After a dangerous brush with preeclampsia, this doctor is raising awareness about the condition among Black women

In her 38th week of pregnancy, Madison Cook had good reason to worry that she had developed the life-threatening complication called preeclampsia.

Her blood pressure was high, and an outpatient test revealed the abnormal presence of protein in her urine — classic warning signs of the dangerous condition. Also she is Black, and she knew that Black women are at higher risk of preeclampsia and more likely to die from it.

But when Cook arrived at Jefferson Einstein Philadelphia Hospital on Jan. 18 expecting to have labor induced, her blood pressure and lab results had returned to normal. On-call physicians recommended that she go home.

Cook is a physician too — a 2nd-year surgical resident at nearby Temple University Hospital — and she pushed back. Her gut feeling was to err on the side of caution and stay at the hospital for close monitoring.

After Cook enlisted the support of her obstetrician, Einstein physicians agreed to admit her after all. She waited more than five hours for a bed to open up, and when a nurse checked her blood pressure again, it had shot up to an alarming 176 over 100.

The story has a happy ending. Baby Sydney was born healthy, and her mother is fine. Still, Cook worries about people in similar situations who lack her medical expertise and might not feel comfortable questioning their physicians.

Her experience drew national attention after she shared her story in a social media thread that quickly went viral, at last count drawing 1.8 million views. It was reshared by dozens of physicians and nurses and U.S. Sen. Tina Smith (D., Minnesota), among other notables.

Einstein has a strong track record in treating preeclampsia and other complications of pregnancy, with rates of adverse outcomes well below the national average.

The hospital stands by its physicians’ initial recommendation that Cook go home, citing the fact that her blood pressure and lab results had returned to normal. They told her she should continue to check her blood pressure at home, just in case.

In an interview, Cook agreed that was a justifiable decision, given her normal lab results and blood pressure readings during the two hours she was in triage.

“On paper, everything was fine,” she said.

But given the abnormal urine test at her outpatient visit and her risk factors (being Black and having a history of high blood pressure), she thinks they should have admitted her immediately.

She said her goal in sharing her story was to raise awareness of preeclampsia and the need for physicians to listen to their patients. She worries especially about Black women, given their higher risk of the condition, and because surveys have found they are less likely to have their medical concerns taken seriously.

She didn’t name Einstein in her social-media post, and identified the hospital later only in response to a media inquiry.

Three months later, she’s back working 80-hour weeks at Temple, delighting after every shift when she comes home to baby Sydney. And she remains unsettled by the thought of what might have been.

In the spring of 2023, Cook was well into her first year as a surgical resident when she became pregnant.

She didn’t want to have the baby at the hospital where she worked, so she opted for Jefferson Health’s Einstein Hospital in North Philadelphia. She picked an outpatient OB-GYN practice with two women physicians of color, in part because she’d seen studies finding that Black patients can have better outcomes when treated by Black physicians.

Cook had elevated blood pressure for years, and she continued taking medication for that condition throughout most of her pregnancy, keeping her blood pressure within normal range. Early in her third trimester she stopped taking the drug, as it was making her feel light-headed and fatigued.

All seemed fine. She checked her blood pressure frequently, and for more than two months, it remained normal. She went on maternity leave, feeling relaxed with the temporary hiatus from her career.

Yet at the 38-week outpatient appointment, Cook’s blood pressure was 140 over 100 — reading 140 when her heart was beating and 100 when it was at rest between beats. That’s just past the 140/90 threshold for diagnosing hypertension in pregnancy, and a possible sign of preeclampsia.

Preeclampsia is characterized by a variety of symptoms that can include liver and kidney dysfunction. Left untreated, it can progress to full-blown eclampsia, with seizures or a coma.

When she tested positive for protein in her urine, Cook recalled, her obstetrician told her to go straight to the hospital. She was going to deliver a baby that day.

When Cook arrived at Einstein’s labor and delivery triage unit soon after 11 a.m., her blood pressure had gone back down, and it stayed normal on multiple readings over a two-hour period.

Laboratory tests of her blood also came back normal, revealing no sign of kidney or liver problems.

