Downton Abbey’s Preeclampsia Drama: Not Just Historical Fiction

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 the 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.”

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