Downton Abbey’s Preeclampsia Drama: Not Just Historical Fiction

February 8th, 2013

by Eleni Tsigas
Executive Director, Preeclampsia Foundation

Downton Abbey, the popular British historical drama set in the early twentieth century, recently caused quite a stir for fans, and for those of us passionate about preeclampsia and perinatal health. A much-loved character on the PBS show died of postpartum eclampsia, shocking and devastating more than eight million devoted viewers. In her fictional death, Lady Sybil became an unwitting celebrity spokesperson for the Preeclampsia Foundation, as we unleashed a broad media campaign to drive awareness and education about a pregnancy complication that today still takes the lives of 76,000 mothers and half a million babies worldwide.

As many Downton Abbey fans and media commentaries wondered in the aftermath of this heart-wrenching episode, could a maternal death like Lady Sybil’s still occur, nearly 100 years later? Indeed, it can and does. In addition, many of the same patient-provider dynamics depicted in this fictional drama are still troublesome today, affecting outcomes for both moms and babies.

Preeclampsia is a rapidly-progressing condition affecting at least five to eight percent of all pregnancies, associated with approximately 15 percent of all U.S. preterm births, and one of the leading causes of maternal and perinatal deaths. Marked by high blood pressure and protein in the urine, preeclampsia is often “silent,” showing up unexpectedly during a routine blood pressure check. However, swelling, sudden weight gain, headaches and changes in vision are important symptoms, often indicating an advanced stage of the disease. Preeclampsia can impair kidney and liver function, cause blood-clotting problems, fluid on the lungs, seizures and, in severe forms or left untreated, maternal and infant death. Eclampsia, one of the most serious complications of severe preeclampsia, can cause seizures that result in coma, brain damage or death.

Downton Abbey’s characters understood nothing of these conditions, though the village physician, who had “known Sybil all her life,” recognized early warning signs as he argued for her transfer to a hospital setting. The reality — that preeclampsia symptoms are often non-specific (they may be present in “normal” pregnancies and thus easily missed) – set up Downton Abbey viewers for a tremendously tragic moment of storytelling.

In modern medicine, our ability to diagnose preeclampsia has improved, thanks to technology that allows us to measure blood pressure and proteinuria rather quickly. But the constellation of symptoms associated with preeclampsia has not changed. They are still non-specific, often dangerous harbingers, and rarely are expectant mothers informed about them.

Know the Symptoms; Trust Yourself

Downton Abbey’s depictions of Interpersonal conflict between the physicians, but especially between the physicians and the family, remain a factor in effective care today. Patients should be – but aren’t always – informed, empowered, and engaged. That is certainly true in a prenatal setting where the woman brings the best knowledge of her body, her sense about her baby, and her maternal instincts to the table, while the provider brings the best diagnostic tools and management skills. It takes a patient-provider partnership to arrive at a timely and accurate diagnosis.

The indicators of Lady Sybil’s preeclampsia – including “muddled thinking” and confusion, edema, headache, nausea, and epigastric pain – are signs and symptoms that today every pregnant woman should be aware of and should readily share with her healthcare provider.

Some say it’s unfortunate that it took a fictional character’s death to raise awareness of a very real health issue. But as a small nonprofit organization, we couldn’t have asked for a better gift to advance our mission. Awareness and education truly do save lives, and Downton Abbey’s plot twist provided us with an important opportunity. The comments elicited by our op/ed article and the accompanying media buzz, as well as the social media flurry on Facebook and Twitter after this episode of Downton Abbey aired, reinforce that there are many women who still need, but aren’t getting, this information. The majority of those exposed to our post-Downton Abbey awareness campaign were appreciative, despite their shock, as they learned about this lingering threat to maternal and child health.

I would always choose a fictional character to do our work, rather than having to attend one more funeral of a real mother who leaves behind a grieving husband and, sometimes, a newborn baby.

Eleni Tsigas is a two-time survivor of preeclampsia and the Executive Director of the Preeclampsia Foundation, whose mission is to reduce maternal and infant death and other adverse outcomes due to preeclampsia by providing patient support and education, raising public awareness, catalyzing research, and improving healthcare practices.

To learn more, see our Expert Q&A with Eleni Tsigas, “What You Should Know About Preeclampsia.”