Those blood tests are a more accurate barometer of preeclampsia than the type of urine dipstick test she’d had in her outpatient visit. That urine test often yields a false positive, meaning it indicates the presence of protein when none is there.

Still, Cook’s urine protein reading at the outpatient visit had been high, at 3-plus. Urine tests with that result are falsely positive in just 7% of cases, according to guidelines from the American College of Obstetricians and Gynecologists, a nonprofit medical society.

Cook did not feel comfortable going home. She’d been scheduled to have labor induced a week later, at 39 weeks. But given the urine test, her risk factors, and her obstetrician’s original recommendation, she felt it was wiser to have labor induced that same day.

She called her obstetrician, who called the on-call attending physician to ask that Cook be admitted. That doctor went back to Cook to discuss the plan.

There were no beds available, the on-call physician said. She said Cook would be better off in a less stressful environment at home, and could continue to monitor her blood pressure there, Cook recalled.

But the pregnant physician was firm. The on-call doctor agreed she could stay, and go forward with inducing labor.

The hospital agreed to admit Cook at 2:15 p.m. She waited in the hospital’s antepartum wing until a bed became available at 7 p.m. Her blood pressure was checked again at 7:30, six hours since it last had been measured in the triage unit.

Hypertension in pregnancy is defined as an elevated blood pressure on two consecutive readings, taken at least four hours apart. Hospital officials said the longer span between Cook’s blood-pressure readings occurred because of her transition between units.

For most pregnancies, readings of at least 140 over 90 are considered a sign of preeclampsia when combined with other tests. For women such as Cook, who’d had high blood pressure before she was pregnant, a level of 140 over 90 is not necessarily indicative of the condition, requiring a more careful evaluation of various lab results.

But when physicians saw her measurement at 7:30 p.m. was 176 over 100, the doctors were stunned, Cook recalled. One of them asked if she felt anxious, suggesting that might be a contributing factor.

In a subsequent reading her blood pressure was 178 over 95 — indicative of severe preeclampsia.

She was treated with magnesium sulfate to reduce the risk of seizures, as well as medication to lower her blood pressure. Cook was happy with her care from then on, and said she got a supportive comment from one of her counterparts, a medical resident.

“I’m glad you stayed,” the resident said, Cook recalled.

Once she was stabilized, Cook received medication to induce labor. Sydney was born early Saturday morning.

Einstein’s patient population is 75% Black, and it has an excellent track record in treating complications of pregnancy, as measured by a standard composite indicator of severe maternal morbidity — a category that includes rates of eclampsia, blood transfusions, and strokes, among other preventable complications.

In a national analysis of data from 2014 to 2017, the most recent years for which this information is readily available, USA Today found Einstein’s rate of these complications was 0.5%, well under the 1.4% median rate of hospitals in 13 states for which data was available.

For Black women in particular, Einstein scored even better in comparison with other hospitals. The hospital’s rate of these complications in Black women was 0.6%, whereas the median rate for hospitals in the 13 states was more than four times that high, at 2.6%.

David Jaspan, the hospital’s chair of obstetrics and gynecology, said in an interview that he was sorry Cook felt her concerns were not taken seriously.

He was not involved in her care but upon reviewing the case and speaking with Cook’s physicians, he said they made the right obstetrical decision based on all the available information.

Told that Cook’s goals included increasing awareness of preeclampsia in the Black community, Jaspan said he was all for it.

“If she wants to partner with us to educate the community on the risks of preeclampsia,” he said, “I would certainly welcome that.”

Cook still thinks her health was at risk when the hospital recommended that she go home. She knows that Einstein’s physicians followed accepted guidelines in reaching that decision, but she believes her risk factors and her outpatient results earlier that day merited more consideration.

A graduate of Meharry Medical College who grew up in Yorktown, Va., she said her experience as a patient reminded her of some difficult calls she’s had to make as a surgeon at Temple.

Sometimes her patients tell her they are in severe pain, yet CT scans and other imaging suggests no apparent cause. In such cases, she reminds herself that patients know their own bodies, so further review may be necessary.

“It’s important to believe patients,” she said. “They know their bodies better than we do.”