Pregnancy is fantastic, but it can take its toll on your body. Once your baby arrives, you’ll enter the postpartum period. It’s a difficult time for most moms who are exhausted and recovering from birth.
As your body changes back to its non-pregnant state, it can throw a few curve balls. Most changes are minor or due to hormone changes, but others can be fatal if ignored.
In the US 30% of maternal deaths occur postpartum. The worrying thing is this number is rising each year.
Your body will show symptoms that you need help. Your caregivers will monitor you in the hospital for these postpartum warning signs. However, do you know what to look out for when you get home?
When you get home from the hospital, you are often focusing on your new baby. Your health usually gets pushed to the side. Often new moms can put tell-tale postpartum warning signs down to being a new mom.
I’ve haven’t written this article to scare you. However, it’s essential you know what postpartum changes are normal for your body and those that are not.
You need to look out for your health postpartum and what to do if you are concerned.
This guide is quite long, so I highly recommend you Pin it or bookmark it for later. That way you can read it over your pregnancy without becoming overwhelmed.
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9 Postpartum Warning Signs to Look Out For After Birth
1. Emotional state
After birth, you’ll experience feeling a bit low, tearful and anxious. These emotions are all completely normal for new moms.
A sudden change in hormones and lack of sleep cause these intense feelings. These symptoms usually start three days after birth and continue for around two weeks.
You’ll hear people refer to this as the ‘baby blues.’
If you experience these feelings for longer or more than these symptoms, it could be the sign of two further conditions.
It can be quite tricky to diagnose postpartum depression as it’s often gradual. You may not even realize you are suffering postpartum depression. You are more likely to develop postpartum depression if you have existing mental health issues, poor support or a recent stressful life event.
It’s difficult to predict who will suffer postpartum depression, as the change to motherhood can be the trigger.
The typical symptoms of postpartum depression are:
- constant feelings of sadness or low mood
- being unable to enjoy life or your baby
- fatigue and low energy
- difficulty bonding with baby
- sleep problems
- loss of appetite
- becoming withdrawn
- poor concentration or decision making
If you feel like you are suffering from postpartum depression, it’s important to seek help and support. Speak to your partner and family or friends for support. Also, inform your doctor, they may prescribe therapy or medication.
Your baby will not be taken away from you if you have postpartum depression. Your caregiver will want to support you and give your family the best start in life.
A lesser known mental health condition is postpartum psychosis. It’s very rare, but when it happens, it’s a medical emergency.
Symptoms usually present within a few days up to 2 weeks but may present later than this.
Again you are at higher risk if you have existing severe mental health conditions or strong family history. Half of all women who suffer postpartum psychosis don’t have any risk factors.
Classic postpartum psychosis symptoms include:
- hallucinations and delusions
- extreme high and low moods
- extreme paranoia
- depression symptoms (see above)
- out of character behavior
- thoughts of harming yourself or your baby
Postpartum psychosis is an emergency situation and requires urgent medical attention. You’ll likely be admitted to a psychiatric ward.
You’ll need medication such as antidepressants, antipsychotics or mood stabilizers. Psychiatric therapy will be required. Recovery usually takes 2-12 weeks but may take up to a year.
Your caregivers will put support systems in place during your recovery. After one episode, you are 50% more likely to experience postpartum psychosis in a future pregnancy.
2. Heavy Bleeding
Regardless of the type of birth you have, you should expect to bleed after delivery. It will start as soon as your baby is born and will last for up to six weeks. This bleeding should initially be no more than the heaviest day of your period.
The flow should then begin to settle to a minimal discharge after a week or two. For more detail on what to expect postpartum check out my postpartum bleeding guide.
Heavy bleeding is a warning sign that you are having a postpartum hemorrhage (PPH). A PPH is Continuous bleeding that won’t stop. Depending on how much you lose it may be a minor or major PPH.
There are many risk factors for PPH, so your caregiver should inform you of this before birth, or give let you know that you are at higher risk due to your delivery.
Straight after birth, you will bleed as your placenta detaches from your womb. You may even be given an injection to control how much blood you lose and to help your placenta deliver.
