As she neared the end of her second pregnancy, Sarah-Grace Richardson experienced “the most excruciating headaches” she’s ever had.
“It felt like lightning was striking my brain,” said the 24-year-old from Greensburg in the US state of Indiana.
“This was really weird, too, because I don’t really get headaches ever.”
Then she delivered her son, Everett, and became sick afterwards.
She was stunned by unexpected vomiting because her first pregnancy and delivery was so uneventful and she assumed the second would be the same.
“I was just vomiting,” she said. “Doctors didn’t really know why.”
She returned home with Everett for a day before the headaches struck again – and she knew something was seriously amiss.
“I couldn’t get my limbs to move correctly,” Richardson said.
“I couldn’t move the right side of my body at all.”
Richardson had experienced a postpartum stroke.
She is sharing her story to help others understand how it happens.
“I’d like to be raising awareness,” Richardson said.
“Don’t spend your whole pregnancy in fear of that happening, but just know the signs.”
Pregnancy and stroke
Toward the end of her pregnancy, Richardson felt run down.
Prior to becoming pregnant, she learned she had ulcerative colitis, a bowel condition that causes lingering inflammation and sores in the digestive tract.
During the pregnancy, she had a flare-up and just attributed her feeling unwell to that.
When she delivered and returned home with Everett, Richardson knew something was different but wasn’t sure what.
“The pregnancy itself was pretty tough especially toward the end,” she said.
By the time she arrived in the hospital just a day after giving birth, she could only move her left foot.
The rest of her body was paralysed.
“I remember a doctor coming in and I asked her, ‘Am I going to die?’ and she just said, ‘I don’t know’,” Richardson said.
“I remember feeling so afraid.”
Once she was admitted, doctors knew Richardson had a postpartum stroke.
It is a rare condition that most likely occurs within 10 days following childbirth, according to the American College of Obstetricians and Gynecologists.
A recent study reported that pregnancy-associated stroke occurs in about 34 per 100,000 deliveries.
Risk factors include if a woman is, or experiences:
- Advanced maternal age (35 years and older)
- African-American race
- Preeclampsia, eclampsia or gestational hypertension
- Migraine headaches
- Hyperemesis gravidarum
- Postpartum hemorrhage
Dr Ryan Overman is a neurologist at Indiana University Health.
“The body wants to prevent excessive bleeding at the time of delivery, but unfortunately this may translate to a risk of abnormal – and sometimes dangerous – clots in some individuals,” Overman said.
“Pregnant women have a risk of stroke that’s about three times higher than non-pregnant women and so that number sounds a bit frightening.
“But again this is very uncommon.”
Know the symptoms
Understanding the symptoms of stroke and getting a loved one help as soon as possible improves one’s outcome, Overman said.
The American Stroke Association uses FAST as a quick reminder of symptoms, which means:
- F: Facial drooping
- A: Arm or leg weakness
- S: Slurred speech or inability to talk
- T: Time to call for help. The faster you get help the better.
Even more unusual than a postpartum stroke?
Richardson had a cerebral venous sinus thrombosis stroke, which affects five in 1 million people a year, according to Overman.
“There’s a blood clot in the veins of the head or neck that will cause damage to the brain, whether it’s because of congestion that deprives the brain tissue of enough oxygen or whether it causes bleeding in the brain,” Overman explained.
“That’s a less common way that a stroke will happen.”
How strokes happen
Most strokes occur after a blockage in the artery.
In Richardson’s case, her stroke “was a slower process”.
Doctors found several clots in her brain, causing damage in both her frontal lobes.
But she also had a brain bleed, making it challenging to control.
Richardson’s outcome seemed bleak at first.
While her family couldn’t see her because of COVID-19 restrictions, they waited in the hospital car park for news.
“The doctor … said, ‘If something happens and she’s not going to make it, we’ll let you come in and say goodbye,’” Richardson said.
Doctors stabilised Richardson and she spent 10 days in intensive care receiving treatment.
She experienced intense double vision and still couldn’t move any part of her body.
“That is a very strange experience,” Richardson said.
“It was humbling for me because … I’m the one who takes care of people.”
By May 5, she went to Rehabilitation Hospital of Indiana, to learn how to care for herself after her stroke.
Doctors weren’t sure if she’d regain use of her limbs, and the therapists were prepared to teach her how to live in a wheelchair.
“The doctors would stop in the room and they asked me to try to move different parts of my body and I was just lying there. I can’t do it,” Richardson said.
“They’d check my eyes and kind of like shake their heads.
“I could see the look on all these doctors’ faces just like no hope.”
Faith in recovery
But Richardson, who has a strong faith, believed God helped her survive the initial stroke and that he’d help her recover.
Already when she started at the rehab hospital, she could speak better than expected.
Soon, she saw great improvements.
“Things started to get better,” Richardson said.
“One day it was like my right hand woke up and all of a sudden I could move my fingers and it was so amazing.
“As a Christian, I believe all this was an act of God.”
Slowly, her speech returned to normal as she gained more use of her hands, feet, legs and arms.
“Miracles were happening. This girl, who was supposed to die, and then she was supposed to be in a nursing home, was beginning to be able to walk. It just absolutely amazing,” Richardson said, referring to her progress.
Sharing her story
When Richardson was released from the hospital, the first thing she did was feed her baby and see her two-year-old son, Bear.
“I got to hold my baby, which was awesome,” Richardson said.
“Just those little things were so sweet.”
Richardson still struggles with some fine motor skills and right leg weakness but she is able to walk and care for her children.
She feels grateful for all the prayers for her from around the world.
And she hopes her story inspires others.
“It’s overwhelming to have an experience where you almost die,” Richardson said.
“Every single day I’ll be doing little things, like folding clothes or changing my kids’ diapers.
“And it’s just like ‘I’m here and I’m alive and I can do these things and it’s just so incredible’.”