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HELLP – In the Beginning – A First Person Account

Brenda Albano

July 16, 2019

I am a worrier by nature. My worries were only compounded by the fact that, despite being young and healthy, we still hadn’t conceived after 11 months of “trying”.

God blessed me during my 12th cycle, but the initial joy and relief upon seeing that “positive” was quickly replaced by a whole host of concerns. Carrying a baby was such an awesome responsibility! The multitude of reasons and ways that I might lose the baby overwhelmed me. My husband liked to tease me that if, like in the old days, doctors asked which one of us to “save” due to serious complications, he would choose me. Fortunately (and despite my husband!) By the time my pregnancy was well established, I had calmed down enough to appreciate and enjoy the miraculous process of cultivating a new life. I began to believe that indeed, things might turn out alright.

Like any conscientious mom-to-be, I flipped through the baby books, reading up on birthing methods, considering the risks, and deciding what interventions I didn’t want. I, like many women these days, wanted to “go natural”, and even wrote in my pregnancy journal that I wanted to give birth without all the “benefits” of modern medicine. To that end, I took hypnobirthing classes, practiced relaxation techniques, did perineum massages, and generally prepared myself mentally for the task ahead. Ironically, at that point, I wasn’t concerned about the outcome and was actually looking forward to the challenge of delivery. I flipped past all the information on preeclampsia and PIH because I seemed to think it didn’t apply to me. Subconsciously, I seemed to believe that the danger had passed and I was in the clear. For some reason, it never occurred to me to worry about delivery complications.

As it was, I had the “perfect pregnancy”. I never had any spotting; I never got really big; I never got uncomfortable, or excessively tired, or swollen, and I managed to keep active throughout. I loved being pregnant! In fact, as labour approached, I was regretting the end of this special time in my life. I didn’t want Jacob out, I loved having him in! Regardless, one certainty about pregnancy is that it is a finite process. Jacob was coming out.

It was around 36 weeks that I had my first inklings that all was perhaps not quite as perfect as I thought. I began having aching pains in my rib cage, which I attributed to the baby taking up too much room. I had nausea and vomiting, too, which I intuitively knew was connected to the rib pain. My sister assured me that she, too, had been nauseous near the end, however, so I didn’t give it much thought. I had one episode of slightly elevated blood pressure that prompted a discussion about preeclampsia with my doctor, but a return visit revealed that my pressure had returned to normal. In retrospect, all of these symptoms speak volumes, but at the time they seemed quite inconsequential.

After several days of contractions, we went to the hospital at 2 a.m. on my due date, Saturday August 12th: My labour progressed slowly, but I managed well with the hypnobirthing techniques I had learned. Nevertheless, the process was too much, and after 24 hours of labour (with another 5 hours estimated before opening to 10 cm) I opted for the epidural. The effect was almost immediate, and I was told to rest for a while in order to be ready for pushing. I couldn’t sleep, naturally, but everyone else did! Ironically, after all that effort I was dilated to 10 cm within the hour. I pushed for 1=BD hours, and Jacob was born at 5:55 a.m., Sunday August 13th. It had been a long, but fairly straightforward labour. I had a headache, but I was wired.

I noticed almost immediately after delivery that my ribs began hurting again, and I asked for some Tylenol for both my headache and my ribs. I figured that my rib cage was just re-adjusting itself to its new found space, and that was why it was hurting. I had breakfast, Marc made all “the calls”, and my doula left around 8:30 a.m. At 9:00 a.m. Marc decided he would go for breakfast himself, and he left me alone holding Jacob. He hadn’t been gone for 30 seconds when I began feeling extremely nauseous and realized I was going to vomit. I had Jacob in my arms, no vessel within reach in which to vomit, and had been told not to try to get up on my own because of the epidural. I buzzed the nurse, but she wasn’t fast enough and for lack of any other option, I threw up all over the floor. I was beginning to crash.

Things start getting a little hazy at this point. My ribs were very painful and I threw up again about an hour later. The force of vomiting made me incontinent, but when I tried to use the toilet afterwards, nothing happened. The nurse examined me and in a very alarmed voice ordered a catheter. I think my blood pressure must have begun spiking at this point because the doctor came in and asked if I or my family had a history of high blood pressure. Things became increasingly chaotic in my room after that, and just as things were getting really crazy my mother walked in. My poor mother! Having received “the call” earlier that morning, she was coming to visit the happy new family. Instead, she walked in on a host of nurses and doctors rushing about in a confused and panicked state, taking blood, administering Demerol, and “consulting” in hushed voices. I remember giving her my hand and saying, “Things aren’t going so well, Mom.” I had no idea what was happening at that point, but I knew it wasn’t good. God bless my mother, she took my hand and sat down beside me as calmly as could be, as if bedlam was exactly what she was expecting to see.