The causes of heavy postpartum bleeding are:
- Your womb is not contacting well
- You have some placenta, membrane or clots preventing the womb contracting
- Bleeding from a cut or tear
- You have a rare anti-clotting blood condition
The blood loss may happen suddenly, or slowly over a few hours. Without treatment, the bleeding will not stop, and you will go into shock (see signs at the end of this guide).
There are two types of PPH.
A primary PPh will happen within the first 24hrs of delivery. The most common cause is that your womb is too weak from labor to contract well. This type of bleeding will usually happen in the presence of a caregiver. They may not be with you at the time you start to feel ill. It’s important to call for help immediately if you feel unwell or notice your bleeding is heavy.
A PPH is an emergency situation so expect a lot of people to come into your room to deal with the situation. They may give you medication, IV fluids, take blood, massaging your uterus and insert a catheter.
A secondary PPH is Any heavy bleeding from day two up to six weeks postpartum. The most common cause is a small piece of placenta or membranes left in the womb.
This type of bleeding is rarer and more likely to happen when you are at home with your baby. If you are soaking more than one maternity pad an hour or passing egg size clots, get urgent help.
A Secondary PPH usually occurs over a few days but becomes dangerous as it doesn’t stop. You are more likely to experience stomach cramps, pain, offensive bleeding and large clots with a secondary PPH.
If you think you are having a PPH at home call 911 immediately, especially if you have signs of shock.
Pain is a common postpartum problem. Most women will experience muscular aches and pains after birth. A C-section delivery will result in higher levels of post-surgical pain. Normal postpartum pain can be treated with rest and mild painkillers
Let’s look at a few causes of pain.
After birth, your uterus contracts to return to its original size. This contraction causes a cramping sensation known as ‘after pains.’ You’ll notice these more with future pregnancies. It’s also common for them to be stronger when you breastfeed.
Afterpains are normal and can be relieved by heat pads, or mild painkillers, just like period pains. They should begin to settle after a few days to a week.
A sore back is common postpartum, as you begin to reuse muscle weakened by pregnancy. You may also experience this from poor breastfeeding posture. Heavy lifting of baby products such as strollers and tubs can cause repetitive strain on your recovering body.
If you have ongoing back issues after an epidural, you need to contact your doctor. They can have you reviewed by an anesthetist or a physiotherapist for exercises.
A spinal or epidural during birth can cause a severe headache post birth. This headache is so severe you’ll struggle to sit up or move around. Its caused by leaking of your spinal fluid from the needle site. Although not an emergency you need an urgent review from an anesthetist.
First line treatment for post-dural headaches is pain relief and bedrest. Some may require a procedure known as a blood patch. This procedure involves injecting a little bit of your blood over the affected area to block the leak.
Another cause of postpartum headaches is a condition known as pre-eclampsia. There are other symptoms involved with this condition which I’ll discuss below.
It can take a few days to open your bowels after delivery. If your poop becomes impacted, it can become excruciating and cause severe stomach cramps. You may find my guide on constipation useful for tips and, medication to help you go.
Endometriosis is an infection of the womb which is common after birth. Infection is more common if your waters have broken for a long time before birth, or you had a C-section delivery.
Tummy pain accompanied by common signs of infection:
- offensive bleeding
- heavy bleeding
- feeling unwell (cold or flu-like)
You will need to be treated with antibiotics to treat the infection. Depending on how severe the infection is this may be oral antibiotics or require a hospital stay for IV antibiotics.
4. Wound issues
If you had a C-section, forceps, episiotomy or tear, then you will have to care for a wound postpartum. Signs of poor wound healing include:
- tenderness around the wound
- deep wound pain
- gaping areas
- green pus discharge
- offensive smell
- feeling unwell
Let’s discuss the two types of postpartum wounds.
A perineal wound is caused by having an episiotomy or a tear during a vaginal delivery. A perineal wound can be tender, swollen and painful to sit on.
Try using painkillers, sitz baths, and ice therapy to soothe your perineum as it heals. It can take up to six weeks for your perineum to heal.
