“Stephanie’s Story: Preeclampsia During Mardi Gras” – with Stephanie Ezcurra Williams

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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.

All right, Stephanie, welcome to the podcast. How are you doing today?

Stephanie: Thank you. I am doing great. It’s a cold day here in Tampa, but all is well. Thank you for having me.

Dr. Fox: I’m glad to hear it’s cold in Tampa. What does that mean to you, degrees-wise?

Stephanie: Yeah, you’re probably going to laugh. It’s about 45 degrees today, which is, you know, substantially cold for Florida.

Dr. Fox: Fair.

Stephanie: But compared to New York, and you know, anywhere else along the East Coast, the Midwest, it is not too cold.

Dr. Fox: Yeah, I went running this morning in Central Park, and it was 25 degrees, and it was really…

Stephanie: Oh, my goodness.

Dr. Fox: It was…I mean, that’s pretty cold. I mean, we get colder, but that’s sort of the breaking point of, like, cold to really cold.

So, all right, I’m sorry it’s so chilly out in Tampa, so…you know. Excellent.

Stephanie: Thank you. We’re getting by. We’re getting by.

Dr. Fox: That’s terrific. So you are a Toaster.

Stephanie: Yes. I am a Toaster, yes.

Dr. Fox: For our listeners who have not been paying attention over the past several months, can you explain what that means?

Stephanie: Yes. So a Toaster is a listener of the podcast “The Toast,” which is hosted by Jackie and Claudia Oshry. The reason this is relevant to the “Healthful Woman” podcast is because Dr. Fox was Jackie’s OBGYN and MSM in New York. So you know, there was a lot of talk about the famous Dr. Fox from “The Toast,” from Jackie, and that is how a lot of Toasters, which is what we call ourselves, have recently been connected to you, and the podcast.

Dr. Fox: And is that how you found this podcast?

Stephanie: That is, yeah. So I got really interested in Jackie’s birth story, not only her second, which involved you a lot, but also her first. And you were a little bit involved with her first pregnancy, so I had heard about you just from her talking about it on “The Toast” podcast. And you know, obviously her second pregnancy came around, and you were heavily involved. You were a main character in the story. So Dr. Fox came up again, and you know, she was on your podcast, you were on the “Patreon.” I heard you on the “Patreon,” and I was like, I really loved your presence and your demeanor, and so I started listening to the “Healthful Woman” podcast after that “Patreon” episode aired.

Dr. Fox: Well, welcome aboard. We’re loving the Toasters that have hopped on the “Healthful Woman” train, and it’s awesome. And have you been weighing in on the debate of the name of this podcast, or are you staying out of that disagreement?

Stephanie: I was telling my husband last night about “What Does the Fox Say,” and he thought it was hysterical. So I mean, I like the name of the podcast. It is a bit of a mouthful. But you know, you have good mentorship with Jackie. She’s going to… She’s the queen of nicknames, the queen of just, you know, naming people, doing the whole thing. I don’t know if you’ve heard the nicknames she has for her siblings, but they are quite all over the place. I know Claudia goes by Turdy. So she’s a really great person to ask about a good name. I think that she could help come up with one for sure.

Dr. Fox: That is… Well, you know, we can use all the help we can get, that’s for sure. We’re open to free advice, so that is great.

Well, what prompted you to volunteer to tell your story on the podcast? Because it’s one thing to tune in and listen, you know, and sort of sit on the sidelines, but it’s another thing to jump in the pool.

Stephanie: Yeah. So there are a few things about my story that I thought would be interesting to share. The first is that when I started listening to the “Healthful Woman” podcast, I was searching just endlessly for preeclampsia stories. And also just, you know, I know that you have a lot of specialists on your show, and a lot of other doctors that come on and talk, and I just couldn’t get enough of the preeclampsia, and HELLP syndrome episodes, and I just feel like there could be more to talk about them, so I wanted to share my story.

I also have an interesting element to my story because my story took place in New Orleans, in the heart of Mardi Gras season. So there’s kind of a bit of an interesting dynamic there, just with Mardi Gras being in full swing. And I don’t know if you’ve been to New Orleans during Mardi Gras, but it is quite the event, so a lot of my story takes place just in the heart of that season, and kind of how that affected my birth story is just a little interesting.

I also am somebody who has never had any kind of health issues in the past. I’ve been very fortunate to have good health, my blood tests are always great, my lab results are always great. And to be kind of faced with this traumatic experience with preeclampsia, and just also a traumatic birth experience, you know, related but a little bit unrelated to preeclampsia, I just felt it was a good platform to share with other people who think, you know, I’m in good health, I don’t have to worry about this stuff. Everything goes according to plan, you know? I’ve never been hospitalized, I’ve never done any of these things. And it’s important to know that, you know, pregnancy, it’s a different ballgame. And even if you’re in great health, if you exercise, if you eat well, you can still have unexpected health outcomes. So I just thought it would be a great platform to share that story on.

Dr. Fox: Terrific. Well you’ve come to the right place. I do agree this is one of the platforms to do that. I agree that no matter how many podcasts we can have from the medical side talking about, let’s say preeclampsia, or HELLP syndrome, or any condition really, there’s tremendous value from hearing the same story from your side, from the person going through it, her side.

Stephanie: Yes.

Dr. Fox: Because again, there is obviously overlap because we’ll talk about some of the medicine in this, but just what is the experience of it, what’s it like? And I think that that’s something that frequently gets missed in a lot of these topics, and it’s not just relevant, but it’s highly important to understand it.

To answer your question about Mardi Gras, I have been to New Orleans, I have not yet been to New Orleans for Mardi Gras. But interestingly, my sister, when she was a senior in high school, she told my parents that she and her friend were going around the Midwest, because we lived in Chicago, to visit colleges so she could make, you know, an informed decision about colleges, but instead they drove my parents minivan all the way down to New Orleans to spend a week at Mardi Gras. Which was, first of all…

Stephanie: Oh, my God.

