Maternal help seeking about early warning signs and symptoms of pre-eclampsia: A qualitative study of experiences of women and their families

Abstract

Background: Pre-eclampsia is a disorder of pregnancy, where delay in diagnosis and management of warning signs and symptoms can lead to serious morbidity and mortality for women and their infants.

Aim: The aim of this study was to understand factors that influenced women's help seeking in response to the onset of early warning signs and symptoms of pre-eclampsia as well as partners or family members' ability to raise their health concerns with healthcare professionals during the progression of the disorder.

Design and methods: A qualitative narrative research design was used. In depth interviews were used to explore the experiences of 23 women who experienced pre-eclampsia and their families in an urban setting in the UK. Purposive heterogeneity sampling was used to select participants.

Results: Themes associated with help-seeking amongst women included: 1) Risk assessment, 2) Self-monitoring, 3) Organisational constraints. Women categorised as at low risk of hypertensive disorders at their antenatal booking appointment reported a lack of information on pre-eclampsia which affected their ability to seek help as they were unaware of signs and symptoms of the onset of the condition. In contrast women categorised as high risk at this initial appointment considered they were offered too much information about onset of pre-eclampsia, although this facilitated help seeking as they were much more able to recognise signs and symptoms of onset and knew who to contact. Of note is that some women did not experience 'classic' signs and symptoms of pre-eclampsia or were unable to distinguish these from normal signs and symptoms of pregnancy. Some women used self-monitoring, mainly self-initiated and self-taught, of their own blood pressure in order to a) negotiate access to treatment and b) to self-discharge from hospital postnatally.

Conclusion: Women and their families need individualised information on signs and symptoms of pre-eclampsia to facilitate timely and appropriate help seeking. Women often used self-monitoring of their blood-pressure to negotiate for help.

Keywords: Antenatal and postnatal pathways; Categorisation of risk; Help seeking; Pre-eclampsia; Pregnancy; Risk assessment; Self-monitoring; Women.