THE weeks following child birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. So, it’s standard practice to monitor a woman’s health during pregnancy and immediately after childbirth.
Now, experts in a study say monitoring a woman’s health even far beyond childbirth is important since she could develop high blood pressure months after childbirth. They suggested that high blood pressure could be missed in some new mothers with no history of high blood pressure if a woman’s medical checkup after having a baby ends immediately after childbirth.
In an analysis of more than 2,400 women, about one in 10 without a history of blood pressure issues were diagnosed with high blood pressure in the year following delivery among a group of racially diverse women that received prenatal care and delivered their babies at Boston Medical Centre.
Nearly a quarter of the women were diagnosed more than six weeks after delivery when many have stopped receiving follow-up care.
“Follow-up care is as important as antenatal care because there are things that can happen to a woman who has just been delivered of a child,” said DrFisayoOluwatosin, a family physician. “For the woman who has just been delivered of a child and is no more under the scrutiny of an antenatal care, there is a tendency to miss out some health conditions like high blood pressure when she does not go for postnatal care.”
Even at Primary Health facilities across Oyo State, MrsFolasadeOladele, a public health nurse, it is expected that during follow-up visits after the delivery of the baby, the mother is assessed for such things as excessive weight gain, swollen feet (oedema), headache, fainting attacks and sleeping well to understand her state of health.
According to MrsOladele, “from these assessment and vital signs, the health care practitioners are able to identify any abnormalities that need to be corrected like high blood pressure or blood sugar or even conditions that they need to refer for specialist care.”
Overall, 12% of women with no history of high blood pressure had the condition within a year of childbirth. While most cases were diagnosed shortly after delivery, 22% were not diagnosed until more than six weeks after the baby was born.
The risk was exceptionally high for Black women and those who were 35 or older, delivered by cesarean section or were current or former smokers.
Blood pressure was measured at least 48 hours after delivery. Additional measurements were taken from medical records through the first year following delivery.
High blood pressure after childbirth, called postpartum hypertension, is typically discovered within six weeks of delivery, either immediately after birth or during a woman’s last postpartum clinic visit four to 6 weeks after delivery.
In severe cases, postpartum hypertension is associated with life-threatening complications, including stroke, heart failure, kidney failure and more. It is well established that women with high blood pressure before or during pregnancy are at risk for cardiovascular disease later in life.
According to Professor Christopher Aimakhu, a consultant obstetrician and gynaecologist at the University College Hospital (UCH), Ibadan, high blood pressure tends to occur more in the last four weeks of pregnancy, around the time of delivery and in the first ten days after child delivery.
He stated that the likelihood of missing a new case of hypertension in a woman that had cesarean delivery is far less because such stay longer at the hospital after childbirth, unlike women with normal vagina delivery that are often discharged 48 hours after delivery from the hospital.
Professor Aimakhu, who linked raised blood pressure in women after childbirth sometimes to stress, said after childbirth, women with any complaints are usually told to come back to the hospital and are also expected to have comprehensive postpartum care at six weeks follow-up visits.
Postpartum care includes assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance.
This medical checkup a woman gets after having a baby is important because new mothers are at risk of serious and sometimes life-threatening health complications in the days and weeks after giving birth. Too many new moms have or even die from health problems that may be prevented by getting postpartum care.
Notably, studies on the use of postpartum care across the regions of Nigeria say the use of postpartum care was highest among urban women with higher education, working mothers, and women who made decisions alone and jointly with their husbands and had access to some form of mass media, particularly radio and television.
Moreover, the researchers suggested that their findings have implications for postpartum care, particularly among women without a history of high blood pressure, because mothers could develop high blood pressure months after postpartum follow-up care had ended. Monitoring during this period could mitigate severe postpartum and long-term cardiovascular complications.
Future research must look at other poor outcomes associated with postpartum hypertension, such as hospital readmissions, subsequent pregnancy complications and cardiovascular disease.