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Pre-eclampsia and high blood pressure in pregnancy

Experiences of self-monitoring blood pressure in pregnancy as part of research

In addition to monitoring as part of routine medical care during pregnancy, some women had monitored their own blood pressure (self-monitoring or home-monitoring of blood pressure) using their own monitor at home or going into their GP surgery to use a monitor in the reception. Some women had checked their blood pressure only occasionally or as a one-off. Josie’s partner was medically trained and he sometimes took her blood pressure at home. Kate had a blood pressure monitor at home and used it once when she felt unwell during her pregnancy. 

Others had monitored their blood pressure more frequently. Some of the women we interviewed had taken part in a medical research study called ‘BuMP’ (‘Blood pressure Monitoring in Pregnancy’) which asked them to test their blood pressure in the morning and evening three times a week.
 

Ruth X had a special arrangement in her first pregnancy with her doctors which meant she was allowed to monitor her own blood pressure at home. She took part in the BuMP study in a following pregnancy.

Ruth X had a special arrangement in her first pregnancy with her doctors which meant she was allowed to monitor her own blood pressure at home. She took part in the BuMP study in a following pregnancy.

Age at interview: 42
Sex: Female
Age at diagnosis: 42
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I’d been attached to the [name of specialist maternity care] unit at 28 weeks because of my medical history. I have polycystic ovaries and because I was termed an older mother because I was 37 at the time, they deemed that I needed a little bit of extra supervision. And one of the things that they decided then was that I needed to have my blood pressure taken very regularly because I was at risk of getting pre-eclampsia. And so there was a bit of a hoo-ing and haa-ing because they said I should have it done at the GP’s surgery and the GP didn’t want the, to take my blood pressure every two days. He thought that was a bit too onerous and so we came to an agreement that I would self-monitor at home using a, you know, a standard monitoring blood pressure monitoring kit that I bought from Boots and so I did morning and evening tests every day and then at 32 weeks, I had a bit of a spike on one of my blood pressure readings. So I phoned the clinic and went into the outpatients day patients’ unit and they kept me there overnight. 
Adjusting routines to fit in self-monitoring

Some women found it easy to fit blood pressure monitoring into their normal routines. Others had to adjust their daily routines a little. The BuMP study asked women to check their blood pressure on three days each week, twice in the morning (five minutes apart) and twice in the evening (five minutes apart). Ruth X said this wasn’t “onerous” and soon became part of her normal routine. She dropped her first son off at school, checked her blood sugar (as she also had gestational diabetes) and blood pressure before going to work in the morning. Others found it more difficult to add blood pressure monitoring into their daily routines. For Ify, it was “hard work”. Women had different strategies. Some took their blood pressure monitors to work. Others preferred to leave theirs at home. Abigail worked from home quite often which made it easier to fit in blood pressure testing: “I could just put it on while I was sat down working”.

Some women found it hard to remember the days and times they were supposed to check their blood pressure. Philippa spoke about the frustration of getting to work and realising she hadn’t checked her blood pressure that morning and the monitor was at home. Some women had strategies to help them remember: setting alarms on their phones or computer calendars and making a chart. Some said their children were quite interested in the blood pressure monitor. Philippa’s two year old son wanted to know why she wasn’t talking when she used the machine and so she explained “[mummy is] just checking that the baby is okay”.

When daily routines changed—going away on holiday, having people visit, being in hospital (either for monitoring or the birth), starting maternity leave—it could become even more difficult to remember to take blood pressure readings on the ‘right’ days. Although the risk of developing pre-eclampsia continues for a few weeks after birth, almost everyone said it became much more difficult to monitor after their baby was born. Ruth Y said having a new baby at home means you “always have your hands full”. Women in the BuMP study were asked to keep checking their blood pressure for six weeks after birth. This was how Ruth X found out that a particular painkiller was making her blood pressure spike and she was then advised by her doctors to stop taking it.
 

Philippa talked about the difficulties of fitting in blood pressure monitoring as part of the BuMP study when she was pregnant and after she gave birth.

Philippa talked about the difficulties of fitting in blood pressure monitoring as part of the BuMP study when she was pregnant and after she gave birth.

Age at interview: 33
Sex: Female
Age at diagnosis: 33
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I must say, that was probably the hardest thing actually remember to do it because I had another child that was quite demanding of attention and having to get that sorted and get off to work, everybody where they were meant to be and dressed and everything as well as finding kind of ten minutes to do this three times a week was a challenge and there were times that I’d get to work and I’d have the reminder on my phone and I’d suddenly think, oh, I haven’t done it today. Which I felt awful about but I think that was, it wasn’t by any means often.

