Postpartum Complications – Signs, Symptoms and Prevention

After having a baby, your body is recovering by naturally cleaning itself and going through the healing process.

For a mother, this amounts to a whole lot of discomfort from cramping and bleeding to body swelling to tender breasts to hair loss to pain sitting down to even having difficulties using the toilet.

Although these things are all normal and nothing to worry about, there is a risk of having more serious pregnancy-related complications.

They’re not super common, but pregnancy-related deaths and maternal morbidity cases have been increasing.

Postpartum complications on the rise

When the Pregnancy Mortality Surveillance System was instituted in 1987, there were around 7.2 pregnancy-related deaths per 100,000 live births in the U.S. As of 2018, that number had risen to 17.4 deaths per 100,000 live births, which equates to about 660 maternal deaths. Out of those numbers, deaths during the postpartum period among black women were more than three times higher than that of white women.

Although the US is spending more on healthcare than any other country in the world, more than two women die every day during childbirth, making maternal mortality in the United States the highest when compared to 49 other countries in the developed world.

It is estimated that 20-50% of those deaths are likely preventable.

Preventable causes such as:

• Hemorrhage
• High blood pressure
• Infections postpartum
• Lack of education on warning signs
• Lack of access to healthcare
• Medicaid ending too soon post-birth. In some states, this ends 8 weeks after delivery. Only 2 months of care!

The biggest cause for these rising numbers seems to be a lack of knowledge and awareness.

Most mothers don’t have their first postpartum doctor visit until four to six weeks after giving birth, but a whopping 40 percent don’t have any kind of postpartum checkup at all.

Due to risk factors, lack of resources, and rising healthcare costs, a large percentage of women completely forego postpartum care, even in cases when they need to see their doctor immediately, to ask them to provide medical advice.

This means that a lot of postpartum complications go undetected until it’s too late.

Three out of five birth-related complications could be treated and prevented if women knew the warning signs and risk factors, and if they went to see their doctor immediately, during the postpartum period.

That’s why we’ve put together a resource to help you be more aware of risk factors, what’s normal, what’s not, and when you should call your healthcare provider.

Common postpartum complications

Things that women normally experience after giving birth can sometimes turn into serious issues. Following are some of the many postpartum complications.

Postpartum hemorrhage and blood clots

Postpartum hemorrhage is the most common complication, and it is a pregnancy-related complication.

Some postpartum bleeding is normal in the first few weeks after delivery for postpartum women, but the excessive bleeding should lessen each day passes.

Vaginal bleeding and blood flow should also go from a bright red color to more of a brown color.

If severe bleeding continues or increases, it could indicate a retained placenta, infection, or other issues.

Postpartum Infections or sepsis

This happens when incisions in the vaginal or perineal area don’t heal properly, parts of the placenta remain inside the body, and infections can set.

Breast infections are also common, and a breast infection can cause the breasts to become engorged and plug the ducts (mastitis) due to frequent nursing.

For most women, in order to continue breastfeeding, the infection of the breast must be resolved first.

Infections can also happen when other wounds or tears, such as c-section incisions or vaginal opening wounds go untreated, causing several health problems and requiring medical care.

Antibiotics can usually clear it up, but if it’s not taken care of and if the infection advances, it can lead to shock and even death of moms-to-be.

Deep vein thrombosis (DVT)

There is a five times more likelihood of pregnant women developing blood clots than non-pregnant women.

This is mostly due to reduced flow of blood to lower extremities as the baby grows, reduced movement, especially if on bed rest, and your body’s natural increase of blood clotting to reduce blood loss during childbirth.

Thrombotic pulmonary embolism

Related to deep vein thrombosis, pulmonary embolism is a health condition that causes a blood clot, usually from the legs, to travel to the lungs and clogs the pulmonary artery.

Cardiovascular disease or cardiomyopathy

Some women may be at greater risk for heart disease if they smoke, are obese, are over the age of 40, or have other issues like hypertension.

Cardiomyopathy is a rare condition where the heart muscles weaken and struggle to pump blood through the body.

Women tend to be at great risk for these conditions postpartum, and either one can lead to heart attack or heart failure.

Stroke

High blood pressure during pregnancy and prolonged birth is the greatest risk factor for causing a stroke in women postpartum.

The period from delivery up to two weeks afterward is the highest window of risk, but it can happen even as long as six weeks after delivery. Nearly 50% of strokes happen postpartum.

Amniotic fluid embolism

Although amniotic fluid embolism is amongst rare health conditions, it’s extremely serious and worth mentioning.