Dr. Fox: Like, God bless her, this is like, awesome, she’s like, legendary for this, and she came back, and like, didn’t want anyone to find out, but she told everyone about it, so of course I found out, but my parents didn’t find out for, like, 40 years…or 30 years. [crosstalk 00:07:16.344] It was like, we were retelling the story, and my parents were like, wait, you went to Mardi Gras? Like, what? I was like, uh, uh…uh-oh. But we were adults by then, but it was cool. So yeah, so that’s my experience with Mardi Gras. So it’s a good story, but I didn’t….I wasn’t personally… I was a good student, I was a rule follower, my sister not so much. So…

Stephanie: Yeah, your sister is bold. Wow.

Dr. Fox: Yes, very. But I digress.

All right, so we’re going to be talking about the birth story for your son, Gus, who is coming up on a year, right?

Stephanie: Yes, it’ll be…he’s nine months now, so he’ll be a year in February.

Dr. Fox: Amazing. All right, so listen, take us to the story. So if he was born in February ’23, I guess we can start the story in ’22.

Stephanie: Yeah.

Dr. Fox: You’re coming into pregnancy, tell me about Stephanie Ezcurra Williams in 2022. Who are you, where are you living, what’s your story, what’s going on?

Stephanie: Yeah, so I’ll take you a little bit earlier than that, just to give some context for people who are listening. But I am originally from California, if you can’t tell from my somewhat Valley Girl accent. I’m from California, born and raised. I moved in 2016. Well, I went to college in the South, and then moved in 2016 to Memphis, where I worked for FedEx Corporate. And my husband at the time was an M3 at the University of Tennessee, so he was a third year medical student. We met in a very traditional way called Tinder. Very, you know…just a beautiful love story, you know? We met on an app, and kind of had a…you know, we just quickly connected. And in 2018, we moved…we got engaged, and we moved to New Orleans, for him to start his residency in urology.

So, he is a urologist, not to be confused with neurology. So I always tell people…

Dr. Fox: Very different, yeah. Very different parts of the body. Yes.

Stephanie: Yes, very different. I always… Like, my joke is, no, it’s the other brain. That’s my, like, kind of go-to joke. But yeah, the other brain, the male brain, urology.

So we moved to New Orleans, and I got a job working at the healthcare system that he was a resident at. So I worked in HR for them, so I was on the corporate side, he was a resident. And we were meant to get married in 2020, April of 2020, and obviously that did not happen, with COVID. So we pushed the wedding back to March of 2021. You know, we still had a relatively normal wedding. That’s a whole other story because we had to replan it, like, four times, and switch venues the month before. It was kind of crazy. You know, we still had COVID protocols in place, we gave everyone masks, so a little bit of a different wedding than, you know, what we expected.

But we did get married in 2021, and after about a year of marriage, we had thought, you know, once he was a chief resident, or going into chief residency, which is your last year of residency, that we would try to start a family. We had always agreed that we wanted to have children, and kind of the question was when. And we just felt like we were financially in a good spot, and just with his schedule, you know, being his last year as a resident, it was a good time. So I stopped taking my birth control in March of 2022, and I didn’t expect to get pregnant so quickly. I have a lot of friends who struggle with fertility, so I was under the impression that it would, you know, take a while, and I got pregnant within, like, two months.

Dr. Fox: Strong work.

Stephanie: Yes. So you know, it worked. It was great, but it was extremely unexpected because I was not expecting it to happen that quickly. Which is, you know, of course a blessing, and I’m thankful for it, but we were a little, you know, unprepared in that sense, because I don’t even think at that point my cycle had regulated.

So what’s kind of interesting is that in June of 2022, I went to my annual OBGYN checkup just for, you know, the Pap smear, the whole fun part of going to the OBGYN, and I had mentioned to her that I had gotten off of birth control, that, you know, we were trying to get pregnant, we weren’t tracking or anything like that, and she had mentioned, you know, do you want to maybe get some blood work done just to kind of see where your levels are? And you know, being married to someone in medicine, working adjacently in medicine, not clinically, but working in a medical field, and I’m always open to learning more about my body, so I said, absolutely. And so we did the blood test, and everything had come back normal. My AMH levels were pretty low, and she didn’t seem to have any concerns about it. But I was a little concerned, and she was like, don’t worry about it, you’re fine, you’re fine, and I was like, okay.

What’s funny, though, about that appointment is that I actually was pregnant at that appointment, but did not know.

Dr. Fox: Right. I was going to ask, did they send an HCG level?

Stephanie: No.

Dr. Fox: Okay. That would have diagnosed it.

Stephanie: And…which is not unusual, right?

Dr. Fox: No, no.

Stephanie: Because I was only two weeks in, and so there was really no reason for her to do any kind of urine sample. I probably wouldn’t have showed up on a urine test. And she didn’t think that I was pregnant, and neither did I, so you know, it wasn’t ordered.

Dr. Fox: Right.

Stephanie: So it’s just a little funny that I went through all this blood work to see how my fertility was, and I actually was pregnant at that time.

Dr. Fox: Beautiful. You’re cured.

Stephanie: Yeah. Yeah, literally. So on the 4th of July, I remember it was the 4th of July, I didn’t know yet at this point that I was pregnant, but we were just doing 4th of July festivities, you know, making the hot dogs…I think I was drinking a beer at this time, and something just said you should take a pregnancy test. And I did, and I was pregnant, and I was like, oh, well, I’m going to put my beer down. It’s probably a good time to put that away, and…yeah. So it was the 4th of July that we found out, and you know, it was really exciting news, so we were very happy about it.

Dr. Fox: That’s amazing.

Stephanie: Yeah.

Dr. Fox: That’s amazing. And how did your pregnancy go?

