions of a traumatic birth experience can last long after the body has healed. I hope it helped to get some of that out. I've touched on the emotional aspect of PE, but I think it deserves further discussion. I plan to write more on it this week.
Nicole's Story
I was 26 years old, married, well-educated, pregnant with my first child, and looking forward to a homebirth with midwives. I had read multiple pregnancy books but felt confident that my pregnancy and birth would be perfect. At 36 weeks I had my home visit from the midwives in anticipation of the birth. A few days later, on a Friday, I finished my last shift at work (a stressful IT position) and looked forward to having a few restful weeks before our little one arrived. On my last day of work I started feeling really uncomfortable and was having difficulty getting my shoes on.
The next morning I had a hard time getting out of bed, and my feet and legs were freakishly swollen. I chalked it up to the final weeks of pregnancy, and started my day. I was expecting my three sisters for dinner, a movie, and a sleepover that evening so I had to clean my house and prep food. I busily prepared for their arrival all day, but started having strange visions of what looked like shooting stars. I wanted to go to the movie store to pick up the rental, but could not fit any of my shoes on my feet. I called one of my sisters and asked her to pick the movie up for me as I was not feeling at my best. Later, I kissed my husband goodbye so that he could spend the night with his parents while my sisters could have a private girly evening.
When my sisters arrived, they took one look at me, and then my legs and feet and immediately expressed their concern. I told them it was normal pregnancy swelling but, with seven children between them, they insisted otherwise. They wanted me to go to the hospital to get checked out, but I declined. We ate dinner and began to watch a movie, but I started to feel really unwell. My older sister drove me to the hospital in our small town, and I had to wear slippers as even my husband’s shoes would not cover my feet.
When we arrived at the ER, the nurse looked at my big belly and reminded me that this hospital did not have a labour and delivery unit, and that I’d have to go the hospital a few towns over for that. I laughed and said that I wasn’t having a baby that night and just wanted to get checked out. She checked my blood pressure and practically sprinted out of the room to get the doctor. A urine test detected protein. I had pitting edema.
The doctor told me that he needed to transfer me to the bigger hospital and that I would have the baby that night. I assured him that no such thing would happen, as I had a home birth planned and my husband was not available. Detecting a stubborn one, the doctor called the midwives to speak with me. There was some kind of miscommunication, and the midwives asked him to discharge me and they would check on me the next morning (a Sunday). Knowing what I do now, I will never understand how this discharge could have happened. My sister had managed to reach my husband (in this time before cell phones), and he had rushed to the hospital by this time. We all returned to our house.
The midwife showed up promptly first thing in the morning, and was immediately concerned. She said I had the highest blood pressure that she had ever seen in a pregnant woman. She wanted to know if my bag was already packed because I was to immediately get to the hospital. My husband and sisters panicked a little, and we rushed to the hospital. Several tests were completed at the hospital, but they had a baby boom that day and the doctor was telling the midwives that he was dead tired and unable to think straight that day. He wanted to induce, and I insisted on waiting a little while longer for the natural birth I had been dreaming about. Nobody had clearly stressed the urgency of the situation to me. I went home. At this point I had gained over fifteen pounds in a period of two or three days.
The doctor and the midwife further discussed the case that evening, and the doctor indicated that he wanted to call me to come back to the hospital. For whatever reason, I did not get the call back. This is entirely unbelievable. I was advised to rest on my side and not get up. I returned two days later for a scheduled induction but again the L&D department was overcrowded so I sat in the hallway for hours waiting for my turn in a room. I was really upset all this time at the loss of the perfect homebirth that I so badly wanted. I finally was induced at noon, and started pushing by 11:00 p.m. Pitocin was never required, and the gel alone had worked at inducing the labour. An IV was hooked up and magnesium sulfate was kept in the room in case of seizure, but never used. The birth was as natural as possible given the circumstances.
The doctor on call had worked in the Yukon, and was accustomed to working with midwives. He was happy to sit in the corner reading a newspaper while the midwives delivered the baby, which is a rarity in OB doctors in cases where care has been transferred from the midwives. At about 1:00 a.m., Ethan Joseph was born weighing exactly 6 lbs. There were indications that his growth had retarded in utero, but at this time I cannot recall how they knew this. We were blessed that he arrived when he did.
Tests returned after the baby was born indicated that I had some liver damage, my blood pressure remained elevated, but the edema started to subside. I wanted to leave the hospital immediately after Ethan was born, but was asked to stay for a short while. At my insistence, I was released later that evening with the midwives following up the next morning. It took a while for my blood pressure to stabilize (about two weeks or so seems about right).
I really mourned the loss of the stress-free birth that I had anticipated, and I did experience some post-partum depression after Ethan’s birth. I had experienced some problems with breastfeeding at the time as well that left me feeling that my body was entirely inadequate to be a mother. I felt altogether like a failure. I cried constantly and my husband didn’t know how to help me (his tough as nails wife). I made connections with an online group of mamas during this time that I will treasure for my entire life, and it was this group of fine women who understood how I felt and helped me through this difficult time. Ethan gained weight slowly but surely, and he is a strong AAA hockey player these days.
I did not have pre-eclampsia during my second pregnancy, but every time my blood pressure went up slightly, my feet felt swollen, or I was generally not feeling well I felt a sense of panic. I had a poor experience with a terrible OB that my midwives that had called for a consult when my blood pressure was temporarily up. That birth also ended up being a hospital birth, but for an entirely different set of circumstances. Thinking of the circumstances regarding both births can still reduce me to tears sometimes, but I have two healthy children and for that I cannot be more thankful.
