“You Probably Won’t Notice Any Symptoms”: Blood Pressure in Pregnancy—Discourses of Contested Expertise in an Era of Self-Care and Responsibilization

Abstract

Pregnancy is not a disease or illness, but requires clinical surveillance as life-threatening complications can develop. Preeclampsia, one such potentially serious complication, puts both mother and baby at risk. Self-monitoring blood pressure in the general population is well established, and its potential in pregnancy is currently being explored. In the context of self-monitoring, the information and guidance given to women regarding hypertension, and the literature they themselves seek out during pregnancy, are vital to perceptions of disease risk and subsequent responses to, and management of, any symptoms. Drawing on online, offline, official, and unofficial sources of information, discourses are examined to provide analysis of how self-responsibilization is reflected in contemporary information, advice, and guidance drawn from multiple sources. A paradox emerges between the paternalistic and lay discourses that seek to challenge and regain control. Findings are discussed in the context of Foucault’s governmentality and medical power.

A qualitative study of the dynamics of access to remote antenatal care through the lens of candidacy

“…One challenge concerns the increased 'responsibilisation' implied by remote care models. Those less fluent in participatory approaches to health, less able to exercise responsibility and self-efficacy [24][25][26][27] and lacking in socio-economic capital, including having a private space to take a call, a phone, and availability to be phoned, may be alienated or put at risk by the degree of responsibility they have to assume for their own antenatal health in remote appointments. Similarly, the use of digital resources described by some participants can help support understanding as to which symptoms require professional attention, but it requires 'digital work' that individuals are not equally able to undertake.…”

Qualitative evaluation of rapid implementation of remote blood pressure self-monitoring in pregnancy during Covid-19

“…The contrast between healthcare professionals and patients has also been highlighted in other research in the pregnant population. A discourse analysis of online, offline, and unofficial sources of information around pregnancy and high blood pressure also found a contradiction between the paternalistic discourse of clinicians and the lay discourse of women that both sought control [ 25 ]. Interestingly, despite clinicians concerns about passing control to women, few women reported not following advice while self-monitoring in our study, which corresponds to findings about telemonitoring of BP in the general population [ 26 ].…”

Is self-management a burden? What are the experiences of women self-managing chronic conditions during pregnancy? A systematic review

“…In pregnancy, the sharing of lay knowledge and expertise is commonplace. Hinton et al demonstrated the nature of information sharing among pregnant people, often now in the form of online communities, in those with pregnancy hypertension or raised blood pressure 28. Pregnant women with hypertension valued the advice and support of their peers, and in the online space peer advice tended to trump the advice of medical professionals 28.…”

“…Hinton et al demonstrated the nature of information sharing among pregnant people, often now in the form of online communities, in those with pregnancy hypertension or raised blood pressure 28. Pregnant women with hypertension valued the advice and support of their peers, and in the online space peer advice tended to trump the advice of medical professionals 28. Support networks are a central part of any self-management model in the general population, often emphasising that ‘self-management is manifested as both an individual and family construct’ 27.…”