For the social media version of this, see the Instagram posts. Black text is written on an ombre style background depicting the colors light blue and light green. The text reads as follows:
*Formerly, I was grossly misinformed and lacked intentional support and protections as a birthworker (which is still true for many birthworkers). Black birthworkers had been talking about self-monitoring -- and I wasn't listening. I believed teaching people how to monitor their own blood pressure was 'out of scope'. I was wrong. This is a vital part of care and a life saving skill to understand & discuss when working with the perinatal population.*
What is Pre-e & What are the Dangers?
Hypertensive disorders of pregnancy happen in 1 out of 10 pregnancies. This umbrella term includes preexisting and gestational hypertension, pre-e, and eclampsia. Pre-e only happens when one is pregnant or postpartum. It can be mild but for some, it can be dangerous for them and their baby.
Complications from hypertensive disorders of pregnancy represent one of the most significant causes of morbidity and mortality. Hypertensive disorders of pregnancy are known risk factors for mortality, stillbirth, preterm birth and small gestational weight, as well as future cardiovascular disease for [parent] and potential complications for the child. Both severe hypertension and mild hypertension need to be managed.
What is the Relationship Between Pre-e & Postpartum Depression?
PPD and pre-e are mutually reinforcing disorders. A pre-e diagnosis has a well documented negative emotional impact on pregnant people (e.g. stress). Depressed or anxious individuals are also at increased risk of developing a hypertensive disorder of pregnancy.
The likelihood of developing PPD is twofold for people diagnosed with pre-e. Elevated stress is a risk factor for developing symptoms of a major depressive episode. The physical stress of pregnancy and the additional stress of pre-e increases this risk, and individuals diagnosed with pre-e show an increased severity of depressive symptoms.
What is the Relationship Between Pre-e & Perinatal Anxiety?
Pregnant people with pre-e often present more health complaints compared to those with uncomplicated pregnancies. Anxiety scores have been shown to be increased for those with pre-e as well. In addition, the highest insomnia severity index scores were observed in people with severe pre-e. Perinatal insomnia couples with issues related to pre-e health management have been documented to potentially contribute to postpartum psychosis.
Anxiety side effects are often caused by concerns about fetal health, hospitalization, and lack of sufficient knowledge about the interventions used and whether or not those interventions are threatening. Somatic symptoms related to the state of one's health are also cause and effect of perinatal anxiety.
Who is Most at Risk for Pre-e?
Those with chronic high blood pressure or kidney disease before pregnancy.
Those with high blood pressure or preeclampsia in an earlier pregnancy.
Folks older than 40 are at higher risk.
Those pregnant with more than one fetus (multiple gestation).
Black pregnant people experiencing their primary pregnancy and/or any subsequent pregnancies.
Family history of preeclampsia.
Blood Pressure Risks/ Dangers for the Queer Community
Research has shown that lesbian and bisexual ciswomen with ciswomen partners have elevated rates of cardiovascular conditions, hypertension and diabetes. Birthing mothers with mother partners experienced disparities independent of sociodemographic factors, comorbidities, and multifetal gestation.
[Queer] adults "experience significant psychosocial stressors that compromise their cardiovascular health across the life span," according to an AHA scientific statement last year on heart health in LGBTQ adults.
Pre-e Risks & Queer Overlap
Same-sex couple parents and their children are more likely to be people of color.
Same-sex couples are getting married later (compared to heterosexual counterparts) and having babies later. Among women in same-sex marriages, the median age at first marriage was 31. Among women in different-sex marriages it was significantly lower at 28.
Queer couples rely significantly on ART for childbearing; thus raising the risk for multiples.
Queer people are more likely to have high blood pressure compared their heterosexual counterparts. Bisexual women specifically were 17% more likely to have high blood pressure compared to their heterosexual peers.
Queer Experiences of Birth Complications
As mentioned pre-e is a serious perinatal complication. Research shows that folks with pre-e report their birth experience as a traumatic event. In one study, queer-identifying participants who experienced birth complications (including hypertensive disorders) felt invalidated in clinical settings. Disrespectful treatment, lack of information on interventions, and deficiencies in care contributed to negative experiences when complications arose during birth.
This includes but isn't limited to:
Separation of family/ restrictive access in NICUs
Multilayered hetero/cisnormative assumptions
Disrespectful treatment from health providers
Violations of bodily integrity
And a lack of targeted support
Lack of efficient information sharing staff to staff to new medical personnel etc., resulting in repeating biased infractions
In addition to the experience of a difficult birth due to medical complications, a lack of trusting care relationships added to clients' experiences of traumatic birth.
Mental Healthcare Postpartum for Pre-e Survivors
Stress caused by a difficult or traumatic pregnancy and birth can override the ability to emotionally cope, bond as a new family, infant feed, and more. Mental health issues like PTSD, PMADs (postpartum depression and/or postpartum anxiety) are diagnosed in greater numbers. Pre-e is a serious condition and combined with and unexpected childbirth experience (induction, caesarean section, emergency medical situation etc.) can leave a family vulnerable.
For those serving queer survivors of pre-e, engaging with the varying aspects of the pregnancy and birth experience is an important part of functional mental health care. This means screening for, validating, discussing, or considering:
The impact of a challenging or traumatic birth which may include bias and disrespect.
Bias or complexity in NICU (if baby was taken to NICU)
Awareness of perinatal mental health issues due to minority stress and lack of resources.
Self-Monitoring
Home blood pressure monitoring is increasingly used for pregnant individuals. The efficacy of this is still in question -- however, if you are working with clients in higher risk categories (Black, queer, blood pressure issues etc.), it is imperative to support them to obtain a collaborative, life-saving approach to perinatal health care. This means advocating for information and education on self-monitoring prenatally and postpartum, navigating information around symptoms (what to do, what to look out for and more), and understanding that 'scope' (e.g. what we can and cannot do/ talk about with clients) can be a cloak of privilege whereas many clients do not have that luxury.
Linked in my bio are resources for info on self-monitoring [a note: much of medical info is linguistically heteronorm, unfortunately].
How to self-monitor at home: https://www.goredforwomen.org/en/know-your-risk/high-blood-pressure-and-women/how-to-monitor-blood-pressure-at-home-infographic
Things to look for and plan: https://www.nhsinform.scot/ready-steady-baby/pregnancy/your-antenatal-care/home-blood-pressure-and-urine-monitoring
How to read your your own blood pressure patient fact sheet: https://www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Pregnancyandbirth/Self-monitoring-of-blood-pressure-during-pregnancy.pdf
Symptoms to look for in considering pre-e: https://www.marchofdimes.org/find-support/topics/pregnancy/preeclampsia
Mixed reviews for self-monitoring at home ("mixed" reviews likely due to differences in sample populations e.g. Black people vs. white) which would mean that populations experiencing greater risk/bias may not be captured in the "mixed results" findings: https://www.npr.org/sections/health-shots/2023/03/28/1166431134/the-simple-intervention-that-may-keep-black-moms-healthier
