Somewhere along your pregnancy or VBAC journey, you’ve likely heard of something called preeclampsia (or pre-e). Chances are you’ve read about it in your pregnancy app, maybe your provider has discussed it with you or maybe you know someone who has been diagnosed with it. Generally defined as persistent high blood pressure during pregnancy, a pre-e diagnosis (or even a possible diagnosis), might feel a little worrisome.
We see comments and questions like this all the time in our community – what does it mean, and is preeclampsia a game-changer for someone desiring a VBAC? In this article, we hope to shed some light on your VBAC options with a possible or confirmed pre-e diagnosis.
What is preeclampsia?
According to the Preeclampsia Foundation, “Preeclampsia is persistent high blood pressure that develops during pregnancy or the postpartum period.” An official diagnosis of pre-e is typically made when there is a persistent high blood pressure along with another complication like increased protein in the urine, severe headaches, sudden decrease in blood platelets, kidney or liver issues, fluid in the lungs, seizures and / or vision trouble.
Symptoms that may indicate you have pre-e could include
- Headaches that won’t go away and / or get worse
- Abdominal pain
- Sudden swelling in the ankles, hands or feet
- Shortness of breath / burning in the chest
- Nausea / vomiting
- Confusion
- Increased state of anxiety
- Visual disturbances (light sensitivity, blurry vision, flashing spots, etc.)
Is preeclampsia serious?
Depending on the source, we know that around 5-10% of births in the US are affected by hypertensive disorders, including pre-e. Rates of pre-e have increased by 25% over the last 20 years, and pre-e is now the leading cause of mother and baby illness and death (Preeclampsia Foundation).
While most times pre-e is managed and resolved with no complications for mom or baby, some cases are serious, marked by a quick and severe progression that can be life-threatening. It’s important to note that complications can occur during pregnancy, delivery or postpartum.
While very rare, especially in the US, eclampsia is a very serious complication of preeclampsia that occurs when the mother has one or more seizures before or after her baby is born.
What causes preeclampsia?
The Preeclampsia Foundation tells us that “Preeclampsia is a complex condition with a number of genetic, clinical, social, and environmental risk factors.” Several sources agree that pre-e starts with the placenta, and for one reason or another, the blood vessels supplying nutrients to the placenta do not develop properly.
Some risk factors that may be linked to a pre-e diagnosis include
- Previous pre-e diagnosis
- Being pregnant with more than one baby
- Having a chronic condition before pregnancy such as diabetes, kidney disease, autoimmune disorders or hypertension
- Use of IVF
- Obesity
- Family history of pre-e
- Being 35 or older
- Complications in a prior pregnancy
- First pregnancy or more than 10 years since previous pregnancy
We also see some sources that suggest higher rates of pre-e in women with lower incomes as well as Black and indigenous women in North America. We agree that this kind of increase is most often due to environmental and access to care factors rather than biological.
How do I prevent pre-e?
While there isn’t a guaranteed way to prevent pre-e (sometimes it just happens even if you don’t have risk factors), there are some things that could be helpful in preventing a diagnosis…
- Maintaining adequate salt intake
- Supplementing with calcium, vitamin D and choline
- Getting your Omega-3’s (NEEDED IS OUR FAVE — get 20% off with code VBAC20)
- Consider the Brewers Diet (many moms suggest starting this before pregnancy especially if you have had pre-e before or are at a higher risk)
- Consuming a diet rich in fruits, vegetables, legumes, whole grains and fish
- Limiting ultra processed foods (fast food, foods with artificial ingredients or additives, etc.)
- Maintaining a healthy lifestyle including things like stress management, adequate sleep, exercise and more to prevent some of the conditions linked to pre-e
- Taking a low-dose aspirin
As always, you should definitely discuss these options with your healthcare provider to make sure they are right for your situation.
Can I have a VBAC with preeclampsia?
The road to VBAC can sometimes feel like an uphill battle. Some providers view certain things (age, weight, birth history, blood pressure to name a few) as tallies against our ability to TOLAC (trial of labor after cesarean) or have a successful VBAC. But, when it comes to pre-e specifically, the good news is that recent research shows TOLAC is a safe option (Archives of Gynecology and Obstetrics, 2023).
While there is evidence that VBAC success rates are a bit lower with a condition like pre-e (59% compared to 76.8% for those without a hypertensive disorder), a pre-e diagnosis alone isn’t a reason to not attempt a VBAC and is actually a completely unrelated to VBAC.
How do I navigate a preeclampsia diagnosis?
Imagine with me for a minute… you’re at a routine prenatal appointment, let’s say you’re 28 weeks, and your provider discovers that you have an unusually high blood pressure. Maybe you’ve also been having some headaches or blurred vision, so your provider orders a urinalysis and, sure enough, there is some protein in your urine.
You receive a preeclampsia diagnosis. Now what?
First, if your provider hasn’t already done so, you may consider asking for a repeat blood pressure and / or urinalysis, just to be sure. If pre-e is confirmed, here are some typical management options…
- Possible diet changes (dietary suggestions listed above that could help prevent pre-e could also reduce the severity of pre-e once diagnosed)
- Personally monitoring your blood pressure, just don’t forget to get your cuff calibrated (moms with pre-e don’t usually feel sick or notice when the disorder is progressing)
- Taking medication to lower blood pressure and / or prevent seizures (as prescribed by your provider)
- Additional appointments to monitor mom and baby
- Bed rest at home to manage blood pressure and increase blood flow to baby
- Being admitted to the hospital for close monitoring
- Delivery of the baby (usually a provider’s suggestion if baby is at least 37 weeks or 34 weeks if pre-e is very severe)
So, to wrap all of that up, here’s what we know –
- Preeclampsia is diagnosed in pregnant women after 20 weeks gestation who have persistent high blood pressure and typically at least one other condition such as protein in their urine.
- There are some risk factors that can make pre-e more likely, but there isn’t necessarily a way to prevent it.
- Treatment is dependent on the severity of your pre-e condition and could include anything from at-home monitoring to medication, bed rest or early delivery.
- In most cases, VBAC is a safe option for moms with pre-e.
- Always, always consult your provider with your questions & concerns and to determine your next steps.
We have had some amazing women share their experiences with preeclampsia on our podcast. Listen in…
- Episode 294 – Hannah’s Induced VBAC due to Preeclampsia + More on the Pelvic Floor with Co-host Rebecca (Listen on Apple Podcasts or Spotify)
- Episode 281 – Emily Shares Her Preeclampsia Story + How to Shift Gears (Listen on Apple Podcasts or Spotify)
- Episode 168 – Briana’s VBAC with a Special Scar + Preventing Preeclampsia (Listen on Apple Podcasts or Spotify)
We know there is great power in sharing our stories. If you have had an experience with preeclampsia, we’d love to hear it and share it with our community if you’re comfortable.
As always, my strong friend, I will leave you with this affirmation and reminder…
We’re so grateful to be on this journey with you!
Don’t forget to join our Facebook community, follow-us on Instagram, check out our Parents VBAC and HBAC Education course and give our podcast a listen where lots of incredible women share their VBAC journeys.
Sources & Additional References
https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720658/
https://pubmed.ncbi.nlm.nih.gov/35578135/
https://www.nichd.nih.gov/health/topics/preeclampsia/conditioninfo/treatments
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