Stephanie: So up until the end, my pregnancy was, I think, very textbook and standard. I didn’t have any kind of medical concerns, you know? I had the nausea, and the morning sickness, and the fatigue, but nothing that was a concern. My blood tests for, you know, genetics and whatnot were all normal. I didn’t have any abnormal anatomy scans or ultrasounds. So everything was pretty…you know, going according to plan. There didn’t seem to be any concerns. I wasn’t high risk or anything like that.

Dr. Fox: Is it the fact that you were married to a doctor, a resident, did that have any impact at all on your pregnancy? Sometimes, you know, they know a lot more, or sometimes, you know, they’re more anxious, or less anxious, or you are, you know? Did that have any relevance to your prenatal care? Or he was just sort of coming along like dads?

Stephanie: Yeah, so I do think towards the end of my pregnancy, it did, and I’ll get into that a little bit, but sometimes when you’re married to somebody in medicine, and your wife may be able to attest to this, but sometimes other medical providers kind of talk to you differently than if you weren’t in medicine. Sometimes I feel like, you know, maybe the risks, benefits, and alternatives of care are glanced over, and not as thorough when you’re married to somebody in medicine.

Dr. Fox: Oh, you mean like the doctor or midwife, whoever, when they’re talking to you, they just assume you guys know more than you do? Or…

Stephanie: Yes. Yeah.

Dr. Fox: Yeah. No, that’s a reality. We try very hard not to do that. I always say, like, you may know some of this, but I’m starting from the beginning, just, you know, to catch everyone up.

Stephanie: Yeah.

Dr. Fox: But yeah, that can definitely happen, unfortunately. It’s not supposed to happen, but it can.

Stephanie: Yeah. I mean, doctors are only human, and so I can understand why that happens. But I do feel like it impacted my care in the sense where there was a lot of information that seemed to be assumed that I understood, that I didn’t actually understand. For example, you know, at the beginning of my pregnancy, I was given a blood pressure cuff, and I didn’t know why. No one really explained to me why.

Dr. Fox: Like a gift.

Stephanie: Yeah, I thought it was just something free. I’m like, it’s free!

Dr. Fox: Hey, here’s a pen, a t-shirt, and a blood pressure cuff.

Stephanie: Yeah. Yeah. And they gave me a scale, too. The scale, I understood that one. I was like, okay, yeah, so you know, you want to make sure you’re gaining weight, and how much you’re gaining and whatnot. But the blood pressure cuff, I was not well informed on why I needed to…you know, the importance of it, why I needed to take my blood pressure. For someone who’s never had blood pressure concerns in the past, it just didn’t really make… It just wasn’t well explained to me on why I needed it. And so…

Dr. Fox: It’s interesting, because I don’t…I mean, it’s not typical that people would be given a blood pressure cuff to take their blood pressure at home, unless they had an increased risk, or unless maybe…

Stephanie: Yeah.

Dr. Fox: Were they doing… I mean, it’s ’22, were they doing reduced visits because of COVID or something at that time still? Or was…

Stephanie: Yes, so they were doing reduced visits, but it wasn’t because of COVID. So essentially what they had told me was that if I did keep on top of my weight and my blood pressure, that I would be able to come to less in-person visits, and do more virtual visits.

Dr. Fox: Ah, okay. I see.

Stephanie: It seemed like it was just kind of a way for them to do some of their vital work without us actually having to come in. It was through, like, you know, the tech side of the health organization.

Dr. Fox: Yeah.

Stephanie: So it wasn’t due to COVID, but every single patient that was, you know, a patient there at that hospital received this.

Dr. Fox: That’s interesting. I mean…yeah, that’s interesting.

Stephanie: Yeah.

Dr. Fox: I mean, I’m not opposed to it, I’m just saying it’s not sort of standard that everyone is told to check their blood pressure every X-amount of time at home unless there’s, you know, a high risk so to speak reason to. But there’s, you know, there’s definitely logic behind it. Like hey, you know, if all we’re really doing is, you know, checking your blood pressure and weight, and maybe speaking a little bit, you could probably do that at home, and we can speak on the phone or whatever, so I get it. But that is interesting, that you actually had a blood pressure cuff at home. Okay.

Stephanie: Yeah.

Dr. Fox: But so you had it at home as your parting gift, or you know, whatever…well, it’s a practice gift, and you didn’t quite know why…all right.

Stephanie: Yes, exactly.

Dr. Fox: Okay. So then what happened as you got towards the end of pregnancy?

Stephanie: Yeah, so I’ll add a little bit of the Mardi Gras element…

Dr. Fox: Oh, yes.

Stephanie: Because it is an important part of the story.

Dr. Fox: Right. You didn’t run into my sister there, correct, as far as you know?

Stephanie: I did not, no.

Dr. Fox: Okay.

Stephanie: As I’m concerned.

Dr. Fox: All right, got it.

Stephanie: Yeah, people have a lot of alter egos during Mardi Gras, so I can’t say for certain.

But you know, New Orleans is a great city. It has a lot of character and charm. I mean, it has its problems, just like any city, but Mardi Gras is, you know, the season of the year. It is two weeks long, and I, the year before, in 2021…or I guess this would have been 2022, because it’s February of 2022, I was in the Krewe of Cleopatra, which is an all-female crew. And for those who don’t know, what it means to be in a krewe is that you ride on a float, you throw beads, and each krewe has their own set number of floats, so let’s say like 30 floats. And these are huge, you know, New Orleans decorated Mardi Gras floats, and it’s a really big honor to be in a krewe. It’s kind of like a social club in a way, that happens just once a year.

And so when I found out that I was pregnant, and would be delivering in March, which was, you know, my due date, I unfortunately decided that I probably couldn’t ride for the year of 2023. Which, you know, at first I actually thought that I would do it. I was motivated to ride in the float. But my friends talked some sense into me, and they’re like, you cannot be eight months pregnant doing this. That’s probably not a great idea.

