Before the Seizure that You May or May not Have

Headline yesterday: Two Proteins Tied to Preeclampsia. Big news, because this is a dangerous, mysterious pregnancy complication. It’s really a "symptom cluster" (elevated blood pressure, proteins in urine, hyperreflexia) with no definitive way to diagnose, cause or cure it. "Pre-eclampsia" means "before the seizure" – the eclamptic seizure being worst of its symptoms and effects (it used to be called "toxemia" because it involves toxins in the blood). There’s some good info here: What Happens Biologically During Pre-E. Pre-e causes a "domino effect" in the mother’s blood – some things (diet, minerals or blood pressure meds) seem to help, but they might just slow down the systemic chain reaction long enough for the baby to be born. But nothing is proven to work, and thousands of mothers (and their infants) die of it.

If it’s caught early, pre-e is medically "managed" by bedrest, monitoring, intravenous anti-seizure medications, or surgical removal of the (hopefully healthy and viable term) fetus. In order to avoid the (very low, but real) chance of a seizure, current protocols demand aggressive management. I’ll assume that, on balance, this does more good than harm – although I haven’t seen any stats that show it. Not even hindsight is 20/20 – it’s impossible to know whether any given interventions actually avoided a seizure, or did any good at all.

When a woman shows up in labor (like I did) presenting some clinical symptoms for pre-eclampsia, the protocol is apparently "everyone freak out." I had BP around 135/90, some protein showing on a urine "test strip," and excelled on my reflex test by kicking the nurse in the face (I was momentarily proud, before I realized was not a good sign). I was immediately given an IV (after two false tries which left me too bruised for anyone to hold my hands through labor). For the next 20 hours I was administered magnesium sulfate, a drug so strong it burns the arms on entry and causes "flu-like" symptoms (dizziness, exhaustion, vomiting). Magnesium, coincidentally, is a drug that's also used to stop labor when women are in danger of delivering prematurely. So, not surprisingly, after 12 hours of being "stuck" at 6 cm of dilation (and after pitocin, artificial rupture of membranes, an intrauterine catheter, and other stuff I probably don’t even know about), I agreed to the doctor’s proposal that "we go ahead and section you." Somewhere in the back of my mind was the recollection that "failure to progress" really means "failure to be patient," that c-sections were not an easy way out of anything, and that somewhere inside me was a baby who knew how to come out of my body the way the good Lord intended. But I don't remember thinking much about this. Mostly I remember that they promised me a cherry popsicle when it was over, at my insistence.

I'm lucky, I know: pre-eclampsia stole my birth, but not my baby. I’m also lucky that I did not suffer serious complications from the interventions and surgery. But yes, the birth still matters -- a point I think Gretchen Humphries says best in her essay You Should Be Grateful. I understand that medicine is an art as well as a science, and I believe that the doctors who put me on magensium me did it with every intention of protection me from seizure and delivering me of a healthy baby. I’m not prepared to second-guess their decisions, even when we saw another OB shake her head in dismay at my chart and tell me my pre-e was "mild." Even though I recently checked my labwork and saw that my actual blood draws did not show positive indicators of pre-eclampsia. I still might have been at risk. They might have saved my life. There’s no way to know.

It’s a popular myth that women are healthier and safer now than in "The Old Days" of childbirth where we didn't have operating rooms and anesthesiologists on-call. While nutrition and sanitation have made birth much healthier (especially compared to eras of historic poverty, malnutrition or social oppression) other things haven’t: Skyrocketing c-section rates since the 1970's, for instance, haven’t lowered maternal or neonatal mortality rates in the same time period. In fact (see below), surgical deliveries carry a higher risk of death for everyone. And this is without considering complications like infected incisions, blood transfusions, pain, depression and anxiety (that are not quantified as "serious" complications by most research, or legally cognizable as damage). And in countless other situations, mothers and babies are exposed to infections, allergens, medicinal error, anxiety and post-traumatic stress -- simply by going to the hospital.

It may be too much to hope for a magic pill for pre-eclampsia (folic acid during pregnancy, for instance dramatically reduces neural tube defects). But science has got to lead us (eventually) to more certainty, less fear, and more accurate and specific treatment. And we have to wonder whether so many women's bodies are truly made (evolved, designed, created) with innate defects that can only be cured by modern medicine. Childbirth is not supposed to be easy, but I have to wonder if it's supposed to be deadly. Do we really need science to save us from the danger of own bodies? How much of this is a symptom of our modern lives -- poor diets, exposure to pollutants, and a culture of fear and mistrust surrounding birth? How much are we asking of medicine, and how much do we need to take responsibility for ourselves?

In some cases, maybe mine (maybe), medical intervention saves lives. I’ll never know. What I do know is that, from here on out, I’m classified as a "high risk" birth – not because of pre-eclampsia, but because of the previous uterine surgery that fear and treatment of pre-eclampsia led to. So we'll see what happens if I do it again. In the meantime I’m learning all I can -- about health and disease; responsibility and trust; risk, fear and courage.