12 Responses to “Downton Abbey’s Preeclampsia Drama: Not Just Historical Fiction

  1. Heather Lesoine says:

    Since my son’s birth 2 years ago at 28 weeks, due to severe preeclampsia, I’ve been so discouraged at the lack of information I had received during my pregnancy. On the day I entered the hospital, I had called my OB’s office to tell them of a week-long headache that didn’t resolve with Tylenol and actually worsened if I laid down. That day, I also had nausea and chills. I later called the on-call doctor and was taken to the hospital with a BP of 211/115! The only things I knew about preeclampsia was from an episode of ER I had watched years ago. At a regular OB-Gyn appointment after Jack’s birth, I asked why I didn’t receive information about pre-e and was told that “it usually happens later in pregnancy.” What a lousy excuse for keeping pregnant women uneducated and uninformed!

  2. Jenn Carney says:

    Than you Eleni – and the PF. Your campaign around the Downton Abbey episode has been excellent. I appreciate having this shorthand way to explain what happened to me. I had no idea that seizures were a possibility – until I woke up in the hospital on a respirator recovering from eclampsia. I agree – it’s much easier to lose a fictional character. I do not want to see more stories of real mothers.

  3. Amber says:

    To Heather Lesoine – Though healthcare providers SHOULD provide information on preeclampsia and many other issues, mothers should make efforts to educate THEMSELVES as well!! The most basic of pregnancy books detail symtoms of many pregnancy-related maladies like Pre-E.

  4. Christine Morton says:

    To Amber and others: unfortunately, not all pregnancy books have accurate or up to date information on preeclampsia. A thorough review of the 60 best selling pregnancy advice books by Jenn Carney and Douglas Woelkers MD is available at the Preeclampsia Foundation. (

    In California, we recognize the need to inform maternity clinicians as well as women; all too often, women’s signs and symptoms are dismissed by providers. The California Maternal Quality Care Collaborative has a forthcoming toolkit on Improving Health Care Response to Preeclampsia, which will be freely available on our website ( This toolkit, like the one on Obstetric (postpartum) Hemorrhage before it, will help clinicians and hospitals be prepared for these obstetric emergencies primarily by helping them recognize and respond to symptoms in a timely way.

  5. Sam says:

    @ Amber, I was one that DID educate myself. When I told my doctor about my high blood pressure @ the grocery store machine know what he said ? “Those machines aren’t accurate”. When I told him I researched preeclampsia on the internet know what he said? “The number one use for internet it porn”. When I told him I had HORRIBLE HORRIBLE heart burn and I cried at night…he said it was normal, when infact it was my liver. When I was gaining 5-10lbs a week, he said I was eating too much. When I was finally 36 weeks and my bp was 188/115 and my proteins were off the charts I got induced, and he said he ‘never seen it coming’.

  6. Natalie Brown-Sherman says:

    I wish more information was around about preeclampsia and eclampsia. I had my eldest son back in 2001. I had eclampsia with seizures, liver and kidney failure. There appeared to be no other warning signs other than me not being able to eat for the entire pregnancy. The eclampsia didn’t appear to start with any preeclampsia signs. I was so scared. I had lived on red cordial and had thrown up violently for 8 months. My son as born at 35 weeks, he had been good at taken what energy he needed to grow. I on the other hand had lost significant weight. Once he was born I was completely back to normal. I also had cholestasis of pregnancy – fun times! I got such conflicting advice on having more children. Since then I have had a further 2 children. In 2011 I had an uneventful pregnancy, but had a high risk obstetrician just in case. It was hard though not knowing if I may end up having seizures again and possibly having further coamplications. I then have had another baby in 2012. Again I wad still considered high risk and very closely monitored by my doctor – he thought I was a bit crazy taking the chance again! At 28 weeks bleeding began an wouldn’t stop. I wasput on strict bed rest in hospital for 3 weeks – very hard on my kids, my husband and myself. They couldn’t work out what the bleeding was from. Was this preeclampsia? What on earth, I was so scared. 5 false labours and at 31 weeks a little boy was born. Early but healthy. They still weren’t sure what the bleeding was from but they said it appeared to be placental abruption. Was this due to preeclamptic signs? I woul love to read further information and research on eclampsia a pre eclampsia as well as OC of pregnancy. There isn’t enough info around, and if it takes. Show, that’s addresses the matter correctly or not to raise the topic up for discussion, then surely that’s good. It’s sad to think that so many women still die each year from this condition.. bring on my awareness and assistance to those who need it. Xxxx love to all gorgeous mums!

  7. Adair Faye's Birth Story says:

    [...] is a nice summary of eclampsia from the National Healthy Mothers, Healthy Babies Coalition: “Preeclampsia can impair kidney and liver function, cause blood-clotting problems, fluid on [...]