Dr. Fox: What was the concern, that you had to stand for so long? Or that there’s like…

Stephanie: Yeah, a few things. The standing for a long time is one, but also if there was any sort of medical emergency, it’d be really hard to get medical care, because all the roads shut down. The floats drive on the actual, you know, paved roads that cars drive down, so it’s really hard to get medical care at Mardi Gras, with road blockages, there’s thousands of people there… So I wasn’t so much concerned about the standing, I was more concerned about…

Dr. Fox: What if.

Stephanie: …if there was a medical emergency, I wouldn’t be able to easily take care of what I need.

Dr. Fox: Okay, fair.

Stephanie: Yeah. Yes. So that was really why. But I still wanted to be a part of the festivities, so on February 8th, I went with friends to help load up the float. Which just means they were the ones riding, and what you do is you take your beads out, and you organize them on the float before you actually ride. The reason you do that is because during the actual event, you don’t want to be opening bags of beads, and organizing them and throwing them. You want it, like, nicely organized in advance, so you do it a few days in advance of the actual parade.

So I went on the 8th. And I had for the few days before that been dealing with some pretty bad swelling, but this being my first pregnancy, I did not know that it was abnormal. I just thought, you know, it’s end of pregnancy things. You get swollen, and you’re achy, and your feet are numb, and these are all things that happen when you’re pregnant. I didn’t know it was anything of a concern. So I’m loading up the float, and I’m huffing and puffing, I’m out of breath, and I get home after about two hours of helping organize this float, and I get home and I take my shoe off, and my ankle is just huge. It’s huge, I’m feeling lightheaded, a little panicky… Which I’d been feeling the days leading up to this, but again, I just… You know, unless you’ve been pregnant before, you just don’t know what’s normal, and what’s normal is different for everybody.

Dr. Fox: Right.

Stephanie: So I just really assumed that this was normal pregnancy things. So I texted my mom, and I sent her a picture, not out of concern, more of like, oh, my gosh, look at my…

Dr. Fox: Take a load of this.

Stephanie: Look at my foot! It’s so big! I was like, this is crazy! And my mom said, she’s had four kids, she was like, you know, I don’t know if that’s really normal, and I was like, really? I think I’m just pregnant. This seems…I think that this is normal. And I ended up messaging a friend… Well, I had posted on Instagram that I was helping load up this float, and I got a lot of messages from people saying, “Are you riding?” “Are you riding?” Because most people… I was very open about my pregnancy on social media, so people knew I was very, very pregnant. And so a lot of people messaged me, asking if I was riding, and I was like, no, I’m just helping load up the float, just helping some friends. Like, I want to be a part of the energy, if I can’t be in the parade, so I thought it would be fun.

And I sent one of my… I would say she’s an acquaintance. She’s a…we’re friendly. We worked out a lot together, but she also happens to be a labor and delivery nurse. And so I sent her a picture of my swollen ankle, and she had responded and said, you know, not to scare you, but have you checked your blood pressure recently? And I was like, what does that have to do with any of this? No, I hadn’t checked it in over a month at that point because, like I said, I’ve always been healthy. I’ve never had blood pressure issues in the past. I’ve always had very stable labs, and blood pressure, and I’ve had normal cholesterol, and all of these things. I’ve never been an unhealthy person, so to speak, that it just didn’t seem like a priority, especially because it wasn’t explained to me why it needed to be a priority.

So I ended up taking my blood pressure, and my blood pressure was 166 over 101.

Dr. Fox: That’s high.

Stephanie: Yeah, which is high.

Dr. Fox: Yeah.

Stephanie: But you know, to me, I’m like, I don’t know what this means. Again, I’m not in medicine. I was a history major, I’m not like a… I’m married to medicine, but I’m not like a science girl by any means.

Dr. Fox: Right.

Stephanie: And I was like, oh, that seems high. So I called my friend, and she was like, if I were you, I’d go to the OBED, and I was like, really? She said, yeah, yeah, I would just…I would go, just to be… You know, that’s a high blood pressure, and you just want precautionary measures. So being someone who is married to a resident, you know, my husband was asleep, and it was about 11 p.m. at this point, and I knew he had to be up early the next morning for work. So I just went in there and said, hey, I’m going to drive myself to the hospital, and go to the OBED.

Dr. Fox: You are awesome, by the way. You’re a trooper. For all the residents out there, we applaud you for letting us sleep while you’re going to the hospital with your high blood pressure, and leaving us be. That is…wow.

Stephanie: Well, you know, and again, your wife can attest to this…

Dr. Fox: No, I hear you. Listen, you know what it’s like.

Stephanie: Yeah.

Dr. Fox: You’re like, this poor guy, like, never sleeps. Like, you know…it’s legitimate. But it’s a little strange. It’s a strange like.

Stephanie: Yeah, no, and…it is a strange life. And just being married to medicine, you really have to be okay being independent, and doing things on your own. And to be fair, I really didn’t realize how big of a deal this was at the time.

Dr. Fox: Yep.

Stephanie: So in my opinion, I…we didn’t live far from the hospital, I was like, I’m just going to drive there, you know? I think it also helps that I worked for this hospital, so I felt comfortable with the organization as a whole. It wasn’t scary to me. And just my husband worked there as a doctor, you know, as a resident, so I’m like, this is not a scary experience for me. I’m just going to go in, they’re probably going to monitor me, and then send me home, was my thought.

Dr. Fox: Right. You’re an insider, yeah.

