After you give birth, your focus is likely on your baby's care. However, health problems can arise in the weeks and months following childbirth, some of which can be life-threatening. It's crucial to be aware of these potential issues and know when to seek medical attention.
A pregnancy-related death is defined as the death of a person during pregnancy or within one year after the end of a pregnancy. It's concerning to note that Black, American Indian, and Alaska Native individuals are 2 to 3 times more likely to die from pregnancy-related causes compared to white individuals.
This article aims to provide a comprehensive overview of postpartum warning signs, helping you distinguish between normal recovery symptoms and those that may indicate a serious problem. Remember, your health should be a top priority after childbirth.
Planning for Postpartum Care
It's advisable to start thinking about your postpartum care plan even before you give birth. Discuss your risk of pregnancy-related complications with your healthcare professional, especially if you experienced issues like gestational diabetes or high blood pressure during pregnancy, or if you had a cesarean birth. Ask about any special care you might need.
The American College of Obstetricians and Gynecologists (ACOG) recommends that postpartum care should be an ongoing process, not just a single visit after delivery. Aim to have contact with your healthcare professional within three weeks of delivery, either by phone or in person. If scheduling an appointment is difficult, reach out to your care team to explore your options.
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During postpartum appointments, your healthcare professional will assess your mood and emotional well-being. You can discuss birth control options and the appropriate time to consider another pregnancy. You can also review information about your baby's care and feeding. The physical exam may include checking your breasts, belly, vagina, cervix, and uterus to ensure proper healing. This is an opportunity to address any concerns you may have. It's also important to inform any member of your healthcare team about your recent childbirth during appointments in the year following delivery.
Understanding the Postpartum Period
Postpartum, or postnatal, refers to the period after childbirth, most commonly the first six to eight weeks, or until your body returns to its pre-pregnancy state. However, symptoms and changes can persist beyond eight weeks.
During this period, major physical and emotional changes occur. Physical changes include breast engorgement and vaginal bleeding, while hormonal shifts also play a significant role. Childbirth is a major physical and emotional challenge, and adjusting to life with a newborn is incredibly demanding.
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Prioritize resting and taking care of your health alongside caring for your baby. Attend scheduled postpartum checkups to allow your healthcare provider to monitor your recovery and identify potential complications. These appointments are also a chance to ask questions and discuss your healing process.
Postpartum Recovery Timeline
Your recovery is unique, but there's a general timeline of what to expect:
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- Uterus Shrinking: This causes cramps and vaginal bleeding. Your provider may massage your uterus to help it contract.
- Hormonal Shifts: These can cause hot flashes, mood changes, and headaches.
- Breast Engorgement: Your breasts will produce milk, leading to painful and swollen breasts, even if you don't breastfeed.
- Perineal Soreness: Pain in the area between your vagina and anus is normal after vaginal birth, with potential vaginal tearing.
- Swelling: Extra fluids can cause swelling, which should subside within a week. However, swelling accompanied by chest pain or trouble breathing could indicate a more serious issue.
- Fatigue: Exhaustion is normal after labor, childbirth, and caring for a newborn. Rest as much as possible.
Three Stages of Postpartum
Healthcare providers classify postpartum into three phases:
- Acute Phase (first 6-12 hours): Monitoring for eclampsia, postpartum hemorrhage, and other medical emergencies.
- Subacute Phase (24 hours to 2-6 weeks): Monitoring for cardiomyopathy, postpartum depression, and urinary incontinence.
- Delayed Phase (6 weeks to 6 months): Gradual return to pre-pregnancy state, with possible treatment for pelvic floor dysfunction, painful sex, and uterine prolapse.
Normal Symptoms of Postpartum
Significant changes occur in the postpartum period, both physically and emotionally, due to hormone changes.
Physical Symptoms
- Soreness and Pain in Perineum: The area between your vagina and anus may be sore, swollen, and tender for weeks.
- Vaginal Discharge (Lochia): Bleeding after birth that starts red and tapers off to brown. This can last up to six weeks. Avoid using tampons.
- Uterus Involution: Your uterus shrinks back to its pre-pregnancy size, causing afterbirth pains (cramps).
- Breast Engorgement and Nipple Pain: Swollen and painful breasts are common, especially if breastfeeding.
- Sweating: Hormonal shifts cause increased sweating, especially at night, which should subside within a week or two.
- Constipation: Difficulty pooping is normal, especially after an epidural. Stool softeners may be recommended. Hemorrhoids are also common.
- C-Section Recovery: Skin stitches take up to 10 days to heal, while deeper stitches can take up to 12 weeks. Watch for signs of infection.
- Hair Loss: Losing hair is common due to hormone changes.
Emotional Symptoms
- Baby Blues: Feeling sad and teary, but these feelings usually go away after a few weeks.
- Postpartum Depression: Extreme sadness and despair that doesn't go away and often requires treatment.
- Postpartum Anxiety: Excessive worrying accompanied by physical symptoms like sleep loss or heart palpitations.
- Weight Loss: Expect loose skin, stretch marks, and concerns about extra weight. Focus on nutritious foods and self-care.
Potential Complications During the Postpartum Period
Many health conditions can develop after delivery. Healthcare teams monitor for severe conditions in the hours and days following birth.
Some of the most serious conditions that can occur include:
- Cardiomyopathy
- Pulmonary embolism
- Amniotic fluid embolism
When to Seek Medical Care
Call your healthcare provider if you experience any concerning signs or symptoms. Call 911 if you have excessive bleeding, difficulty breathing, chest pain, or thoughts of hurting yourself or your baby.
