The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Summary of Pre-Eclampsia Issues

This is not intended as a substitute for good care with someone who knows you personally and is concerned with you as an individual. But I would like to offer some general observations related to your letter in the online birth center news.

You have touched upon a very controversial topic in prenatal care. Historically, the three great killers of mothers around childbirth have been eclampsia (convulsions of pregnancy), infection, and hemorrhage. However, there is no real agreement as to the causation of eclampsia or even as to the common pathway of events. It has never been clearly defined as a disease, and even the various syndromes around it have had much discussion among providers and consumers of health care. So you have a description of symptoms that often occur together and in some cases lead to a final common pathway producing disease, disability, and sometimes death.

The classic triad in what is commonly called pre-eclampsia (because of the belief, not proven, that it will lead to eclampsia if not treated) is hypertension, edema, and albuminuria. For generations women presenting during pregnancy with any one of these symptoms were treated as if they were ticking time bombs, ready to explode. And, women who had much more ominous symptoms (like epigastric or liver pain, jaundice, visual changes, unrelenting headaches, hyperreflexia) were ignored if they didn't have the classic symptoms.

Recently it has been learned that some of the most ominous warning signs of impending disaster can be found primarily through lab tests, for example decreased platelet levels, increased uric acid, wacky liver function tests. This would point to the syndrome(s) being concerned more with liver function than with kidney function, as often had been thought in the past. And there may be an immunological factor as well, and maybe even a hereditary factor. But the reality is that very few people are doing research of any quality on these issues, because they haven't even clearly defined their terms! How can they talk to each other if they don't know what they mean?

An OB named Tom Brewer had a theory that there is a specific syndrome among all this mishmash of conditions. He called it metabolic toxemia of late pregnancy. He proposed that the liver was overloaded by the stress of detoxifying the normal load of pregnancy (hormones, waste products of mom and babe, etc.) and that poor nutrition was a major contributor to this overload. In particular, insufficient calories caused the body to burn protein for fuel (instead of burning carbohydrates or fats). Or, conversely, sufficient calories but without adequate protein would deprive the liver of the raw material needed to metabolize and excrete the normal byproducts of metabolism and detoxification. Insufficient albumin in the bloodstream causes the plasma to leak into the tissues (a phenomenon known as third-spacing, commonly seen among alcoholics with liver damage, victims of kwashiorkor, and women with severe pre-eclampsia) and the visible symptom of this is edema. Also, inadequate nutritional support for the liver can lead to damage in the basement cells of the kidney, causing much needed albumin to be excreted instead of recirculated. Most traditional practitioners, especially OB/GYNs, have a knee-jerk negative reaction to Dr. Tom, but if you have studied any physiology I urge you to read his book and think about it for yourself. His theories don't explain every case, but he makes a clear call for being a good diagnostician.

Well, all you have right now is elevated blood pressure, so what does this have to do with you? Because you are pregnant, I bet that every one you have seen about this is blaming the hypertension on your pregnancy, and is foreseeing that you will eventually get pre-eclampsia. I would also wager that no one has done any kind of diagnostic work up to see if there could be something else making your blood pressure rise. Could it be stress? Is your blood pressure high when you are at home, or only at the office? Are you having to work long hours? Are finances an issue? think about all the changes going on in your life. Are you getting enough exercise? Are you doing things just to please yourself? I could go on and on about these issues but I think you get the picture.

Please also remember that if you are not getting the care you think is appropriate, you always have the right to get another opinion from a second provider.

Your relationship with your primary prenatal provider needs to be based on trust and good communications...both directions.