Stephanie: Yeah. Yeah, I felt like an insider. It didn’t seem scary. So I just went into our bedroom, and I was like, hey, you don’t need to worry about it. I’m going to go, I’ll call you if there’s a problem, or if I need anything, and just drove myself to the hospital. And I get there, and they’re all like, you came by yourself? I was like, yeah… I didn’t even have…like, I didn’t even have like a hospital bag or anything, because this is how just uninformed I was about this being a big deal. And they checked my blood pressure, and they had determined that I was going to deliver that night, and in my head I’m like, okay, I need to call my husband…I was not expecting any of this. Like, we don’t have a crib set up, we don’t have anything set up…

And they’re like, yeah, you’re going to have to deliver. They ordered…I feel like I’m going to say the name wrong, but it’s Labetalol? Is that it?

Dr. Fox: Labetalol, perfect.

Stephanie: Yes, Labetalol. They ordered…

Dr. Fox: Yeah, blood pressure medicine.

Stephanie: Yeah, it’s just…I believe it’s magnesium.

Dr. Fox: Yeah, magnesium, Labetalol. You got it.

Stephanie: Yes. So they were ordering that, and then just kind of, you know, I called my husband, he rushed over… What I didn’t love about this experience was that because they were certain I was delivering, they had me sign all the consent forms without my husband there. Which is fine, but between you and I, I couldn’t tell you exactly what I signed.

Dr. Fox: Yeah.

Stephanie: It was really rushed…

Dr. Fox: It was pretty generic, I assume. It just says you’re giving them consent to take care of you. I mean, everything in there is just legalese.

Stephanie: Yeah.

Dr. Fox: There isn’t anything that specific.

Stephanie: Okay. Well, there was just…I don’t even know. I don’t even remember signing the forms, I just know that at some point along this 30-minute ordeal, I had signed forms, you know, consented to delivering, the anesthesiologist spoke to me, all of this kind of stuff, and then just miraculously, my blood pressure dropped back down, just on its own. They didn’t give me the magnesium. They had ordered it, everything, they put an IV in me, and they did not actually administer the medicine.

So I stayed at the hospital for a few days, and on the 10th… So this was on the 8th, on the 10th they let me go. I went home, I was getting ready to see my krewe do their parade, because we lived two blocks from the parade route, and had my, you know, my makeup on, and my beads on. And I knew that I wasn’t in, you know, the best shape, but because it was only two blocks from my house, I was like, I’ll go down there, you know, spend ten minutes, and then come back up if I’m feeling like it’s too much, or I’m… You know, I just want to have a good time. So we try and have a good time, and my blood pressure spikes back up to 174 over 109. I go back in there, go back to the hospital, they admit me again. My blood pressure is high, but it’s not severe at this point, so they send me back home the next day.

Dr. Fox: How many weeks are you at this time?

Stephanie: I am just 35 weeks at this point.

Dr. Fox: So what… I assume they gave you some sort of diagnosis. Did they say you had preeclampsia? Did they say you had gestational hypertension? Did they give you a specific diagnosis at that time, like, why your blood pressure was elevated?

Stephanie: Yes. Yes, and I should have mentioned this before, but on the 8th they did, you know, a blood test and a urine test, and I had protein in my urine, my platelets were dropping pretty substantially, and…

Dr. Fox: Already on the 8th?

Stephanie: Already on the 8th, yes.

Dr. Fox: Uh-huh. So they said you had preeclampsia?

Stephanie: They did say I had preeclampsia, and they said that they would deliver me at 37 weeks, if I could make it to 37.

Dr. Fox: Right, if you can make it that far. Right.

Stephanie: So that would be…yes. But they didn’t want to deliver me unless it was absolutely necessary.

Dr. Fox: Yeah, yeah, unless it got severe or something.

Stephanie: Yes.

Dr. Fox: Okay.

Stephanie: And so at this point it was kind of teetering between severe and just preeclampsia. It was, you know, really high, but then my body would kind of even it out, and it would end up to be like 147 over, you know, 100, which is still high, but it’s not in the severe range at that point.

Dr. Fox: Right, right.

Stephanie: So they’re like, we’re not going to deliver you, we’re just going to monitor you. They also had given me a steroid shot so that my son’s lungs could develop.

Dr. Fox: Right.

Stephanie: So I got that as well.

Dr. Fox: Right, probably two steroid shots.

Stephanie: Yes, it was within…it was I think 24 hours apart, possibly.

Dr. Fox: Yeah, correct. Correct. When… I mean, you ultimately, it was just a few days later, what was it that made the decision to deliver? Because you were going back and forth and back and forth, and at some point they said, you know, we’re delivering you. What was it that made them…that pushed it over the edge?

Stephanie: Yeah, so my blood pressure got up to 189 over 109, and wouldn’t go back down. It was just continuing to creep up, creep up, creep up. I think I got up into the 200s at one point.

Dr. Fox: Whoa.

Stephanie: Yeah.

Dr. Fox: And that was on the 12th, right?

Stephanie: That was on the 12th, when I actually delivered. And my platelets kept dropping, and they were worried about having to do… I guess, and maybe you can speak to this, but I guess there was a concern that I would need to deliver, and be, like, fully put under anesthetics because my platelets were too low, and they didn’t necessarily want to do that?

Dr. Fox: Right. Right, if your platelets are low enough… Platelets help your blood clot, so if your platelets are very, very low, the fear is that you’re going to bleed a little bit more than somebody else. Which is obviously a problem for surgery, but also it’s a problem to get anesthesia in your back, like an epidural or spinal, because they’re worried that if they put a needle in your back, you can be bleeding internally in your back, near your spinal cord, which can paralyze you. So if there’s a concern about bleeding, the anesthesiologist typically would not feel it’s safe to do a spinal epidural, so they’d have to put you to sleep. So that’s the reason, if that makes sense.

Stephanie: Gotcha.

Dr. Fox: Okay, so tell me about that day. So we’re on the 12th, your blood pressure is really high, and they’re like, all right, today’s the day we’re going to deliver the baby.

