Hypertension Experiences Affecting Recovery from Delivery (HEARD): a mixed-methods interview study of postpartum people affected by hypertensive disorders of pregnancy.

BACKGROUND: Postpartum care for hypertensive disorders of pregnancy (HDP) varies in terms of content, quality, and duration. People postpartum from pregnancies complicated by an HDP are known to have a variety of physical and emotional sequelae both from the HDP itself and associated complications (e.g., prematurity, traumatic birth). This study interviewed a geographically and socially diverse sample of recently postpartum people who had HDPs to better understand the needs of this population.

METHODS: Semi-structured interviews were conducted with participants recruited from social media. Both qualitative and quantitative methods were used to characterize the resulting transcripts. Transcripts were reviewed for patient-reported obstetric history and variables pertaining to intrapartum and postpartum care (e.g., gestational age at delivery, delivery mode). Birth experience was then categorized as positive, neutral, or negative by reviewer assessment. Sentiment analysis was performed to objectively identify elements of participants' transcribed speech with emotive content. The emotive content of positive and negatively framed birth experiences was then qualitatively reviewed by thematic analysis.

RESULTS: 67 interviews were analyzed from individuals affected by the entire spectrum of HDPs: 38.8% (N = 26) had gestational hypertension, 56.7% (N = 38) had a form of preeclampsia, and 4.5% (N = 3) had eclampsia or HELLP. Among those with negative birth experiences, fear was the dominant negative emotion identified in the sentiment analysis. This was driven by mentions of "anxiety" in reference to both the birth process and blood pressure management. Trust was the characteristic positive emotion, largely expressed by uses of the word "helpful". Participants used "helpful" to identify services such as peer support communities that would have been beneficial to them or counseling they would have liked to receive about HDPs or their long-term effects. They identified lack of information and education about HDPs as a key gap in current practice.

CONCLUSIONS: People postpartum from HDPs who described negative experiences felt that more information about their diagnosis and its management from their obstetric providers would have improved their experience along with postpartum support from people who had similar lived experiences. These insights point to practical interventions that can be undertaken both nationally and institutionally to enhance postpartum HDP care.