It’s essential to avoid infection in this area as it can come into contact with bacteria from poo. If you notice any of the signs of poor wound healing (above), seek help for antibiotic treatment. Your wound may also need re-sutured.
If your perineum is excruciatingly painful, you may have a hematoma. It’s a sizeable blood-filled blister which forms inside the tissues. These can fill with a significant amount of blood and causes the same symptoms of shock seen in a PPH.
Seek help immediately as a hematoma requires draining in a theatre environment with re-suturing of the wound.
You will have an abdominal wound after a C-section delivery. Healing of this wound is essential as it leads directly to your womb. Your wound may be tender to touch and movement for up to 6 weeks post-surgery.
If the wound gets infected, you are likely to contract endometriosis (discussed in the pain section).
You may be given a dose of antibiotics during your C-section to prevent this happening. Your dressing is usually removed in 2 days post-surgery. Airing the wound promotes healing and prevents infection.
Keeping the wound clean and dry will prevent infection. If you have a skin fold covering the wound, a dry dressing can keep the area free from moisture.
Observe the signs of infection above. Again these need to be treated with antibiotics to help the wound heal.
A Hematoma (blood filled lump) or abscess (pus-filled lump) can also develop on a C-section wound. These are rarely drained from a C-section wound unless excessive and causing you severe pain.
Seek a medical review if you have pain or sign of infection and feel a hard lump near your wound.
Postpartum anemia is a condition caused by low iron levels in your blood. A significant blood loss after delivery is the most common cause of anemia after birth.
Routine blood work will detect if you have low iron levels. It’s easy to treat anemia with iron supplements or an IV iron infusion.
The trouble is that anemia can go undetected as symptoms can be put down to being a new mom. Untreated anemia can put a lot of stress on your body as it prevents vital oxygen being carried around in your blood.
Anemia can also make you more susceptible to postpartum infection and low milk supply when breastfeeding.
Signs of anemia include
- severe fatigue/lack of energy
- rapid heartbeat
- breathlessness (with activity)
- pale skin
- poor sleep
- leg cramps
If you have any of these symptoms, contact your doctor for blood tests to check for low iron levels.
6. Postpartum Preeclampsia
You’ve probably heard of preeclampsia in pregnancy, but it can still appear postpartum. Pre-eclampsia is a condition that causes dangerously high blood pressure and protein in your urine.
Symptoms develop over a few days or weeks. Left untreated it will cause seizures and other life-threatening complications.
Symptoms to look out for are:
- High blood pressure
- protein in your urine
- a headache (usually frontal) that don’t resolve with painkillers
- vision changes- blurry, flashes or spots, light sensitivity
- severe swelling – especially face, hands and feet
- Pain under your right ribs
- nausea or vomiting
- poor urine output
These symptoms will usually present within 48hrs of delivery. This means you are likely to still be in the hospital if it happens. However, it but can even present up to six weeks postpartum. Although it’s rare, you can develop postpartum pre-eclampsia without having any symptoms during pregnancy.
If you are at home when you experience any of these symptoms, contact your caregiver for an urgent review. Unless you have a blood pressure monitor at home, you won’t know if your blood pressure is high until you get checked.
If you have ongoing blood pressure issues or a stong family history of pre-eclampsia, consider buying a home monitor. Wrist blood pressure cuffs, like this one, are fairly inexpensive although it is best to use an arm cuff monitor.
If your blood pressure is over 140/90, you will need to give blood and urine samples for diagnosis. You may need to be admitted for further observation and bed rest. The first line of treatment will be blood pressure medications. You may also be given a drip to prevent seizures.
7. Thrombosis (Blood Clots)
This condition is when blood clots develop in your blood vessels. They slow or stop the flow of blood. If the clot dislodges and travels to your lungs, it can become fatal.
During postpartum is the time thrombosis is most likely to occur. Your body is designed to clot well after birth to stop your losing lots of blood. Unfortunately, this means you are at higher risk of developing blood clots.
Lack of movement due to C-sections, traumatic births or bed rest can cause slowed blood flow. If you are at higher risk of developing clots, your doctor will prescribe blood thinning injections and compression socks. These will help improve your blood flow and prevent clots.