Stephanie: Yeah, so that day was pretty standard. We were going to go to a Mardi Gras parade again, because like I said, they happen every single day up until Fat Tuesday. And we live, also, two blocks from the parade route, so it’s really easy for us to just walk down there, enjoy it in the manner that we want, and then go back into our home, which is nice. So we were getting ready again to go see a parade, and I just had this feeling. I don’t know what it is about blood pressure, but anytime I had high blood pressure, I almost felt a little bit panicky, like I was having a panic attack. My heart rate was high, my head hurt, it just…I don’t know how to explain it, but it’s like you can feel that your blood pressure is high.

Dr. Fox: Okay.

Stephanie: So I took it, and that’s when it was 189 over 109. And at this point, my husband had purchased a manual blood pressure cuff to double-check, because I was thinking, you know, maybe it’s this electronic one that’s just…

Dr. Fox: Right.

Stephanie: You know, I know I’d had high blood pressure in the hospital too, but I really didn’t want to go back in just to be observed for another night, to not deliver. So he manually checked it, and he got an even higher number, and he was like, I think we need to go into the hospital. So after about an hour, I sat in the dark, and I was like, manifesting lowering my blood pressure. It doesn’t really work like that, though, when it’s preeclampsia.

Dr. Fox: Right.

Stephanie: So I went into the hospital, and it was sustained high for I guess over an hour at that point, and they had asked me, do you want to… They said, you know, you’re for sure going to deliver tonight. And this is also Super Bowl Sunday, just an FYI [inaudible 00:33:29]

Dr. Fox: Ah.

Stephanie: But yeah, another piece of the story.

Dr. Fox: Right.

Stephanie: So I can hear, like, Rihanna in the background singing, and all the nurses are in the nurses station, watching the football game, and I’m like, this is great. This is exactly what I saw for myself.

So they had said, you know, you can either be induced, or we can do a C-section. And you know, I was very satisfied with, you know, with my care up until this point. This is where I have a little bit of a struggle, because I felt like the risk, benefits, and alternatives of having a C-section were not well explained to me. And I think part of that is because I hadn’t had that point in my pregnancy care where my doctor had gotten to sit down with me in, like, an organized fashion, and explain what the options were, or what that meant.

Dr. Fox: Right.

Stephanie: It was really, really quick, right? It was just that there’s more of a risk with C-section, but we can do it. We feel comfortable doing it. But I didn’t know what the risks were. It wasn’t explained to me.

Dr. Fox: Right. Was it your doctor, or was it a doctor you didn’t know?

Stephanie: It was not.

Dr. Fox: So it was someone covering, who was ever on at the hospital on that, I guess Sunday?

Stephanie: Yes.

Dr. Fox: Okay.

Stephanie: And this is a teaching hospital.

Dr. Fox: Sure.

Stephanie: And you know, my husband was a resident, I absolutely love residents, but I think it was explained to me maybe by an intern, which is a first-year resident.

Dr. Fox: Right.

Stephanie: So there was just… You know, it’s a teaching hospital, so there was a lot of different people talking to me with different, you know, experience levels, and years of experience, and so it just wasn’t…I didn’t feel well informed, and looking back, I wish that I had asked more questions about this. But I [inaudible 00:35:07] an elective C-section, is ultimately what had happened. Because they had said, you know, you’re going to deliver tonight, it’s just the manner of which you want to deliver, which, you know, is your choice. And in my head, I’m thinking, well, I’ve been in and out of this hospital, I know C-sections are faster, can I just deliver the baby so we can stop this song and dance? That was my mentality.

Dr. Fox: Right. Right.

Stephanie: But the C-section did not go according to plan. One, I was put on magnesium at that time because of the severe blood pressure, and so I’m throwing up the entire C-section, for one. Which is not a great experience. I had also eaten Taco Bell, so I wasn’t…

Dr. Fox: So you’re throwing up tacos?

Stephanie: Yes, yes.

Dr. Fox: Okay.

Stephanie: Which is so embarrassing. It’s not something I eat often, but you know, pregnancy cravings, so I’m going to Taco Bell….

Dr. Fox: There’s no shame. There’s no shame here. You’re pregnant, you got a…you know, you get a free pass. You do whatever you want to. You’re…you know, go for it.

Stephanie: Yeah, and I was like, this has been just in and out of the hospital, a poor experience, I just want my Baja Blast and a quesadilla. And so there was no NPO, which, you know, we didn’t have time for me to digest my food, so I’m throwing up… And my husband is next to me, and he’s scrubbed in, and we get into the C-section. First they have to move us to a different room because the lights in OR1 didn’t work, so I had to be moved to OR2, which was just…

Dr. Fox: It’s glorious.

Stephanie: You know, it’s just all the things are happening, all the small things that don’t need to be happening are happening right now. And again, as Rihanna is performing on stage.

Dr. Fox: Right.

Stephanie: I was like, I want to be watching this… But so I get in there, and my husband, I’m talking to him, I don’t even know what I’m saying at this point, you know? I have an epidural in, I’m throwing up, like, I don’t even know what we’re talking about, and he’s going, “Shh, stop talking,” and I’m like, “What?” And he’s like, “This is taking too long. Something’s wrong.” And I’m thinking, okay, well, what is it? So my husband stands up, looks over…

Dr. Fox: Right. I mean, he’s a surgeon. Yeah.

Stephanie: And he’s a surgeon. So he looks over the sheet, and the anesthesiologist is like, “Hey, man…” who my husband has worked with before, and he’s also a resident. He’s like, “Hey man, I need you to sit down,” because, like, you can’t be doing that.

Dr. Fox: Sit down, coach. All right…

Stephanie: And my husband’s kind of starting to panic. I’ve never seen him, in my whole pregnancy, panic at all, not even with the preeclampsia, nothing, and he’s starting to panic. And so I start to get nervous, because…

Dr. Fox: This is why, this is the exact reason why you don’t operate on family.

