Tennis star Serena Williams is a high-profile example of a fairly common, but very serious, healthcare complication for pregnant women. And now the new mom is speaking out about the health scare that sidelined her for six weeks and prompting a national discussion about post-delivery complications.
According to the U.S. Centers for Disease Control and Prevention, about one-fifth of the 4 million women who deliver in the U.S. each year have a serious problem before they start labor and one-fourth will have serious complications during labor or delivery.
After an easy pregnancy, Williams, who shared her story in the February 2018 issue of Vogue, had to have an emergency cesarean section (C-section) because her baby’s heart rate was dropping rapidly during contractions. The C-section went smoothly and her daughter, Olympia, was born on Sept. 1, 2017. But what followed was far from smooth, Williams told the magazine.
The next day, Williams suddenly felt short of breath. Having suffered a pulmonary embolism in 2011 – a sudden blockage of an artery in the lungs – she immediately alerted her medical team about her symptoms.
Williams had a history of blood clots in her lungs and had been taken off blood thinners before delivery. A CT scan revealed several small blood clots in her lungs and a heparin drip (used to help prevent blood clots) was started within minutes.
Unfortunately, the complications did not end there. After suffering some severe coughing from the clots in her lungs, the sutures on her C-section incision gave way. The blood thinner they put her back on to save her life caused bleeding at the incision site, and a large hematoma – a collection of clotted blood that forms outside the blood vessels – had filled her abdomen.
Yet another surgery was needed, and a filter was inserted into a major vein so no more clots would find their way to her lungs. As a result of these complications, Williams wasn’t able to get out of bed for six weeks.
“Someone with a history of blood clots should be managed very differently around the time of delivery,” said Dr. James T. Christmas, HCA’s national medical director of Women’s and Obstetric Services.
“In looking at over one million patients in our facilities back in 2006, we determined that [blood clots after cesarean delivery] was a leading cause of maternal morbidity,” Dr. Christmas said. “For that reason, in 2008, we initiated a policy in all of our hospitals where patients who have a cesarean section – without fail – have sequential compression devices put on their legs when they’re put on the table.”
According to Dr. Christmas, this policy has virtually eliminated post-cesarean thromboembolism in all HCA-affiliate hospitals and is now the standard worldwide.
Symptoms that may indicate a developing blood clot include:
- Persistent pain in the calf (typically described as a charley horse-like pain)
- Asymmetric swelling of the lower extremities
- Sudden onset of chest pain, shortness of breath or a rapid heart rate
If you experience any of the symptoms above, you should inform your nurse if you are in the hospital or call your physician if you have been discharged home, says Dr. Christmas.
“We want to advocate for our patients, but we also want our patients to advocate for themselves,” Dr. Christmas said. “If you perceive there is something wrong you should absolutely, 100 percent of the time, notify your caregivers and ask for an explanation.”
If you are pregnant, it’s important to recognize that pregnancy itself is a risk factor for developing blood clots. To minimize your risk, adhere to the following recommendations:
- If you’re going on a long trip, stay hydrated and ambulate at least once an hour to maintain circulation (in the car or on a plane)
- If you are a smoker, quit smoking
- If you are hospitalized, you may be put on medications to decrease your risk of developing a blood clot
James T. Christmas, MD, is director of maternal-fetal medicine for HCA Virginia. HCA Healthcare operates 120 labor and delivery units that help deliver approximately 219,000 babies each year.