“From the first [ob-gyn] visit, you should be measuring blood pressure,” Dr. Goje says. Doctors should also be reiterating the warning signs of hypertensive issues during pregnancy, so pregnant people—and their partners—can be on the lookout for them.
Red flags pregnant people should watch out for include vision changes, upper abdominal pain, and persistent or unusual headache, Dr. Penfield says. The CDC also notes that swelling of the hands or face, trouble breathing, heavy vaginal bleeding or discharge, and overwhelming tiredness are also signs that you should see your doctor ASAP.
A number of health conditions can be caught and addressed through blood pressure screenings throughout the pregnancy and postpartum periods, Dr. Goje says, explaining that monitoring blood pressure can alert doctors to gestational hypertension, which occurs when you only have high blood pressure during pregnancy; preeclampsia, which occurs when a pregnant person’s blood pressure suddenly spikes; and eclampsia, which is a potential consequence of preeclampsia and can cause seizures.
Making regular blood pressure screenings the standard of care may help reduce the disparity between Black and white maternal deaths, Dr. Goje says. This is because routine blood pressure measurements wouldn’t be dismissed by doctors, whereas health complaints from Black pregnant people are sometimes ignored due to their doctors’ racist biases. “Depending on the setting, some patients feel unheard, but when you have your blood pressure measured, this is an objective measurement” of one aspect of your health, she explains. “A provider should see the measurements and act on [them].”
The new recommendations also draw attention to the prevalence of telehealth appointments, which, Dr. Goje explains, is an important topic, given how popular virtual visits became during the pandemic. Some people at major hospitals may be able to take blood pressure cuffs home with them to use throughout their pregnancies and after giving birth, including during telehealth appointments, she says. In these cases, telehealth visits may work, since the provider can watch their patient take their blood pressure and assess whether it’s getting higher. But if a person doesn’t have access to a blood pressure cuff they can use at home, telehealth visits may not cut it, Dr. Goje says. The new recommendations say more research needs to be done to determine how pregnant people and their doctors can utilize telehealth technology without skipping over vital screenings, like blood pressure checks.
What else needs to be done to address the maternal mortality crisis?
Regular blood pressure checks aren’t the only interventions that need to be instituted to keep pregnant people safe. Addressing the maternal mortality crisis—and the fact that it disproportionately affects Black people—would mean making significant changes to our current health care system, Dr. Goje says.
For starters, it would help if all health care personnel who come into contact with pregnant people receive implicit bias training. According to the American Academy of Family Physicians (AAFP), implicit bias is “pervasive” in the health care industry, and it often harms patients.
In addition to training programs that address implicit bias, making sure Black people have access to other community care workers, such as doulas—trained professionals who provide educational, physical, and emotional support and care during pregnancy and childbirth—could also help. That way, if a person feels their voice isn’t heard, their doula (or someone in a similar role) could help them create a birth plan, and serve as an advocate and escalate their concerns to the doctor. “Health care systems are adding more levels of care to our [pregnant] patients [because] evidence supports having a multi-level approach,” Dr. Goje says.
Ultimately, she explains, the new screenings are one step forward within a complex systemic problem that requires our attention: People who work in health care, alongside our lawmakers, need to do much more work to truly reduce Black maternal mortality. This includes collecting more data, providing resources for maternal mental health, and extending Medicaid services to ensure that pregnant people get the support they need during and after childbirth.
“There are a lot of racial disparities,” Dr. Goje stresses, “and bringing back [the conversation around] blood pressure in pregnancy is important.”