A DVT can develop up to 6 weeks postpartum. There are three main areas they are likely to develop: leg, pelvis or lungs.
Deep Vein Thrombosis (DVT)
A DVT is most likely to appear on your leg. With postpartum women, this is often your left leg. However, it may develop in your right leg.
Common symptoms to look out for on your legs are:
- swelling (one leg looks bigger than the other)
- pain (especially when flexing your toes to your shin)
- tender to touch
- warm, red spot on the leg (usually at the back below the knee)
A DVT may also appear in your pelvis, although this is a lot rarer. The symptoms of a pelvic DVT are often mild and often passed off as postpartum aches and pains.
Look out for:
- Pain in your pelvis (mild or severe)
- Ongoing lower back pain on one side
- Enlarged veins near the pelvis
- Heavy aching on one side of your pelvis
If you think you have symptoms of a DVT contact your doctor for an urgent review. Try not to be overly active until you see a doctor as it may dislodge the clot.
You’ll have blood tests and scans performed to diagnose a DVT. Treatment will be ongoing treatment with blood thinners as well as keeping mobile and hydrated to improve blood flow.
Pulmonary Embolism (PE)
A pulmonary embolism is a condition that can develop if you have a DVT that is left untreated. A PE means you have a blood clot in your lung. Usually, this blood clot has detached from a leg or pelvic DVT and traveled to the lungs.
A pulmonary embolism can be fatal if left untreated.
Common symptoms include:
- Chest pain
- shortness of breath
- signs of shock
If you start to experience symptoms of a PE, call 911 immediately. Inform your partner or family to do this if you have DVT symptoms as your condition may change quickly.
Once diagnosed you will be admitted to hospital. You may be given medications to dissolve the clot. Other treatments include surgery to physically remove the clot.
8. Breast problems
Breast problems can occur whether you choose to breastfeed or not. Your breasts will fill with milk for your baby until you signal you don’t need it. If baby does not empty the milk from the breast, it can cause painful breast conditions.
These conditions are more likely to happen if you do breastfeed, as your breast continue to fill and empty.
Let’s discuss the common breast problems during postpartum.
One your mature milk comes in your breasts fill with milk. Until your or baby empty them, they continue to swell and become hard to touch.
You’ll experience this around day 3-4 whether you breastfeed or not. Your chest will feel massive, heavy and warm.
You’ll likely leak milk at the slightest touch or even if your baby is crying. The pain and leaking is your body signaling to feed your baby.
If you choose not to breastfeed, keep your breasts cool, supported and take mild painkillers. Don’t express milk off; it signals to the body your baby needs it, and you’ll make more.
If you are breastfeeding put baby to the breast often. Your breast should start to feel soft after a few minutes. You might even hand express off a few drops until the breast softens.
If you experience regular engorgement even with regular feeds, seek help from your midwife or a lactation expert. The problem may be that your baby is not draining your breast during a feed.
The inside of your breast is made of ducts, similar to orange segments. These ducts can become blocked if the milk isn’t draining correctly during a feed. You will feel this as a triangle shaped lump on your breast.
A blocked duct may be caused by a tight-fitting bra digging into your breast tissue. Make sure you have a good supporting nursing bra which doesn’t dig in.
To resolve a blocked duct, try massaging that area of the breast. Then latch baby onto the breast for a feed. You can continue the massage as baby feeds.
Once the ducts unblock, the pain will stop. Seek help from a lactation specialist if you continue to have issues with blocked ducts.
If engorgement or blocked ducts are left untreated, it can lead to mastitis. As your breast fill the trapped milk is forced out of the ducts into the breast tissue. Mastitis can occur in one or both breasts.
You’ll notice mastitis on your breasts with these symptoms:
- hot hard and tender to touch
- feeling unwell (flu-like symptoms)
It’s best to continue breastfeeding your baby with mastitis as stopping can make the problem worse.
If you don’t feel feverish, get a lactation specialist to make a feeding assessment. They will help resolve the problem and prevent it returning after the mastitis resolves.
