“It's really easy to fall under the radar and get lost” – being unseen in postpartum care pathways after hypertensive pregnancy

Hypertensive disorders of pregnancy, experienced by around 10% of women, are among the most severe health problems affecting people during and following pregnancy. Symptoms can persist in the weeks and months following birth, with potential to impact longer-term health. Postnatal care has long been recognised as a critical period for mother and baby, and emerging evidence suggests it is a window of opportunity for cardiac remodelling after a hypertensive pregnancy. But provision is often not fit for purpose and haphazard. To understand what care women receive, how it gets done, and additional barriers for minority or socially deprived groups, we undertook interviews and focus groups with 44 women with a recent hypertensive pregnancy and interviews with 36 health professionals providing postnatal care in National Health Service (NHS) maternity care, primary care and community services in England. Analysis revealed that, despite the first six weeks being an important period for managing blood pressure, women often fall through the cracks between secondary and primary care. Invisible to these siloed clinical specialities, women are faced with new self-management and surveillance responsibilities alongside the work of new motherhood. Analysis, informed by Meleis's transitions theory and Gidden's concept of ‘distanciation’, develops Scott's ‘sociology of nothing’ to explore responsibilities and consequences of being ‘unseen’ between services.