  8. IT HAPPENED TO ME: I Had Pre-eclampsia During Pregnancy … | Pregnancy Guidelines says:

    [...] Downton Abbey”; [...]

  9. Angie says:

    I had, so did my sister. I had a c-section 4vweeks early. My husband and I had been married 12 years but had been using condoms for about a year. Apparently the Mthfr gene is implicated in this and in other bad stuff.

  10. Denise says:

    When I had my first child (of 3) I was admitted to the hospital 6 days before my due date with the thought I had preeclampsia. After watching the Downton Abby episode I had no idea I could have died! I do remember being short of breath and the huge amount of swelling. I just thought it was the last month of pregnancy and never wanted to experience it again. I did have my other two children earlier than this one. So many of those feeling I had were the symptom of preeclampsia and I just thought it was the last month of pregnancy. My delivery included 3 hours of pushing followed by a c-section. This all really did a number on my brain function. Comparing all this to my two other pregnancies, there truly was a difference in my 1st, I believe due to this condition. My doctor was great though all of it.

  11. Susan Carol says:

    My son was born 31 years ago, I had preeclampsia/toxemia, I was 3 weeks over due when he was born. My doctor told me to “go home and take it easy.” That didn’t communicate to me that it was a problem. I went touring with my parents 4 weeks before, I knew I was spilling protein in my urine, but that was all I was told. I went jogging with my husband the day I thought I was in labor and wasn’t. We went to the hospital, hoping against hope that it was time. That is when they told us I was not in labor but I was going to be induced. It took 4 days. I wasn’t even told until the 3rd day that I was supposed to be on bed rest, when we went to the nurses station to ask them to have another women in my room not to smoke in the room. In all reality, I did not realize the seriousness of the issue until the last few weeks when I have been looking into it.
    I do not remember what my blood pressure was when I got to the hospital, but I do remember that my reflexes were brisk enough that I kicked the doctor in the face.
    My daughter in law’s mother also had preeclampsia, she could not see by the time they got to the hospital. And last night I read it is hereditary! So much for grandkids!
    Doctors really need to tell expectant moms if there is a problem. We had absolutely no idea there was a problem. They induced me for 4 days, and I was on meds the entire time I was in the hospital. It was an absolutely horrible experience. I never wanted to have another child!
    My daughter in law is also a nurse practitioner with a masters in midwifery, she says that they would never do what they did to me now. I hope no mom ever has to go through what I did, it was horrible.

  12. Nurse Cindy says:

    I was a Newborn/Pediatric ICU nurse for about 10 years when my daughter was born 23 years ago. I went to high risk deliveries all of the time so I chose my Obstetrician carefully and he was/is one of the best still. I was initially watched at home for swelling in my legs. I gained 25 pounds of fluid weight in 3 days and they thought my skin might split. I worked/was hospitalized in a tertiary care facility specializing in the care of high risk moms and babies. I developed HELLP syndrome High blood pressure, elevated liver enzymes, and low platelets (clotting factors). I also developed renal dysfunction. My perinatologist and OB monitored me closely. With bedrest and Magnesium (treatment for pre-eclampsia) I lost fluid and my blood pressure stabilized. My liver enzymes and kidney function continued deteriorating so I was delivered at 36 weeks. My baby was on Oxygen for about a day and then did well. My OB and perinatologist at the time decided not to treat me after the baby was born because delivery most often cures the problem. Normally, Magnesium is continued after delivery for a day or 2 but because everything had stabilized but my liver and kidney function, my doctors decided to “spare” me the discomfort of the magnesium because they felt I was not “that sick”. Unfortunately, about 1 day after delivery I began to feel poorly, thinking it was just the delivery that was making me feel bad. I could not think straight and thought I was overtired. Unfortunately my husband decided he was tired and went home for the night. I became eclamptic, I coded and was resuscitated. I worked in the NICU area for about 30 years and it was an extremely rare experience. I now have a seizure disorder as a legacy, but I survived. I knew my OB and perinatologist for many years and if I hadn’t seen them perform in other critical situations, I may have been more upset with them. They were good doctors who had a rare lapse in medical judgement. later I was told they “underestimated” how sick I really was. After me, no one got by without staying in labor and delivery on Magnesium when they were pre-eclamptic. I worked with these guys for many years and know my case was rare for such an experienced team. I understand as an intensive care nurse that patients can deteriorate rapidly. It is standard of care now to be treated before and after delivery when pre-eclampsia presents. My case was extreme. It is best to be cared for in a regional center used to these types of patients, but coding/being on a ventilator are very rare.

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