This postpartum complication occurs when amniotic fluid, fetal cells, or other fetal materials enter the mother’s bloodstream and cause a reaction.

This can trigger sudden respiratory failure, followed by cardiac arrest, and then hemorrhaging, usually at the site of placental attachment.

This can happen after both cesarean delivery and vaginal birth, and it is made more likely by prolonged labor.

Postpartum depression

One of the most common postpartum complications is Perinatal Mood and Anxiety Disorder (PMAD), which affects around one in five women.

So-called baby blues can happen during pregnancy as well as after childbirth, but it usually subsides within the first couple of weeks postpartum.

If it lasts longer than that or interferes with your ability to care for your baby or yourself, talking to your doctor will allow you to get the help you need for this very treatable condition.

Warning signs and symptoms during the postpartum period

There are some common symptoms and warning signs that should prompt you to get medical help from your healthcare provider as soon as possible.

If you experience any of the following, call your doctor as soon as possible:

• Fever of 100.4F (38C) or higher
• Other fever-like symptoms such as chills, shaking, clammy skin, and excessive sweating
• Any incisions that aren’t healing, are red, swollen, and tender, or have pus
• A leg that has become red or swollen and is painful or warm to the touch
• A severe headache that doesn’t improve after taking medicine or that affects your vision
• Pain or burning when urinating (other than the pain from an episiotomy or a perineal tear)
• Pain in your lower back while urinating, or needing to pee more than usual
• Severe pain in one or both sides of your abdomen or in your lower belly
• Racing heart or heart palpitations
• Lumps or red streaks in your breasts, extreme tenderness, unusual redness, swelling, and pain
• Foul-smelling vaginal discharge

For the following symptoms, seek medical attention immediately by going to the hospital or calling an ambulance:

• Excessive bleeding (soaking one or more hospital or maxi pads in an hour or less) and/or passing clots larger than prune size
• Shortness of breath, trouble breathing, or feeling like you might pass out
• Chest pain or a squeezing pain that keeps getting worse
• Seizures
• Thoughts of hurting yourself or your baby

When to see a doctor

If you have any of the warning signs that indicate pregnancy-related complications, you should call your doctor as soon as possible.

Even if they turn out to not be life-threatening, they could be signs of an infection that, when caught in time, can be treated before becoming more serious.

It is always best to call your doctor and make sure; always let your healthcare provider make the decisions.

Heavy blood loss, inability to breathe, the possibility of passing out or losing consciousness, and chest pain or tightness are some of the most critical signs of an urgent medical situation.

In these cases, you should get to a hospital immediately or call an ambulance.

The important thing is to not hesitate or second guess.

If something doesn’t feel right, or you suspect that you might be having some kind of postpartum complication, it’s better to have it checked out and be sure.

Things can go from bad to worse quickly if left untreated, and it’s not worth risking your life over.

Can you prevent postpartum complications?

The best way to prevent postpartum complications is through planning and awareness.

Even before you give birth, discuss with your doctor if you have any pre-existing health issues that might put you at risk, such as diabetes or gestational diabetes, high blood pressure or preeclampsia, a history of smoking or cardiotoxic drug use, obesity, being over age 40, or having a family history of conditions like heart disease.

In addition, make postpartum care a priority.

Ideally, try to see your doctor for your first postpartum checkup by the third or fourth week after delivery.

If you can’t make a physical appointment, at least have a phone or video call to discuss how you’re doing and if there’s anything you’re concerned about or want to ask about.

No matter what, make sure to have at least one postpartum visit within 12 weeks of delivery. Ideally, you would see your physician as early as 2 weeks and no later than 6 weeks postpartum.

This way, your doctor can physically check you to see how you’re healing, how you’re feeling physically and emotionally, and if there is anything you should be concerned about.

Postpartum complications can occur even months after pregnancy, so for the first year after delivery, note anything that seems out of the ordinary, and when you see a doctor, always mention the date when you gave birth.

This can help him/her correlate if an issue might be pregnancy-related.

Birth Assistance

One of the most significant ways you can increase your chances of a positive birth outcome is to hire a birth and postpartum doula, a midwife, or any advocate for your health, and see your physician more often.

Midwives participate in 70% of all births in Europe and Japan, however, less than 8% in the US!

The doula has been proven to enhance oxytocin release which decreases stress reactions, fear, and anxiety, and increases contraction strength and effectiveness in both birth and postpartum experiences.

A doula can also decrease your chances of having a c-section by 20%.

You might be thinking, “But I will already have a labor & delivery nurse at the hospital. Why do I need a doula?”

