Postnatal blood pressure monitoring at home

Patient information leaflet

This leaflet helps to answer the following questions:

• How to measure your blood pressure?
• What targets to aim for?
• When to seek urgent medical help?

Why does monitoring matter?

• If you had high blood pressure (hypertension) during pregnancy or birth, this could continue after the baby is born.
• Some people may also develop high blood pressure after birth, despite having had normal blood pressure previously.
• Monitoring your blood pressure at home helps protect your health and reduces the need for hospital visits.

Why is postnatal hypertension dangerous?

• High blood pressure after birth can be just as serious as high blood pressure during pregnancy.
• If left untreated, it can lead to life-threatening complications such as:
  • Seizures (eclampsia)
  • Stroke
  • Heart failure
  • Organ damage (particularly to the liver and kidneys)
  • Pulmonary oedema (fluid in the lungs).
• These complications can develop quickly and without warning.
• This is why it’s important to continue monitoring your blood pressure even after the baby is born, and to take any symptoms seriously.

Red flag symptoms – Seek emergency help immediately

• If you experience any of the following, call for urgent medical help or go to the hospital right away:
  • Severe headache: not improving with simple painkillers, such as paracetamol
  • Vision changes: blurred vision, flashing lights, or loss of vision
  • Pain in the upper belly area: especially under the ribs on the right side
  • Vomiting: more than just mild nausea
  • Sudden swelling: in your face, hands, or legs
  • Shortness of breath or chest pain
  • Feeling generally unwell: in a way that is difficult to explain.
• These symptoms may indicate postnatal pre-eclampsia or other serious complications.

Blood pressure targets and what to do with your readings

• Important: If your blood pressure stays below 120/70 mmHg for 24 hours, your healthcare team may advise you to gradually reduce your medication.
• Do not stop taking your medication unless you have been told to do so.

Adjusting medication after birth

• If your blood pressure remains well controlled, at or below 120/70 mmHg for 48 hours, you can start tapering your medication.

For Nifedipine:

• Reduce by 10mg per dose (for example, reduce from 20mg twice a day to 10mg twice a day).
• If your blood pressure is still well controlled 48 hours after starting the lower dose, it can be reduced again.
• Once each dose reaches 10 mg, you can reduce the number of daily doses by one dose (for example from three times a day to two times a day then stop).

For Labetalol:

• Reduce by 200 mg per dose. (for example, reduce from 400mg twice a day to 200mg twice a day).
• If your blood pressure is still well controlled 48 hours after starting the lower dose, it can be reduced again.
• Once each dose reaches 200 mg, you can reduce the number of daily doses (for example from three times a day to two times a day then stop).

If you are on two different blood pressure medications:

• Always start by reducing one type of tablet first.
• Once that has been safely stopped, you can begin tapering the second.

Example for Nifedipine: Here’s an example of how to taper if you're currently taking Nifedipine 20mg three times daily:

• Reduce to 10mg three times daily
• After 48 hours, if BP still controlled, reduce to 10mg twice daily
• After 48 hours, if BP still controlled, reduce to 10mg once a day
• After 48 hours, if BP still controlled, stop your medication.

Example for Labetalol: Here’s an example of how to taper if you're currently taking Labetalol 400mg three times daily:

• Reduce to 200mg three times daily
• After 48 hours, if BP still controlled, reduce to 200mg twice daily
• After 48 hours, if BP still controlled, stop your medication.

Low Postnatal Blood Pressure

If your blood pressure falls below 90/50 mmHg or you feel dizzy, faint, or unwell, contact your maternity team without delay.

How to check your blood pressure at home

Follow these steps each time:

1. Sit quietly for 5 minutes before taking a reading
2. Sit with your back supported and feet flat on the floor
3. Rest your arm at chest level on a table or armrest
4. Put the cuff on your left arm (unless told otherwise)
5. Take the first reading
6. Wait one minute
7. Take a second reading
8. Write down both readings and note any symptoms
9. Do this morning and evening
10. Do this ideally 1 hour after taking your medication or if you feel any symptoms of high/ low Blood Pressure.

Remember: Always take TWO readings, one minute apart.

How often to monitor

• Morning and evening for the first 7 days after birth.
• Continue daily measurements if your blood pressure remains high or you are still taking medication until you are reviewed by your GP or in the hypertension clinic.
• You should continue checking your blood pressures for an additional 5 days after you stop your medications.

Contact information

Whittington Hospital Maternity Triage (24/7): 020 7288 5880
Address: Whittington Hospital, Magdala Avenue, London, N19 5NF
Website: https://www.whittington.nhs.uk

Maternity Triage is located in Betty Mansell Ward on Level 3 of the Kenwood Wing.

Triage is open 24 hours a day, 7 days a week. It is staffed by experienced Midwives and a specialist Doctor. You don’t need an appointment – you can just turn up.

Hypertension clinic: whh-tr.whitthypertensioninpregnancy@nhs.net

Emergency Advice

• If you feel very unwell, have a blood pressure reading above 160/110 mmHg, or experience red flag symptoms, do not delay:
• Call 999, go to A&E, or contact maternity triage immediately.

Blood Pressure Recording Diary