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Some postpartum symptoms are cause for serious concern, and it's important to know the difference between what's normal and what could signal a problem.
According to the Centers for Disease Control and Prevention (CDC), one in three pregnancy-related deaths happen after pregnancy - one week to one year postpartum. (Another third happen at delivery or in the week after delivery.) And more than 80 percent of all pregnancy-related deaths may be preventable.
The main causes of death after pregnancy are mental health conditions, severe bleeding, heart disease and stroke, high blood pressure, and infections.
Several factors play a role in pregnancy-related deaths, says the CDC. Women aren't always informed about the warning signs to look for, and some women have limited access to healthcare.
Get medical care right away if you have any of the following signs or symptoms of complications - or if you just feel like something isn't right. Some symptoms can come on suddenly and quickly worsen. Getting help as soon as possible is crucial.
| Symptom | Description | Potential Causes |
|---|---|---|
| Severe Headache | Sudden, intense pain that may worsen over time, possibly with blurred vision or dizziness. | Postpartum preeclampsia, stroke. |
| Dizziness or Fainting | Ongoing or intermittent dizziness, lightheadedness, fainting, or memory lapses. | Anemia, preeclampsia, heart or lung problems, blood sugar problems. |
| Changes in Vision | Flashes of light, blurry vision, double vision, blind spots, or temporary vision loss. | Postpartum preeclampsia, stroke. |
| Fever | Temperature of 101 degrees F (38.5 degrees C) or higher. | Breast infection (mastitis), uterine infection, incision infection, urinary tract infection. |
| Trouble Breathing | Feeling unable to breathe deeply or shortness of breath, possibly with chest tightness. | Pulmonary embolism, postpartum preeclampsia, peripartum cardiomyopathy, lung infection. |
| Overwhelming Tiredness | Sudden, extreme weakness and fatigue, even with sleep. | Depression, anemia, diabetes, infection, heart problems. |
| Chest Pain or Rapid Heartbeat | Tightness or pressure in the chest, pain radiating to the back, neck, or arm, rapid or irregular heartbeat. | Heart attack, peripartum cardiomyopathy, pulmonary embolism. |
| Severe Belly Pain | Sudden, severe abdominal pain that worsens over time. | Endometritis, postpartum preeclampsia, appendicitis, cystitis. |
| Severe Nausea and Vomiting | Extreme nausea, inability to keep fluids down, dehydration. | Viral infection, liver or pancreas problems, food poisoning, postpartum hemorrhage, heart disease, postpartum preeclampsia, appendicitis or bowel obstruction. |
| Severe Swelling of Hands or Face | Swelling of the face, hands, or mouth, sudden weight gain. | Postpartum preeclampsia. |
| Swelling, Redness, or Pain in Leg | Swelling, tenderness, redness, or warmth in one leg, possibly with pain when flexing the foot. | Deep vein thrombosis (DVT), peripartum cardiomyopathy. |
| Thoughts About Harming Yourself or the Baby | Feelings of sadness, hopelessness, anxiety, or scary thoughts. | Postpartum depression (PPD), postpartum psychosis. |
| Vaginal Bleeding or Discharge | Soaking through pads hourly, passing large clots, or discharge with a foul odor. | Postpartum hemorrhage, retained placenta, infection. |
The location of your belly pain may provide a clue to the cause:
- Pain or tenderness in your lower belly may signal endometritis, an infection in the lining of the uterus.
- Pain in the upper right belly or shoulder may signal postpartum preeclampsia.
- Pain may be caused by issues unrelated to pregnancy, such as appendicitis or cystitis.
Self-Care After Having a Baby
The best thing you can do for your health after you give birth is listen to your body. If something doesn’t feel right, please reach out to your healthcare provider.
One of the most important things you can do for yourself after giving birth is to allow yourself time to rest and heal. While this may be easier said than done, getting rest allows your body and mind time to recover. Ask for help when you need it. This could mean limiting visitors, asking for help with childcare or asking for help with things like cleaning and making meals.
Other than resting, some of the other ways to take care of yourself in the weeks after delivery could involve:
- Nutrition: Try to drink lots of water and eat healthy foods like lean protein, fruit, vegetables and whole grains. Staying hydrated can also help with constipation.
- Caring for your perineal area: If you had a vaginal delivery, you may be sore for a few weeks. Using a peri bottle with warm water to rinse after using the bathroom and using witch hazel pads are ways to help your bottom feel better.
- Limiting physical activity: While you may want to return to your pre-pregnancy size, don’t rush to exercise or get back in shape. Begin slowly so you don’t accidentally injure yourself.
- Mental health support: Don’t be afraid to ask for help and be patient with your emotions. The postpartum period can be challenging in so many ways. If you feel sad, overwhelmed, anxious or stressed, talk to a friend, your partner or your healthcare provider about it. There are many resources available to support you.
When to Contact Your Healthcare Provider
Some postpartum symptoms could be signs of a problem. You shouldn’t ignore your symptoms or feel shame discussing how your recovery is going. If you have concerns either about how you’re healing or how you feel, it’s best to contact your healthcare provider.
Some symptoms you should watch for include:
- Heavy vaginal bleeding.
- Passing several large clots.
- Fever higher than 101 degrees Fahrenheit (38 degrees Celsius).
- New pains or an increase in pain.
This list is not meant to cover every symptom you might have. If you feel like something just isn't right, or you aren't sure if it's serious, talk to your health care provider. Be sure to tell them if you are pregnant or were pregnant within the last year.