If you begin to feel feverish, seek help from your doctor for a review. It’s likely you’ll need antibiotics to clear up the mastitis.
If you do require antibiotics, I recommend seeing a lactation specialist to ensure the problem doesn’t return.
Without treatment for mastitis, it can turn into a breast abscess. This is a pocket of pus which fills in the breast. An abscess can also develop if your body doesn’t respond to treatment for mastitis.
A breast abscess gives the same symptoms as mastitis. You will probably be able to feel the abbess inside your breast.
If you think you have a breast abscess you need to seek urgent help from your doctor.
Your breast will be scanned to diagnose an abscess.
A breast abscess is treated by draining the pus with a needle or making a small cut into the breast tissue. A doctor will do this procedure as a day case under local anesthetic. You will them start on a further does of antibiotics to clear up the infection.
If you have cracked or damaged nipples, you may develop breast thrush. It’s a fungus that thrives in warm, sugary environments. You may pass the thrush onto your baby who will show symptoms in their mouth.
Breast thrush symptoms include:
- Shooting pain in your nipples
- itching or burning nipples
- red or shiny nipples
- deep breast pain
Also check your baby for symptoms including:
- white patches in the mouth (not milk)
- fussiness at the breast
- red, bumpy diaper rash
You are more likely to suffer from breast thrush if you are taking antibiotics while breastfeeding.
To treat thrush, you’ll need medicated ointment for both you and your baby. If you get treatment for one but not the other, you will continue to pass the thrush back and forth when feeding.
Your doctor will be able to prescribe nystatin or miconazole for your baby’s mouth and your nipples.
9. Toilet trouble
Going to the bathroom after delivery can be scary. You’re sore and probably have stitches which you’re worried about.
The worst thing you can do is avoid eating and drinking well to hold off going to the toilet. This delay can lead to a few problems which you don’t want to have to add to your recovery.
It can be common to develop a urinary infection after birth. Lack of fluids can lead to a build-up of bacteria, especially if you have a wound from stitches.
Common urinary infection symptoms include:
- Burning sensation passing urine
- a small amount of urine
- dull ache in your lower abdomen
- offensive or cloudy urine
- feeling unwell
If left untreated, a bladder infection can spread to your kidneys. Without getting oral antibiotics to clear the infection you are likely you become so unwell you’ll be admitted to hospital.
If you are entirely unable to pass urine after birth, you may have urinary retention. This is a severe condition that requires immediate medical attention.
Its more common postpartum as pushing, birth damage or catheter use can cause issues with the bladder emptying.
You’ll need a bladder scan to show that you are not retaining urine even after peeing. If you still have urine remaining you may need an indwelling catheter to rest your bladder.
You’ll also require follow up from a physiotherapist to make sure your bladder function returns to normal.
Loss of sensation
A loss of the urge to pee requires attention. You may even lose the feeling when you are peeing, resulting in leaking.
Weak pelvic floor muscles can cause the loss of sensation. However, this symptom can signal damage to your bladder during birth. Begin doing your Kegel exercises after birth, and make an appointment to discuss any leakage with your doctor at your postpartum follow up.
Your doctor may refer you to a physiotherapist or a gynecology specialist for further treatment.
Piles are a common condition to develop postpartum. Pushing during delivery causes stress on the rectum, leaving to the swollen blood vessels that cause piles.
Piles can be extremely painful, and also cause rectal bleeding. Although this can be alarming it’s not an emergency situation. Increasing your fluid intake and using a hemorrhoid treatment like Dr. Butlers ointment will reduce them over a few days.
If any problems continue to seek a review from your doctor.
If you don’t feel right, your instincts are often right. Not all the conditions in this guide require emergency help but may do if left untreated. Use the infographic below to know how soon to get help. If you start to experience a few of these signs of shocks call 911 immediately:
- Feeling clammy or cold
- Pale skin
- A racing heart
- Dizziness or fainting
- Nausea or vomiting
Remember to tell any caregiver that you have had a baby recently and what symptoms you are experiencing. This will help them to treat you quickly should you deteriorate further.