Abstract
Objective: One in 20 women are affected by pre-eclampsia, a major cause of maternal and perinatal morbidity, death and premature birth worldwide. Diagnosis is made from monitoring blood pressure (BP) and urine and symptoms at antenatal visits after 20 weeks of pregnancy. There are no randomized data from contemporary trials to guide the efficacy of self-monitoring of blood pressure (SMBP) in pregnancy. We explored the perspectives of maternity staff to understand the context and health system challenges to introducing and implementing SMBP in maternity care, ahead of undertaking a trial.
Design: Exploratory study using a qualitative approach.
Setting: Eight hospitals, English National Health Service.
Participants: Obstetricians, community and hospital midwives, pharmacists, trainee doctors (n=147)
Methods: Semi-structured interviews with site research team members and clinicians, interviews and focus group discussions. Rapid content and thematic analysis undertaken.
Results: The main themes to emerge around SMBP include i) different blood pressure changes in pregnancy ii) reliability and accuracy of BP monitoring iii) anticipated impact of SMBP on women iv) anticipated impact of SMBP on the antenatal care system, v) caution, uncertainty and evidence vi) concerns over action/inaction and patient safety.
Conclusions: The potential impact of SMBP on maternity services is profound although nuanced. While introducing SMBP does not reduce the responsibility clinicians have for women’s health, it may enhance the responsibilities and agency of pregnant women, and introduces a new set of relationships into maternity care. This is a new space for reconfiguration of roles, mutual expectations, and the relationships between and responsibilities of health care providers and women.
Strengths and limitations of this study:
•Qualitative study to explore maternity staff perspectives on self-monitoring of blood pressure in pregnancy
•Diverse sample includes voices from across multidisciplinary maternity teams
•Focus groups held across 8 hospitals in the English National Health Services, including hospital and community midwives
Design: Exploratory study using a qualitative approach.
Setting: Eight hospitals, English National Health Service.
Participants: Obstetricians, community and hospital midwives, pharmacists, trainee doctors (n=147)
Methods: Semi-structured interviews with site research team members and clinicians, interviews and focus group discussions. Rapid content and thematic analysis undertaken.
Results: The main themes to emerge around SMBP include i) different blood pressure changes in pregnancy ii) reliability and accuracy of BP monitoring iii) anticipated impact of SMBP on women iv) anticipated impact of SMBP on the antenatal care system, v) caution, uncertainty and evidence vi) concerns over action/inaction and patient safety.
Conclusions: The potential impact of SMBP on maternity services is profound although nuanced. While introducing SMBP does not reduce the responsibility clinicians have for women’s health, it may enhance the responsibilities and agency of pregnant women, and introduces a new set of relationships into maternity care. This is a new space for reconfiguration of roles, mutual expectations, and the relationships between and responsibilities of health care providers and women.
Strengths and limitations of this study:
•Qualitative study to explore maternity staff perspectives on self-monitoring of blood pressure in pregnancy
•Diverse sample includes voices from across multidisciplinary maternity teams
•Focus groups held across 8 hospitals in the English National Health Services, including hospital and community midwives
| Original language | English |
|---|---|
| Article number | e037874 |
| Pages (from-to) | 1-10 |
| Journal | BMJ open |
| Volume | 10 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - 1 Dec 2020 |
Keywords
- hypertension
- maternal medicine
- organisation of health services
- qualitative research
ASJC Scopus subject areas
- Medicine(all)