When Doctors Use Anxiety as an Obstacle to Patient Self-Advocacy

When Doctors Use Anxiety as an Obstacle to Patient Self-Advocacy

To me, it seemed straightforward enough: something wasn’t right with my blood pressure. It had never even crept above 110/70 before, much less headed into the danger zone. Now, just 24 hours after a grueling 30-hour labor with my daughter, it was steadily hovering in the 150s over 90s. My nurse didn’t share my concern.

“I really don’t think it’s a problem,” she told me.  “I think you’re just panicking. We know about your—your history,” she finished, her eyes darting to another staff member knowingly.

I wondered what sort of violent felonies I’d committed that I wasn’t aware of before realizing what she meant. A single word nestled among my pre-existing medical conditions: anxiety. It looked innocuous, but, I’d soon learn, it would affect every aspect of my postpartum treatment.

“It’s never been high before, and I’ve had anxiety most of my life,” I protested mildly. She looked like she didn’t believe me. Strange, I thought, but surely if there was a problem, they’d let me know.

Still, my blood pressure never stopped spiking, with its highest readings over 160. “Are you nervous?” one nurse frowned at me as the cuff tightened.

“Well, I’m definitely nervous about my blood pressure,” I responded honestly. “Could there be something wrong?”

“If you’re nervous, that’s probably the issue. You have to stay calm,” she chided.

The pattern continued, with one staff member after another insisting that I was “just anxious” — which, of course, made me more and more nervous. When my husband asked if my high readings could be a sign of something more serious, one hospital midwife shook her head and took my hand. I didn’t want her to. “I have anxiety, too,” she confided, leaning into me like we shared a secret. “That’s all this is. Once you’re home and calmer, your blood pressure will go down.”

After several days of inpatient monitoring for a uterine infection I’d developed during labor, I was sent home with a stack of papers and not a word about my blood pressure readings or my growing headache (that, too, was “nerves”). I insisted on buying a monitor to use at home, though I secretly wondered if they were right: maybe I was paranoid or just letting my anxiety get the best of me. After all, I hadn’t studied medicine, so what did I know?

At home, I asked my husband to read my blood pressure to himself, and only to let me know if it was high. If it was anxiety causing my wonky readings, maybe I shouldn’t be taking stock of them at all, I reasoned. That night, he took one look at the monitor and paled: 175 over 110, the highest it had been in my life. We headed dutifully to the hospital and were sent home after a few hours with blood pressure medication and more warnings about anxiety, but my readings stayed high. We finally went to the hospital again — the third time now — and insisted this be taken seriously.

During our six-hour wait at the ER, I thumbed through my lab results online, desperately trying to understand what could be going on. They’d asked me for a urine sample at some point — the last few days were a blurry haze — and the results noted excess proteins. A few clicks later and I’d discovered the diagnostic criteria for postpartum preeclampsia, a potentially serious complication that kills over 75,000 new mothers each year.

Gripping my smartphone, I shoved it towards the nearest ob/gyn, whom I hadn’t met yet, when I was finally led to an ER bed. “These are my lab results. Could I have postpartum preeclampsia?”

Narrowing her eyes at the numbers on the tiny screen, she took a quick look at my latest blood pressure reading, which was now higher than ever, and grimaced. “Yes, it looks like this is a severe case. Have you gotten magnesium yet?” she asked. I told her no, that I’d been told it was just anxiety.

“Anxiety doesn’t cause postpartum preeclampsia,” she said firmly, with no room for argument.

I didn’t know whether to feel vindicated or angry. I was readmitted for another several days in the hospital and 24 hours of magnesium, delivered intravenously, to prevent a seizure. I’d been right all along, but at what cost?

I thought I knew the score, the way that physiological symptoms often get converted into psychological ones when you take up space defined as female. During college, I’d had an ovarian cyst rupture that was misread as a panic attack. Years later, just before I’d gotten pregnant, I’d cried and said “no, stop” through a vaginal ultrasound at the ER after another painful cyst rupture, while the tech ignored me and pushed on and inward, hard.

I’d become numb to trauma and too used to telling the stories in Daria’s voice and rolling my eyes about their gendered implications. I’d read The Yellow Wallpaper and the articles about claiming your autonomy during the birth process and the statistics about how often women’s pain gets dismissed. I knew it was worse during childbirth, that a third of new moms experience birth trauma. I’d heard the horror stories about not being heard, listened to, seen. About being pathologized and belittled and even assaulted.

It seemed at once like a medical horror show and utterly commonplace. It all seemed too obvious, too sexist in a Gender Studies 101 sort of way, to be real. I knew the theory. I wasn’t ready for it to become practice — to threaten my life in such a visceral way.

Months of pregnancy, though, had worn down my resolve. A series of indignities and pain that I quickly learned I was supposed to tacitly accept had left me lost. My pregnant belly pushed in front of me in all my social interactions had led the way to docility in the face of strangers’ knowing smiles and invasive questions and touching, so much touching, from ultrasound wands and gloved hands and chilly fingertips.

Rhetoric around preparing for birth, especially within circles that claim to advocate for empowered mothers, often advises us to trust, to let go, to believe in the process — so I tried. Wasn’t I supposed to perform some sort of moral goodness? Adopt some kind of beatified smiling-through-the-pain act? So until the very end, I smiled thinly and tried not to argue when they told me things I knew were untrue about my own body, its history, the numbers it lit up on the screen. The spectre of the Good Mother haunted me and told me to hush.

But what got under my skin most and worked its way into the knots in my back, settling there like a daisy chain hung with worry stones, was the aftermath: The silencing. I noticed a distinct pattern when I talked to family and friends about what I’d gone through. They smiled hesitantly and delivered platitudes with similar themes:

“Well, you got an amazing baby out of it.”

“All’s well that ends well.”

“Could have been worse.”

“Be grateful.”

Though their attitudes were well-intentioned (and I’ve probably done the same to other new parents, not knowing any better), they belied a certain fundamental truth, a sickness at the core of our understanding of motherhood. It’s probably bound up with Eve and the penalty she paid for getting it on with a snake and subsequently being betrayed by her alleged partner, a lie rubbed hard into our neural grooves like so many toxic spices.

Pain — psychological, emotional, relational, physical — is often, too often, presumed to be our maternal birthright. If you took a road trip and it went awry, no one would say the journey didn’t matter, no matter how lovely and majestic the destination.

But culturally? We don’t see mothers as travelers. The ugly underbellied truth is that we persist in seeing them as the cars. And if the car gets a little banged up along the way to paradise? Well, so be it.

But trauma and condescension and poor health are not the dues we pay for the privilege of childbirth and the right to take up space.

And I’m not the vehicle. I’m the driver.

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