Stephanie: Yes. Yeah…

Dr. Fox: It’s just you can’t sort of be the way you need to be.

Stephanie: Yes.

Dr. Fox: Understandably. That’s not a character flaw, that is human.

Stephanie: No, right, right. Well, and that’s the thing you have to remember about just everything with medicine is that all of these individuals are human. And so it’s hard, when you’re married to medicine, you see both sides of it, right? And so it’s a little hard.

So essentially what happened was my son was head down, like normal, but his head was floating, and disengaged. So he was not, to my understanding, far enough down the birth canal in order to take him out.

Dr. Fox: Yeah, hard to easily get the head out of the incision, if the head is sort of higher than the incision. That happens.

Stephanie: Right. Yeah, so he was floating, and disengaged. They had to cut through my abdominal muscle as well, which isn’t super common, I don’t believe.

Dr. Fox: Mm-hmm, to make the incision bigger, basically. Yeah.

Stephanie: Yes, they had to make… Yeah, exactly. They did three different tries with the Kiwi vacuum, they could not [inaudible 00:38:45] they all popped off. They ended up calling in, you know, backup. Which I don’t know what backup assistance was going to help with necessarily, but they did have other people come in to the OR as we’re in the middle of the surgery.

Dr. Fox: Right.

Stephanie: And finally, what this surgeon ended up doing was flipping my son, and pulling him out breach, by his feet.

Dr. Fox: Feet first, yeah. Yeah.

Stephanie: And so when he was delivered, it had been five minutes, the delivery time, which I believe is pretty long. I mean, you would know. I believe that’s pretty long to deliver, for a baby to be without oxygen and to be delivered. Is that correct?

Dr. Fox: So they’re not always without oxygen. It depends on the circumstances. Meaning from making the incision on the uterus to delivering the baby, five minutes is definitely longer than typical for a C-section, it’s usually within a minute, but it doesn’t mean, necessarily, that during all those five minutes, the baby’s without oxygen. It sort of depends on the circumstances. The baby can be perfectly fine, you know, just floating around in there. So it really… Again, each case is individualized, so I don’t…

Stephanie: Gotcha.

Dr. Fox: You know, I’m not sure why in your delivery the baby would have been without oxygen for five minutes. It’s possible, but I don’t know why that would have been, just from struggling to get the head out.

Stephanie: Yeah, okay. No, that’s good to know.

Dr. Fox: Yeah.

Stephanie: And so, he was delivered, he was floppy… His APGAR score was, like, a 1, which is obviously not great.

Dr. Fox: Yeah.

Stephanie: You know, purple, not breathing, he had a faint heart rate. So they did some breathing treatments on him, he had an NG tube, and he ended up staying in the NICU for about a week.

Dr. Fox: Mm-hmm. And he was 35 weeks when he was born, right?

Stephanie: Yes.

Dr. Fox: So yeah, it’s hard to know how much of that is related to the delivery, versus just being a 35-weeker whose mom had preeclampsia and was on magnesium. Because a week is sort of probably about average for…I’m guessing, I’m not a neonatologist, for a baby that’s born 35 weeks, is my guess. So who knows? I’m not sure.

Stephanie: Yeah.

Dr. Fox: How is he… But he recovered, though? After the six days, he went home, you know…

Stephanie: Yeah, so he… They just kept telling me he had a traumatic birth, he had a traumatic birth.

Dr. Fox: That’s…

Stephanie: And I didn’t know what that meant.

Dr. Fox: Yeah, I don’t know. That’s a very… I mean, it’s a very colloquial term, “traumatic birth.”

Stephanie: Right.

Dr. Fox: Because, you know, it doesn’t… It sounds like it was difficult to get him out, which is, again… It can be traumatic emotionally, obviously, to you, to the doctors, it could be traumatic to the baby, like again, based on the circumstances. But if the baby’s just floating around, and they’re just trying to geometrically figure out how to get him out of there, it shouldn’t be traumatic for him to wait five minutes to come out.

Stephanie: Yeah.

Dr. Fox: And the low APGAR at one minute doesn’t necessarily mean it was low oxygen, because sometimes premature babies have that, sometimes it’s just the fact that you were on magnesium. I mean, who really knows? I mean, the five-minute Apgar is a better sort of indicator of how he was doing, and if they sent blood tests on the cord… I mean, there’s things they can do.

Stephanie: Right.

Dr. Fox: But yeah, I don’t know. We try not to say “traumatic birth,” because it doesn’t… Like, what does that mean? Like you say, “I don’t know what that means,” and I don’t know what that means.

Stephanie: Yeah.

Dr. Fox: It can be very… It can be different things to different people, for good reason. It’s quite vague, what that means.

Stephanie: Right. And isn’t every birth essentially traumatic? I mean, it’s a big, you know, physical burden for both baby and mom. So you know [crosstalk 00:42:12.958]

Dr. Fox: Right, yeah. It depends how you view the word “trauma,” yeah. I mean, yes.

Stephanie: Exactly. Not even in the term of emotional trauma, but just anything your body goes through like that is considered…in a way, I think would be considered trauma just because it’s an uncertain… I mean, I had abdominal surgery, and that’s traumatic.

Dr. Fox: Yeah, sure. It’s a big deal.

Stephanie: So, I don’t… You know, it was a little unclear to me, you know? He had an NG tube, he had a CPAP machine, but overall, he is doing really well.

Dr. Fox: Great.

Stephanie: Leaving the NICU was hard because we had to get to the hospital really early to be discharged so that we could get home before the floats started rolling for Mardi Gras again. The whole Mardi Gras element was just a disaster.

Dr. Fox: Right, right. Right.

Stephanie: So the doctor had to meet us there really early to discharge. She had to come in early, because otherwise we would have gotten caught behind hours of parade shenanigans.

