Downton Abbey Breakdown – What Happened to Sybil?

Whoa!  We didn’t see that coming.  What happened to Sybil? I mean, they started dropping symptom-hints in the first scenes and it was obvious something was wrong, but OMG… We loved her. It’s devastating. If you’re among the millions of viewers wondering what the heck happened to Sybil, we’re here to break it down for you.  Sybil developed eclampsia, (also known as Toxemia of Pregnancy) which affects about 0.2% of pregnancies. Back in the day before modern medicine found ways to manage this potentially terminal complication of pregnancy, women died with some regularity from eclampsia, or a related complication called HELLP Syndrome. 

Preeclampsia (sometimes called pregnancy induced hypertension) is a pre-curser to eclampsia. It occurs in approximately 5-7% of all pregnancies when a pregnant woman develops high blood pressure and protein in the urine after the 20th week of pregnancy.  It can be extremely dangerous if not properly managed, but in this day and age, in developed countries like the US, it’s uncommon that women die from preeclampsia anymore.  It happens, but not often. In undeveloped countries though, death from preeclampsia or eclampsia happens more frequently.  While exact statistics for how many women die from hypertensive disorders like Sybil’s are hard to nail down, it’s among the top three causes of maternal mortality.

Lots of women have no symptoms at all when pre-eclampsia is developing.  Some women develop only mild pre-eclampsia that never progresses beyond mild symptoms.  Some women, however, become extremely ill and may develop seizures or become comatose (that’s called eclampsia).

The hallmark signs of pre-eclampsia are high blood pressure, headaches, upper abdominal pain, blurry vision or seeing spots, sudden weight gain, swelling of the hands, face, feet, legs and eyes, protein in the urine, general irritability, confusion and sometimes, nausea, vomiting and decreased urine output. 

Lots of women develop high blood pressure during pregnancy, either from weight gain, stress of pregnancy, exhaustion, a family predisposition for hypertension…heck, even a big baby sitting on a major blood vessel can drive the old blood pressure up temporarily.  It’s estimated that 20% of all pregnancies develop some type of high blood pressure component and most of the time, women live within reach of health care and receive appropriate medical treatment that keeps their blood pressure under control.  High blood pressure does not cause preeclampsia or eclampsia.  It’s a symptom of those conditions, but it is not the cause.  Nobody knows specifically what causes these conditions and no one knows how to prevent women from developing them. 

Sybil had symptoms that were so obvious, no one should have missed them:  confusion, headache, swelling, etc. 

When these symptoms happen, most women (again, in developed countries with access to medical care) go the hospital where tests are run.  If pre-eclampsia is diagnosed, they receive drugs to bring down their blood pressure and a mineral called magnesium sulfate to prevent seizures.  They might have to be delivered before labor starts on its own, either by induction or C-section.  They also have their blood tested frequently to make sure they don’t develop HELLP syndrome, a blood clotting disorder that can cause massive bleeding, kidney and liver failure, pulmonary edema and organ failure. 

That’s what happened to Sybil.  She lived in a time before magnesium sulfate and other medications were available that could have saved her life.  And, the village doctor who recognized what was happening and was advocating for her to be taken to the hospital for delivery by C-section (the only possible cure at that time), was overruled by the obstetrician and Lord Grantham.  No wonder Cora banished him from her bedroom.

We’ll be writing about hypertensive disorders related to pregnancy in February, when we’re focusing on all kinds of matters of the heart. To read more information about preeclampsia and eclampsia, log on to Preeclampsia.org. For now though, let’s all bow our heads and observe a moment of silence in honor of our favorite Grantham sister, Sybil.  And let’s be grateful we live in a time when we have solid medical treatments that can prevent most women from dying from these diseases.  And let’s bear in mind that the whole reason why Every Mother Counts exists is because women in many parts of the world still live without even basic access to medical care. It’s up to all of us to find solutions so that every mother survives childbirth.  It’s the 21^st Century.  Mothers shouldn’t die anymore.