They called in the OB on call who examined me in quite a cursory way. His examination seemed to reveal nothing of real concern, and apparently (my husband told me later) he and my doctor had quite a heated discussion in the hall afterwards. Nevertheless, my doctor prevailed (thank goodness!) and eventually came to tell me that they thought (“thought”! This gives you some idea of how rare this disease is) I had developed HELLP syndrome and that I should be transferred to the General where they had more experience with high risk pregnancies. I asked her if I could die, and she said it was within the realm of possibility. They gave me a pill to control my blood pressure, which I promptly threw up. After that, everything was given to me intravenously.

So, with Jacob only about 8 hours old, I was transferred by ambulance to the General. I’ll never forget the sight of my mother bringing my little baby to me for a kiss goodbye, all dressed up in his “going home” outfit. Somehow, this wasn’t how I’d imagined the circumstances of him putting on his going home outfit; I regretted not being able to dress him myself. My poor husband was already in quite a state, his words of having the doctor “save me” in case of complications were coming back to haunt him, and now he had the added responsibility of taking his very new baby to another hospital. They refused to take baby Jacob in the ambulance because he wasn’t the patient and they had no safe way of transporting him, so it was up to my husband to get him there. Marc, consumed with worry over me and exhausted from the long labour, had no idea how to get to the General. Nor was there any guarantee that Jacob would be accepted into the nursery due to “policy”, and to top it all off, it was about 35 degrees Celsius outside and we didn’t have air conditioning in the car. Under the circumstances, it’s not surprising he got lost on the way.

In the ambulance, they administered oxygen, and at the General they set me up in the ICU. They put me on magnesium sulfate and something else for nausea, drew all the blinds to block out the light, and put a towel on the door so it wouldn’t make any noise. They also installed a device not unlike a tap in my arm because they would be taking so much blood. They had to do blood tests every few hours to check my liver enzymes and my platelets. I came extremely close to having a platelet transfusion: my platelets dropped to 32, and if they had reached the 20s, I would have had a transfusion. I was allowed visits from immediate family members, but only 1 or 2 at a time, for about 60 seconds. Everybody snuck in so quietly, and talked in low voices. I thought they were all behaving very strangely, but apparently it was to prevent triggering convulsions. And I was so thirsty! The doctors wouldn’t let me drink anything, but they gave me ice chips and strict orders not to overdo it. It was a very surreal experience to be fed ice chips by my sister … My husband would pop in now and again, but then tell me he had to go to be with my family. I couldn’t understand why my family was holding a vigil outside my room; I had no idea how serious my condition was.

I was in the ICU for 2 days, undergoing multiple blood tests and being hooked up to IV’s. The magnesium sulfate made my eyes go all wonky and made me feel like I had lead in all my limbs and head. It also gave me nightmares, although no hallucinations fortunately! Finally, my counts began heading in the right direction (platelets up, liver enzymes and blood pressure down) and I was on the mend. It was only after the danger had passed that I fully understood how close to the edge I had been. I cried at that realization. They sent the hospital psychologist to discuss the trauma with us and to offer her an open door anytime in the future because, like she said: we can never look at pregnancy and delivery the same way again.

Miraculously, Jacob was fine, really fine, the entire time, and there were never any worries about him. The truly amazing thing is that throughout all of this trauma, I managed to breastfeed. Well, I suppose in reality it was Jacob who was doing all the work. I just laid there, and rolled over on cue. Because of the medication and trauma my milk was slow coming in, but we managed an extremely successful breastfeeding stint.

Since my bout with HELLP, I have done a lot of research, only to conclude that there isn’t much known about this syndrome. The people that are supposed to know about it seem to have only limited experience with it (the doctor that delivered me had never seen it before). The only mention of it in “What to Expect…” is a very small footnote under the section on preeclampsia. It is extremely rare, which makes it all the more dangerous because it is often misdiagnosed.

Would I do it again? Absolutely. I can say with positive certainty that Jacob is worth it. Will we have more children? My husband initially didn’t want to, and quite frankly the trauma scarred me more deeply than I originally thought. However, after much soul-searching, we have now begun trying for a second baby. I will worry throughout any pregnancies I may be blessed to have in the future, but knowing what to expect and what to look for is empowering. I have discussed the risks with my doctor; they are very real but slim. I will be considered high-risk and followed accordingly. I hope and pray that it is all behind me, but I cannot responsibly ignore the possibility of developing HELLP again. It is out of my hands, however, and I can only hope that in my case, HELLP was truly a “first pregnancy” disease.

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