Sara McGinnis was pregnant with her second child and something felt off. Her body was swollen. She was tired and dizzy.<\/p>\n
Her husband, Bradley McGinnis, said she had told her doctor and nurses about her symptoms and even went to the emergency room when they worsened. But, Bradley said, what his wife was told in response was, \u201c\u2018It\u2019s summertime and you\u2019re pregnant.\u2019 That haunts me.\u201d<\/p>\n
Two days later, Sara had a massive stroke followed by a seizure. It happened on the way to the hospital, where she was headed again due to a splitting headache.<\/p>\n
Sara, from Kalispell, Montana, never met her son, Owen, who survived through an emergency delivery and has her oval eyes and thick dark hair. She died the day after he was born.<\/p>\n
Sara had eclampsia, a sometimes deadly pregnancy complication caused by persistent high blood pressure, also known as hypertension. High blood pressure makes the heart work in overdrive, which can damage organs.<\/p>\n
Sara died in 2018. Today, more pregnant people are being diagnosed with dangerously high blood pressure, a finding that could save their lives. Recent studies show the rates of newly developed<\/a> and chronic maternal high blood pressure<\/a> have roughly doubled since 2007. Researchers say the jump in cases is likely due in part to more testing that discovers the conditions.<\/p>\n But that\u2019s not the whole story. Data shows that the overall maternal mortality rate<\/a> in the U.S. is also climbing, with high blood pressure one of the leading causes.<\/p>\n Medical experts are trying to stem the tide. In 2022, the American College of Obstetricians and Gynecologists lowered the threshold<\/a> for when doctors should treat pregnant and postpartum patients for high blood pressure. And federal agencies offer training in best practices for screening and care. Federal data<\/a> shows that maternal deaths from high blood pressure declined in Alaska and West Virginia after implementation of those guidelines. But applying those standards to everyday care takes time, and hospitals are still working to incorporate practices that might have saved Sara\u2019s life.<\/p>\n In Montana, which last year became one of 35 states to implement the federal patient safety guidelines, more than two-thirds of hospitals provided patients with timely care, said Annie Glover<\/a>, a senior research scientist with the Montana Perinatal Quality Collaborative. Starting in 2022, just over half of hospitals met that threshold.<\/p>\n \u201cIt just takes some time in a hospital to implement a change,\u201d Glover said.<\/p>\n High blood pressure can damage a person\u2019s eyes, lungs, kidneys, or heart, with consequences long after pregnancy. Preeclampsia \u2014 consistent high blood pressure in pregnancy \u2014 can also lead to a heart attack. The problem can develop from inherited or lifestyle factors: For example, being overweight predisposes people to high blood pressure. So does older age, and more people are having babies later in life.<\/p>\n Black and Indigenous people are far more likely to develop and die from high blood pressure in pregnancy than the general population.<\/p>\n \u201cPregnancy is a natural stress test,\u201d said Natalie Cameron, a physician and an epidemiologist with Northwestern University\u2019s Feinberg School of Medicine, who has studied the rise in high blood pressure diagnoses. \u201cIt\u2019s unmasking this risk that was there all the time.\u201d<\/p>\n But pregnant women who don\u2019t fit the typical risk profile are also getting sick, and Cameron said more research is needed to understand why.<\/p>\n Mary Collins, 31, of Helena, Montana, developed high blood pressure while pregnant this year. Halfway through her pregnancy, Collins still hiked and attended strength training classes. Yet, she felt sluggish and was gaining weight too rapidly while her baby\u2019s growth slowed drastically.<\/p>\n Collins said she was diagnosed with preeclampsia after she asked an obstetrician about her symptoms. Just before that, she said, the doctor had said all was going well as he checked her baby\u2019s development.<\/p>\n \u201cHe pulled up my blood pressure readings, did a physical assessment, and just looked at me,\u201d Collins said. \u201cHe was like, \u2018Actually, I\u2019ll take back what I said. I can easily guarantee that you\u2019ll be diagnosed with preeclampsia during this pregnancy, and you should buy life flight insurance.