And what about after the baby was born, did you find it easier or harder to manage?

Harder. Much harder. Much harder. I had a, the service on my phone that would remind me if I hadn’t done it. It didn’t remind me to do it. It would remind me if I hadn’t done it but I’d put my own timers on my phone right the way through so I would remember on Monday, Wednesday and Friday to do the set times. But then after the birth, I do remember several times when the alarm on my phone would go off and I’d think, right, I need to do that and then suddenly something else would happen, the baby would need a feed, need a change, be sick, my older child would need something else and kind of an hour would pass and then I’d get a reminder and think, oh, I forgot to do it again and, by that point, it was too late in the day.
 
 

Elaine made some adjustments to her daily routines so that she could take her blood pressure readings for the BuMP study.

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Elaine made some adjustments to her daily routines so that she could take her blood pressure readings for the BuMP study.

Age at interview: 33
Sex: Female
Age at diagnosis: 33
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When you did the blood pressure, you had to sort of be still for five minutes before to allow things to settle. Check your blood pressure and then wait for another five minutes and then check it again. Now, at work-, I normally get up for work, so a normal day, say at six o’clock in the morning and then I’m at work, rarely am I sat still. So in order for me to be able to do that, I set my alarm for 15 minutes before early, so I then would wake up at quarter to six, so then I’d be able to have my five minutes rest, do my blood pressure, another five minutes, do my blood pressure again before then my alarm went off to actually properly get up. So just with that little adjustment. And then the one in the evening, I would do almost whilst-, or just after tea or watching TV just before going to bed. So, very early in the morning and very late in the evening to try and get those readings in. Since going on maternity leave or having the baby, was again just having time to try and fit it in and adjusting the routine. I didn’t necessarily feel it was burdensome. I think Monday mornings, when I normally get up at half past five, setting my alarm was quarter past five was a little bit annoying but it was only once a week.
 

Ify sometimes found it a struggle to check her blood pressure on the right days.

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Ify sometimes found it a struggle to check her blood pressure on the right days.

Age at interview: 35
Sex: Female
Age at diagnosis: 34
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Tell me what it was like taking part in in the trial? How did you find it?

Initially, I was very excited to start with and my first week, must have been about 16weeks, when I started and it was all alright. I kept doing what I was supposed to do, took my blood pressure three times a week, twice a day for three times a week, which was fine until about the third trimester, the last stage and I thought, oh my goodness. How long can I carry on doing this? 

[Laughs]

Because there were days where I felt not very well and there were days when I had to go to work and get back home tired and I have a family to see to, I mean there were a lot of things happening the way it is, I couldn’t. I would take them but I made up as I went, I don’t know if I was allowed to that but I felt I ought to do it three times a week.

But I made up as I went and put recordings down. But, for example, if I was meant to take it on a Wednesday and I forgot on the Wednesday. I took it on a Thursday.

But I write it Thursday and date it at the time it, you know, yeah, generally, but, when I came out of hospital, after I had the baby, for about a week or so I couldn’t, it was really very hard settling in with a new baby and having had a section, sometimes I forgot. Forgot to take my blood pressure.
Emotional impact of self-monitoring blood pressure

Looking for reassurance about their health was a key reason women self-monitored their blood pressure in pregnancy. It gave Sally “peace of mind”. Ruth Y said she found it “very reassuring and also very empowering” to be able to “take charge” of her health in this way. Some found it helpful being able to check their blood pressure whenever they wanted. Philippa and Amy both took their blood pressure when they had headaches (see section on signs and symptoms). However, blood pressure is only one piece of a jigsaw of symptoms. So, as Kat cautioned, it was important not to take self-monitored blood pressure results as “the be all and end all”: “there could be so many different factors that affect a certain reading and so it’s just good to be aware of that really”.
 

Towards the end of her pregnancy, Kat had some high blood pressure readings. She contacted her midwife and said it was reassuring to be able to check her blood pressure herself whenever she wanted.

Towards the end of her pregnancy, Kat had some high blood pressure readings. She contacted her midwife and said it was reassuring to be able to check her blood pressure herself whenever she wanted.