They are not for everyone: these are suggestions.

There are a lot of women who want to keep it between their partner, family, or friends, and this is wonderful!

Do what you feel comfortable with.

Labor vs Delivery Nurse

Nurses provide support when they can, but research has shown that labor and delivery nurses can only spend a limited amount of time in each patient’s room, while doulas are there the entire time for support.

The majority of the time that a nurse is in the laboring patient’s room, they are doing other direct clinical care, such as administering medications or performing interventions, maintaining equipment, applying and assessing the electronic fetal monitor, and documenting on the computer.

For 12% of each person’s labor, the nurse provided labor support including emotional, physical, or informational support, or advocacy.

More experienced nurses were more likely to spend time providing emotional support.

So, while nurses are amazing, they can’t do everything. Having that doula, having a midwife, to help support you for that extra care can be great.

C-section vs Vaginal Births

Since 1985, the World Health Organization (WHO) has considered the ideal rate for C-section births to be between 10% to 15%.

However, according to the Center for Disease Control reports are over 31% in the United States. More than twice the recommended number for C-sections by the World health organization WHO.

Some hospitals are as high as 50-70%.

Why is this an issue?

Well, with any major surgery, there are risks associated.

This includes blot clots, infection, postpartum hemorrhages, anesthesia reactions, or other surgical injuries.

Not to mention recovering from carrying a baby for 35-40 weeks, then adding a major surgery.

Plus, America is the only country in the developed world that doesn’t guarantee paid maternity and family leave.

45% of parents are back to work before their 6-week checkup because they can not afford to stay home.

Returning to work before that 6-week period is not an ideal choice, yet in many situations, there is no choice.

The Mayo Clinic also reports that mothers face a higher risk of potentially serious complications in future pregnancies after a C-section.

More C-section studies include:

• Research states that mothers under 25 years old who had C-sections after they started labor, were 60% more likely to have complications than their counterparts who had a vaginal delivery.
• Pregnant women 35 or older who had C-sections after they went into labor were 4x more likely to have complications than mothers over 35 who had vaginal births.
• And lastly, mothers 35 and older who had C-sections, without first going into labor, were five times more likely to have severe complications than mothers who had vaginal births.

The lack of affordable healthcare, lack of maternal care and education, medical inductions, and other drugs are very, very common, but NOT normal!

The US doesn’t devote enough resources to quality maternal health and women lack education on serious warning signs that something is going wrong in their postpartum period.

Medicaid

Another surprising reality is that almost half of births in the USA are covered by Medicaid.

Almost 50% of births in the United States! And then Medicaid ends after 60 days currently. Excuse me? Postpartum care should not end at 60 days!

But there is light, hope, and a movement happening. Both women and men are opening their eyes to fight for better postpartum care in the US. Doulas, midwives, childbirth educators, therapists, physical therapists, and many more are sounding the drum to band together and create change!

It’s not all doom and gloom – there is hope happening!

Hidden in the recent American Rescue Plan Act of 2021 is a new option to extend this Medicaid postpartum coverage from 60 days to 12 months for all states.

The new option can take effect starting April 1, 2022, and would be available to states for five years.

But which states will take up this option? Illinois was the first to say yes on April 12th. Why that matters: 52% of pregnancy-related deaths in the U.S. occur within a year of giving birth.

In Illinois, it’s 80% of maternity deaths.

The big picture is the expansion may also help shrink the maternal death rate across races and ethnicities.

Conclusion

Your body goes through a lot during pregnancy and after giving birth.

Postpartum complications can have serious consequences, with rates of pregnancy-related deaths and maternal morbidity cases increasing in recent years.

The majority of these complications are preventable, and lack of knowledge and awareness is a significant factor contributing to their rise.

Common postpartum complications include postpartum hemorrhage, infections, deep vein thrombosis, cardiovascular disease, stroke, and postpartum depression.

Warning signs and symptoms that should prompt immediate medical attention include fever, excessive bleeding, shortness of breath, chest pain, seizures, and thoughts of hurting oneself or the baby.

Preventative measures include discussing pre-existing health issues with a doctor, prioritizing postpartum care, and thinking about hiring birth and postpartum doulas or midwives.

The high rates of C-sections in the US, lack of maternity leave, lack of access to healthcare, and Medicaid ending too soon post-birth are all factors contributing to the rising rates of postpartum complications.

Recent changes in legislation offer hope for improving postpartum care and reducing maternal mortality rates.

Through education and awareness, hopefully, we can bring those statistics down and have more happy, healthy mothers enjoying long lives with their children.