Understanding Pre-eclampsia
While pre-eclampsia is a fairly common condition, it nevertheless requires accurate and prompt diagnosis, monitoring and treatment. In the UK, approximately 5% of women are affected by the condition to varying degrees, with potential for severe morbidity and mortality, for both mother and baby. Supporting women through a diagnosis of pre-eclampsia requires sensitive and accurate information sharing, as well as the involvement of women and families in their own care.
This book from the founder of Action on Pre-eclampsia (APEC), Isabel Walker; midwife and New Zealand APEC founder, Joyce Cowan; and Emeritus Professor of Obstetric Medicine, Chris Redman, aims to give health professionals and women with pre-eclampsia answers to common questions regarding its aetiology, diagnosis and treatment. The book does not profess to be a textbook on pre-eclampsia, but instead is a useful starting point, particularly for women, student midwives, and medics. The pathophysiology of pre-eclampsia is an evolving science, but this book gives an excellent overview of the aetiology of the condition, although I was surprised to see placenta abruption being described as ‘bleeding into the placenta’—such a serious complication would perhaps have merited a more detailed and accurate definition and list of symptoms. Its usefulness for qualified midwives is, in my opinion, limited, given that I would expect even a newly qualified midwife to be familiar with such a common condition. The authors explain their reasoning for excluding in-text referencing, which seems appropriate for the audience; however, there is a disconcerting number of statistics used without a reference. While this gives women helpful information on their condition, this limits its usefulness for health professionals, and it would be difficult to use the book as a source of evidence for advice.
The tone of the book does not always marry with midwifery's social model of childbirth. This book is very medical in nature, and while pre-eclampsia is certainly a serious medical condition—and, at times, an obstetric emergency—I feel that there is room for maintaining a woman's right to informed choice. The book suggests that women should defer to medical opinion, at times saying: ‘you need to adjust your expectations […] and accept a few unwelcome truths’, ‘you may have no choice over the mode of delivery’ and ‘you will need to submit to an intrusive level of monitoring’ (p67). Although these statements may be based on recommendation, I struggle to imagine how I could use them in practice. I'm more inclined to believe that care planning and decision-making should be shared, and to suggest that a woman must ‘submit’ to medical control runs the gauntlet of disempowerment, trauma and long term psychological effects.
However, the extracts from the authors' qualitative research give a useful insight into women's experiences of pre-eclampsia and their concerns. Interspersing factual advice with these extracts has great potential for creating a holistic picture of the experience of pre-eclampsia. I did, however, find that the majority of these extracts focused on negative aspects of care, and the fear that women felt for their own life or that of their baby, omitting the narratives of women who were promptly diagnosed, treated and given a positive birth experience. With good quality care, pre-eclampsia does not have to be a terrifying and life-threatening condition.
Overall, I could recommend this book to student midwives, or to women experiencing the condition, with the caveat that most cases of pre-eclampsia are well managed and have good outcomes. However, there is no other book like this available and it is therefore a valuable source of information for women. Such a comprehensive text is invaluable, and so I commend the authors for their work and look forward to future editions.