Age at interview: 27
Sex: Female
Age at diagnosis: 27
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Okay and what about what the actual monitoring showed? Did it show any raised blood pressure through your pregnancy? 

Yeah, there was, towards the end it did go, for me, very, quite high. I mean, generally, it wasn’t very high but for me for it was it was very high and I did have did have concerns, at that stage, so I did contact my midwife and that was really good reassurance. I found that really, really helpful because you can think, because I felt fine but if you’ve got high blood pressure, and I did it a couple of times extra just to make sure it wasn’t just that one time and it was a bit high but there wasn’t there wasn’t anything to worry about, which was good, but it was really nice to have that reassurance. 

But you can check and you can do additional ones as well additional readings. To help out, so yeah, that was good.
 

Taking part in the BuMP study made Ruth Y more aware about her health in pregnancy, which she saw as a good thing.

Taking part in the BuMP study made Ruth Y more aware about her health in pregnancy, which she saw as a good thing.

Age at interview: 40
Sex: Female
Age at diagnosis: 40
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It was very straightforward to do, you know, mechanistically, sticking your arm in a tube and pushing a button, you know, is absolutely no problem at all. If anybody was worried about oh, I don’t think I could do it by myself, then, you know, it’s not it’s not a not a difficult thing to do. And I think for me, it increased my awareness of, the potential conditions I could suffer from and I thought that was a very positive thing, so it did make me go away and sort of read a bit more about what it was.

What preeclampsia was and how it would manifest itself and what it would result it.
Women who went on to develop pre-eclampsia (or had done so in a previous pregnancy) were often more unsure about the emotional benefits of self-monitoring. Angela found checking her blood pressure could make her more anxious, which in turn made her blood pressure rise and worried her further. Vicki said self-monitoring was both good and bad – it was “nice to know that I could check myself” but also meant she was constantly reminded of the possible problems that could develop. But overall, Vicki felt it was better for pregnant women to know if there was a problem so they could get medical help sooner rather than later. 

Women had mixed experiences of giving their home-monitoring readings to health professionals. Kate had a high blood pressure reading but when she called the maternity ward, they said the monitor “must be faulty”. But the reading was correct and Kate was admitted to hospital a few hours later.

Some preferred taking their own blood pressure rather than a health professional doing it. Amy said “it’s like torture for me”, and she felt more comfortable at home. In contrast, Vicki thought her blood pressure was probably lower when it was taken during a stay in hospital as she was less busy and with “your feet up”. Most said they didn’t have a preference either way.
 

Amy didn’t like having her blood pressure checked. Through the BuMP study, she was able to monitor it herself at home. This meant that she could relax a bit and get more accurate results.

Amy didn’t like having her blood pressure checked. Through the BuMP study, she was able to monitor it herself at home. This meant that she could relax a bit and get more accurate results.

Age at interview: 34
Sex: Female
Age at diagnosis: 31
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I don’t like having my blood pressure taken. You can take as much blood from me as you like.

Put any needles in front of me, that’s fine, but show me a blood pressure monitor and, for some completely bizarre and unknown reason, I just would want to run away. So it always was a little bit elevated but that would be the top figure rather than the bottom figure, generally, that was elevated.

So I’d have to have it done maybe three times with a bit of a sit down and a quiet and a relax in between. And then it kind of brought it down to normal, so yes, I have had high blood pressure readings before and I have then had to have it kind of done repeatedly to check that it was fine.
 

Samantha Y self-monitored her blood pressure in pregnancy as part of the BuMP study. She developed high blood pressure and found it could be frightening to see the readings.

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Samantha Y self-monitored her blood pressure in pregnancy as part of the BuMP study. She developed high blood pressure and found it could be frightening to see the readings.

Age at interview: 29
Sex: Female
Age at diagnosis: 29
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Sometimes it was a real shock. You’d just be laying there and they’d take your blood pressure and, yeah, it’d be really high.

Did you find that worrying? 

Yeah, my partner did actually, more than anything. There was one point where he was he wanted me to come off it because he thought that it was making me more worried and I wouldn’t be worried, I’d only be worried sometimes when, because there was a couple of times when I was going to go and see my sister and I had to take it before I went out and then it was, like it was through the roof and then that would sort of make me really anxious because I’d be, when I got admitted to hospital like the, after, one time it was really high, they made me stay in overnight to monitor me, and then after that, it did make me anxious, when I’d taken it and it was high, because then I knew I was going to have to go into hospital.
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