Black maternal health and hypertension beyond pregnancy; in conversation with Tinuke Awe.

Black Maternal Health Awareness Week is a time to recognise a persistent and uncomfortable truth. Outcomes in maternal health are not equal. Black women and birthing parents continue to experience higher rates of complications, delays in care, and poorer outcomes across pregnancy and after birth.

These differences are not explained by biology alone. They reflect how care is delivered, how risk is recognised, and whose concerns are taken seriously.

At Hesta, we believe that improving postnatal health begins with acknowledging these realities and addressing the gaps that follow women and birthing parents into the months and years after birth.

One of the most important and often overlooked areas is hypertension.

Understanding hypertension in and after pregnancy

Hypertension means persistently raised blood pressure, typically defined as readings of 140/90mmHg or higher. During pregnancy, it can present in several ways:

• Chronic hypertension, which exists before pregnancy

• Gestational hypertension, which develops during pregnancy

• Pre-eclampsia, a more serious condition involving high blood pressure and signs of organ stress, often affecting the kidneys, liver, brain or clotting system.

These conditions are well recognised during pregnancy because they can affect both the parent and the baby. Monitoring during pregnancy is usually structured and frequent.

What is less consistently understood is that the effects of these conditions do not end at birth.

How prenatal hypertension affects postnatal health

For many women and birthing parents, blood pressure changes continue after delivery. This can happen in several ways:

• Blood pressure that was elevated during pregnancy may remain high after birth

• Blood pressure may return to normal initially and then rise again in the weeks that follow

• New hypertension, including postpartum pre-eclampsia, can develop for the first time after delivery, even in women who had a normal blood pressure during pregnancy.

These changes most commonly occur within the first 6 weeks after birth but risk can persist beyond this period.

There is also a longer-term consideration. A history of gestational hypertension or pre-eclampsia is linked to an increased risk of cardiovascular disease later in life, including chronic hypertension, heart disease, and stroke.

This means that even if blood pressure appears stable shortly after birth, there may still be an underlying risk that requires monitoring over time.

Why postnatal monitoring matters

The postnatal period involves significant physiological change. Blood volume adjusts, hormones shift, and the body recovers from pregnancy and birth. These changes can affect the cardiovascular system in ways that are not always immediately visible.

Without structured follow-up, hypertension can go undetected.

Symptoms may be subtle or attributed to the general exhaustion of early parenthood. These can include:

• Persistent headaches

• Visual changes

• Dizziness

• Swelling

• Chest discomfort or shortness of breath

Some of these symptoms - especially severe headache, visual disturbance, chest pains or shortness of breath - require urgent medical assessment. Otherwise, regular blood pressure checks provide a simple way to identify a developing problem before it becomes more serious.

Blood pressure is usually checked in the early days after birth.  But “longer-term” follow up often centres around the 6-8 week check postnatal care often centres around the existing  single postnatal checkpoint at six to eight weeks, with limited follow-up beyond that point.

As Tinuke Awe, co-founder of Five X More and Hesta advisor, shared during a recent conversation with Hesta about the realities of postnatal healthcare:

“The postnatal period deserves the same level of clinical attention, resourcing, and accountability as pregnancy and birth.”

Her experience highlights how gaps in follow-up can have long-term consequences.

A lived experience of missed hypertension

Tinuke experienced pre-eclampsia during her pregnancy. At her six to eight week postnatal check, elevated blood pressure was recorded in her notes. She was not told about this finding, and no follow-up was arranged.

“Nobody told me, nobody explained what it meant… or suggested any follow up monitoring.”

Years later, she discovered this information while reviewing her medical records.

By that point, her blood pressure had risen significantly and required medication.

“I remember just getting to a place of feeling very unwell… I’m dizzy at night… and then it’s like oh yeah, your blood pressure’s through the roof.”

This experience reflects a broader issue in how medical information can sometimes be recorded but not communicated. Follow-up is not always built into care pathways. Individuals are often left to recognise symptoms and seek help themselves.

Inequality in recognition and care

For Black women and birthing parents, these challenges are often more pronounced.

Evidence shows that Black women are more likely to have their symptoms dismissed or minimised, or experience delays in recognition with symptoms not fully acted upon. This can delay diagnosis and treatment, particularly for conditions that rely on both measurement and clinical judgement.

Tinuke spoke directly to this:

“For Black women who are more likely to have their concerns dismissed and their symptoms minimised, that investment is actually not optional.”

Hypertension is a clear example of how these dynamics can affect outcomes. Early detection depends on both routine monitoring and responsiveness to reported symptoms.

When either is missing, risk increases.

What good care should include

A more effective approach to hypertension across the postnatal period would include several key elements.

Clear communication

If blood pressure is elevated at any stage, this should be explained in plain language. Individuals should understand what has been identified and what it means for their health.

Ongoing monitoring

Those with a history of gestational hypertension or pre-eclampsia should have structured follow-up beyond the six-week check. Monitoring may include regular blood pressure measurements and review of symptoms, either through in-clinic checks or home blood pressure monitoring where appropriate.

Education on risk

Women and birthing parents should be informed that pregnancy-related hypertension can have long-term implications for cardiovascular health. This knowledge supports earlier engagement with care.

Accessible pathways to support

If symptoms develop or concerns arise, access to care should be straightforward. Long waits and fragmented services can delay necessary treatment.

Support for self-advocacy

Not everyone feels confident raising concerns or asking for further checks. Providing clear information and language can help individuals communicate their needs more effectively.

As Tinuke highlighted:

“Trying to give them a little bit more power… to just have the language to be able to advocate for themselves.”

Looking ahead

Black Maternal Health Awareness Week brings attention to disparities that require sustained action.

Hypertension is one area where improved postnatal care can make a meaningful difference. Early identification, consistent monitoring, and clear communication can reduce risk and support long-term health.

At Hesta, we believe postnatal care should reflect the reality of recovery. It should extend beyond a single check and provide ongoing, clinically led support that evolves over time.

The postnatal period is a critical phase for health. Recognising and responding to conditions such as hypertension is an essential part of that care.

Because every woman and birthing parent deserves to be informed, supported, and listened to throughout their recovery and beyond.

A note from Hesta

If you have experienced high blood pressure during pregnancy, or if something about your recovery does not feel right, it is worth checking in with your GP or via a service like Hesta.

The Hesta Health Check is designed to give you a clearer picture of your postnatal health, including cardiovascular markers, alongside personalised guidance on what to monitor and what to do next.

It is one way to move forward with more clarity and confidence in your recovery.

Written by Hesta Health and validated by a postnatal clinician. Tinuke Awe is a black maternal health advocate, the co-founder of Five X More and Mums & Tea and an advisor to Hesta Health.

Black Maternal Health Awareness Week 2026 runs from April 20 - April 26. To find out more go to https://fivexmore.org/black-maternal-health-week-2026 or follow Five X More on Instagram.