\u2019\u201d<\/p>\n Indeed, Collins was airlifted to Missoula, Montana, for the delivery and her daughter, Rory, was born two months early. The baby had to spend 45 days in a neonatal intensive care unit. Both Rory, now about 3 months old, and Collins are still recovering.<\/p>\n The typical cure for preeclampsia is delivering the baby. Medication can help prevent seizures and speed up the baby\u2019s growth to shorten pregnancy if the health of the mother or fetus warrants a premature delivery. In rare cases, preeclampsia can develop soon after delivery, a condition researchers still don\u2019t fully understand.<\/p>\n Wanda Nicholson<\/a>, chair of the U.S. Preventive Services Task Force, an independent panel of experts in disease prevention, said steady monitoring is needed during and after a pregnancy to truly protect patients. Blood pressure \u201ccan change in a matter of days, or in a 24-hour period,\u201d Nicholson said.<\/p>\n And symptoms aren\u2019t always clear-cut.<\/p>\n That was the case for Emma Trotter. Days after she had her first child in 2020 in San Francisco, she felt her heartbeat slow. Trotter said she called her doctor and a nurse helpline and both told her she could go to an emergency room if she was worried but advised her that it wasn\u2019t needed. So she stayed home.<\/p>\n In 2022, about four days after she delivered her second child, her heart slowed again. That time, the care team in her new home of Missoula checked her vitals. Her blood pressure was so high the nurse thought the monitor was broken.<\/p>\n \u201c\u2018You could have a stroke at any second,\u2019\u201d Trotter recalled her midwife telling her before sending her to the hospital.<\/p>\n Trotter was due to have her third child in September, and her doctors planned to send her and the new baby home with a blood pressure monitor.<\/p>\n Stephanie Leonard<\/a>, an epidemiologist at Stanford University School of Medicine who studies high blood pressure in pregnancy, said more monitoring could help with complex maternal health problems.<\/p>\n \u201cBlood pressure is one component that we could really have an impact on,\u201d she said. \u201cIt\u2019s measurable. It\u2019s treatable.\u201d<\/p>\n More monitoring has long been the goal. In 2015, the federal Health Resources and Services Administration worked with the American College of Obstetricians and Gynecologists to roll out best practices to make birth safer, including a specific guide to scan for and treat high blood pressure. Last year the federal government boosted funding for such efforts to expand implementation of those guides.<\/p>\n \u201cSo much of the disparity in this space is about women\u2019s voices not being heard,\u201d said Carole Johnson<\/a>, head of the health resources agency.<\/p>\n The Montana Perinatal Quality Collaborative spent a year providing that high blood pressure training to hospitals across the state. In doing so, Melissa Wolf, the head of women\u2019s services at Bozeman Health, said her hospital system learned that doctors\u2019 use of its treatment plan for high blood pressure in pregnancy was \u201chit or miss.\u201d Even how nurses checked pregnant patients\u2019 blood pressure varied.<\/p>\n \u201cWe just assumed everyone knew how to take a blood pressure,\u201d Wolf said.<\/p>\n Now, Bozeman Health is tracking treatment with the goal that any pregnant person with high blood pressure receives appropriate care within an hour. Posters dot the hospitals\u2019 clinic walls and bathroom doors listing the warning signs for preeclampsia. Patients are discharged with a list of red flags to watch for.<\/p>\n Katlin Tonkin is one of the nurses training Montana medical providers on how to make birth safer. She knows how important it is from experience: In 2018, Tonkin was diagnosed with severe preeclampsia when she was 36 weeks pregnant, weeks after she had developed symptoms. Her emergency delivery came too late and her son Dawson, who hadn\u2019t been getting enough oxygen, died soon after his birth.<\/p>\n Tonkin has since had two more sons, both born healthy, and she keeps photos of Dawson, taken during his short life, throughout her family\u2019s home.<\/p>\n \u201cI wish I knew then what I know now,\u201d Tonkin said. \u201cWe have the current evidence-based practices. We just need to make sure that they\u2019re in place.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n