Realising there is a high blood pressure problem in pregnancy
Of the women we spoke to, many had found out they had raised blood pressure and/or protein in the urine at a routine medical appointment. Some women had pre-existing risk factors so were receiving extra appointments and problems were picked up with monitoring.
For some, their blood pressure had been gradually rising at each appointment. If a blood pressure reading was just ‘slightly raised’ or ‘a bit high’, it wasn’t usually a cause for alarm and the doctor or midwife might suggest the approach of just “keeping a close eye” on it. Women were either invited back to re-check their blood pressure or, in other cases, no further action was needed right away and the situation was re-assessed at the next routine appointment. The women who were taking part in the BuMP research study were asked to self-monitor their blood pressure at home.
If a woman’s blood pressure readings were high enough to be of concern to doctors and midwives, then she might be sent into hospital to be monitored more closely or sent home with a 24 hour monitor. Lyndsey had a high blood pressure reading at a routine midwife appointment at 7 months (33 weeks) and she was sent to the hospital for further checks. All seemed to be okay and so she was asked to come back every few days for the next two weeks for ongoing checks. Samantha Y was admitted to hospital several times during her pregnancy – pre-eclampsia was suspected but never confirmed one way or the other. She was shocked by the midwife’s reaction to her blood pressure reading and “didn’t really understand what was going on at first”.
Some women we spoke to had gone in to hospital and stayed in for a night or more; depending on the results of the monitoring, they were then either allowed home the next day or kept in for longer. Helen Y and Aileen had been given 24 hour monitors to wear at home when it was thought a blood pressure problem might be developing. They wore these monitors over a 24 hour period (including during the night) and then took the equipment back to the hospital so the readings could be checked. Women who had a ‘very high’ reading at a routine appointment and who were experiencing other symptoms (such as headaches, swelling, visual disturbances and/or protein in their urine) were usually admitted to hospital immediately and most stayed for some time. Paige knew the situation was serious when she saw her GP at 32 weeks about headaches and he arranged for her to go to hospital by ambulance. She remembered her doctor saying “you need to get there now”.
Some women had symptoms (such as swelling and headaches) which prompted them to see a doctor or midwife who ran tests which identified a high blood pressure problem. Symptoms can develop quite slowly or, other times, quite suddenly.
Sometimes women had been unsure who to contact if they were worried. Munirah had been given a list of phone numbers of hospital clinics, including the maternity triage, but it wasn’t clear who to contact for particular queries. Kate and Tracey had both called the NHS medical helpline when they felt unwell, and were advised to call the maternity ward. Occasionally a high blood pressure problem was picked up when the woman was seeking help from a medical professional for a different health concern or reason. Those women who had a very high reading when they self-monitored their blood pressure as part of the BuMP study were told to seek medical help as soon as possible and knew to contact their midwife. Pre-eclampsia was sometimes picked up while a pregnant woman was staying in hospital for another reason. Angela knew she had high blood pressure towards the end of her pregnancy and she went into hospital when labour started – the situation became more serious when her face quickly became very swollen and test results also showed protein in her urine.
Pre-eclampsia can also develop postnatally (after giving birth). Sometimes this was picked up during their hospital stay or after discharge (e.g. a check-up appointment, at an appointment for another health reason, an appointment made by the woman because of symptoms) or through self-monitoring. The amount of information women were given at diagnosis varied. Some women’s doctors or midwives had explained it to them in detail, while others felt they should have been given more information right from the start. Samantha Y was reluctant to look up about pre-eclampsia online in case it made her more frightened: “I just listened to what they [doctors] told me and left it at that really”. Emma was glad her GP had forewarned her that she would probably be staying in hospital for some time. Women had different emotional responses to diagnosis. You can read more about women being asked to stay in hospital as well as their experiences of ongoing monitoring and treatment.