Dr. Fox: Yeah. So they’re with you, we got a 5 a.m. discharge for these guys. We’ve got to get them out before traffic.

Stephanie: Yeah, it was super early, and we’re just fighting against these floats.

Dr. Fox: Wow.

Stephanie: And we could see in the window of my son’s hospital, you know, of the NICU, and I’m like, I see the floats floating up, we have to go now. Like, we’ve got to hurry this up.

Dr. Fox: Wow. So how long did it take for your blood pressure to come back to normal? Days, weeks, months?

Stephanie: Days.

Dr. Fox: Days.

Stephanie: It was pretty immediate. I will say that I do feel as though I might have… My blood pressure seems higher than it normally…like, the baseline seems a little bit higher.

Dr. Fox: Mm-hmm.

Stephanie: I didn’t used to have concerns of hypertension, and now… I actually went to my primary care physician about three weeks ago just for my annual checkup, and my blood pressure was higher. So I don’t know if that is a result of the preeclampsia, if, you know, it can affect your baseline blood pressure postpartum, or if it’s just lifestyle, you know? I am a new mom, we moved, I work full time, so it could also be stress-related. But I did find that interesting, that even though my severe blood pressure dropped almost immediately postpartum, but even still, my baseline seems to be higher than my pre-pregnancy baseline.

Dr. Fox: Yeah. I mean, there’s a lot of sort of research into that, and there’s some evidence that having preeclampsia might, like, remodel your blood vessels in a way that makes them react differently later, meaning having the preeclampsia sort of affects your body later. And there’s a lot of research that indicates it’s not that, but in fact it’s having preeclampsia sort of unmasks something that was already there, underlying, and that people who get preeclampsia are people who are at risk for having high blood pressure afterwards. And it could be both, it could be a combination… But it’s definitely, if someone has preeclampsia in pregnancy, it’s more common that in their lifetime, they’ll have hypertension, for whatever reason. It doesn’t mean they will get it, it’s just, you know, their odds go up a little bit. So maybe. Who knows? It’s hard to say.

Stephanie: Yeah.

Dr. Fox: Ultimately, we’re unlikely to figure it out in the near future. But it’s something that, you know, you get watched for, and ultimately, as long as you’re watched for it, typically, you know, you’ll be okay, you know? Either you need medicine, or you don’t at some point in your life.

Stephanie: Yeah, yeah. And you know, it also could just be lifestyle related.

Dr. Fox: Yeah.

Stephanie: But I always do wonder, I had COVID and the flu during my pregnancy as well, and…

Dr. Fox: Yeah, maybe.

Stephanie: You know, I’ve looked at some research, you know, PubMed, whatever, to see if there’s research on that, and it seems that there has been some research going on, but it’s really inconclusive at this time.

Dr. Fox: Yeah. Yeah, I would agree with that. Yeah, some things indicate it might increase your risk of preeclampsia, but the vast majority of people who got COVID in pregnancy did not get preeclampsia, so it’s hard to know for sure. It’s possible, I would say, that they’re related.

Looking back on all this, you know, you’re coming up on a year, what is it you want our listeners to take away from your story?

Stephanie: Yeah, so I think that something that was really kind of eye-opening to me is that pregnancy really can affect your baseline health. And I don’t mean baseline as in when you’re not pregnant, I mean things that you’ve never experienced before, you can experience in pregnancy, even if you have absolutely no history of it. I never had a history of high blood pressure. I’ve always been very fortunate to have really good health. I’ve never been concerned about my health, I’ve never been hospitalized. And it shocked me that all of a sudden, I was in this predicament where I was, you know, preeclamptic, and if it wasn’t taken care of, could get much worse. And for someone who’s never experienced any kind of health concerns, this was just eye-opening.

So I think it’s a matter of, you know, even if you think something cannot happen to you, or you walk into your pregnancy feeling very healthy, and being very fortunate with what you have, and never having concerns does not mean that you cannot, you know, ignore that these could be possibilities. I know that there has been a lot of conversation recently just in preeclampsia in general. I don’t know if you saw, but that Olympic athlete had recently passed from preeclampsia about a year ago. She was pregnant. And I mean, I think that that is really telling, that somebody who’s in the kind of shape and health of an Olympic athlete can still get something serious like preeclampsia, and you know, potentially have fatal results from that.

And so I just want people to not think that they are immune to any kind of, you know, health issues that could arise in pregnancy, and just to be an advocate for yourself, and prioritize your health even if it seems unlikely to happen to you.

Dr. Fox: Amazing. Yeah.

Stephanie: Yeah. Yeah.

Dr. Fox: Terrific.

Stephanie: Cool.

Dr. Fox: Stephanie, thank you so much for volunteering to tell your story. Thanks for listening, first of all, which is great.

Stephanie: Of course.

Dr. Fox: Appreciate it. Love it. Thank you for volunteering. It is, it’s a great story. Yeah, there’s a lot of lessons there. Preeclampsia is no joke. Most people go through it, and they do fine and they recover, obviously, so we don’t try to scare the hell out of people, but it needs to be taken very seriously. As you said, it’s a real condition that if not taken seriously can go horribly wrong, unfortunately.

Stephanie: Yes.

Dr. Fox: And yeah, and that’s a really important lesson, and I’m glad it ultimately did work out for you. I’m glad Gus is doing well, and yeah, thank you so much.

Stephanie: Yeah, absolutely. And like I said, I feel like I got to spend an hour chatting with a celebrity today. So I appreciate your time, and this is a great experience, and I’m really glad I got to share my story, so thank you for giving me the opportunity.

Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast, or any other topic you would like us to address, please feel free to email us at HW@healthfulwoman.com. Have a great day.

The information discussed in “Healthful Woman” is intended for educational uses only, and does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health, and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.

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