August 27, 2019

Reviewed by Kimberly Langdon M.D.

Before we talk about the scary stuff that can happen after birth, it’s important for you to know a few things. First, this stuff is really rare, so if you’re prone to anxiety and think this might make you worry unnecessarily, it’s okay to stop reading now and file this away as a resource for if you notice symptoms. You may also want to share this with a close friend or family member, so they can help look out for you.

Second, as with all of our information, this is not “medical advice.” We summarize the data and evidence-based science for you so that you can feel more comfortable and knowledgeable when you talk to your doctor. We do not replace your doctor. So, if you feel like something isn’t right, please call your doctor right away.

The overwhelming majority of issues you’ll experience in the weeks following childbirth are totally normal. Things like nipple pain, mommy thumb, and painful sex can be excruciating, but are still generally considered non-urgent. Even though they’re normal, you can and should, get help for them, but they’re not life-or-death situations.

However, in rare cases, there are signs that something is really wrong. These are serious concerns that need to be addressed ASAP. You really need to call your doctor right away. Because these are the ones that, if not treated, can be fatal. However, most pregnancy-related deaths can be prevented and early treatment is key. One way to catch these issues earlier is for you to recognize something as a symptom and report it quickly. We’ll go through some of the top causes of maternal and pregnancy-related deaths, so you’ll know what to look out for.

Postpartum Infection

There are many different types of infections that develop during the postpartum period. While rare, some can be serious and life-threatening if not treated. The most common types of infection are surgical site infections (SSIs) and endometritis (uterine infections). The telltale sign of infection is a fever of 100.4℉ or higher. Abdominal pain, foul-smelling discharge, or redness at the incision site if you had a cesarean section are other signs that warrant a call to your doctor.

Read about symptoms, risk factors, and treatments

Postpartum Hemorrhage

Postpartum Hemorrhage is when you have more bleeding than normal after delivery. Usually the uterus contracts on its own after delivery, which puts pressure on the bleeding blood vessels where the placenta was attached. If the contractions are not strong enough, the blood vessels will keep bleeding, causing hemorrhage. It usually occurs within 24 hours, but can occur up to 12 weeks after delivery. Besides uncontrollable bleeding, other symptoms include low blood pressure, dizziness, and high heart rate.

Read about symptoms, risk factors, and treatments

Postpartum Cardiomyopathy

Postpartum cardiomyopathy (PPCM) is when your heart has trouble pumping blood to your body and it typically occurs between the final weeks of pregnancy and the first 6 months after delivery. Symptoms include shortness of breath, chest pain, racing heart or skipped beats, leg swelling, fatigue, frequent urination at night, swollen veins in your neck, and low blood pressure. This condition is often missed because these symptoms are mis-attributed to other causes, so if you’re experiencing any of these, talk to your doctor to rule this out.

Read about symptoms, risk factors, and treatments

Postpartum Preeclampsia

Postpartum preeclampsia is a serious condition related to high blood pressure (hypertension) that usually occurs within 48 hours of childbirth, but can develop up to six weeks postpartum, or later. Symptoms include high blood pressure, upper abdominal pain, nausea, changes in vision, swelling of the hands or face, vomiting, visual changes, severe headaches, seizures, decreased urination, and shortness of breath.

Read about symptoms, risk factors, and treatments

Postpartum Depression

Postpartum depression is one of the most common mood disorders during the postpartum period, affecting an estimated 20% of new mothers. Some of the most common symptoms include crying and sadness, irritability and anger, suicidal thoughts, changes in appetite and/or sleep, and feelings of hopelessness. Postpartum depression and other perinatal mood & anxiety disorders can lead to substance use disorder, overdose, suicide or accidental death. In fact, suicide is one of the leading causes of maternal death in the first year after childbirth.

Read about symptoms, risk factors, and treatments

Venous thromboembolism

Venous thromboembolism (VTE) is a disorder that includes deep vein thrombosis and pulmonary embolism. It is one of the leading causes of maternal mortality in the US, causing almost 10% of maternal deaths.

Deep Vein Thrombosis

A deep vein thrombosis is when a blood clot develops in a deep vein, usually in the leg or pelvis. Pregnant women are at high risk, and the risk is even higher in the weeks after delivery. It can lead to a pulmonary embolism, if the clot travels to the lungs. Common symptoms include leg pain, leg swelling, and red or hot skin where the clot occurs.

Read about symptoms, risk factors, and treatments

Pulmonary Embolism

A pulmonary embolism is when a blood clot, often a deep vein thrombosis blocks one of the arteries in your lungs. It typically occurs during or shortly after delivery and is more common after c-sections and in patients with a history of blood clots. Common symptoms include chest pain, shortness of breath, and dizziness.

Read about symptoms, risk factors, and treatments

What can you do?

• Be on the lookout.
• Tell someone if something feels wrong.
• Share this info with loved ones who can help you recognize the symptoms.

Warning Signs and Symptoms

Call 911 if you experience the following:

• Chest pain
• Shortness of breath
• Seizures
• Thoughts of hurting yourself or others

Call your healthcare provider right away if you experience the following:

• Bleeding that soaks through 1 pad per hour, or has clots bigger than a golf ball
• Incision that doesn’t appear to be healing or is red and more painful
• A leg that is red, swollen, warm, or painful
• A fever of 100.4 degrees or higher
• Headache that does not improve, even after medicine, or is accompanied by vision changes

Sources:

Maternal death and pregnancy-related death. March of Dimes. Retrieved on August 14, 2019 from
https://www.marchofdimes.org/complications/pregnancy-related-death-maternal-death-and-maternal-mortality.aspx

Hilfiker-Kleiner D, Schieffer E, Meyer GP, Podewski E, Drexler H. Postpartum cardiomyopathy: a cardiac emergency for gynecologists, general practitioners, internists, pulmonologists, and cardiologists. Dtsch Arztebl Int. 2008;105(44):751–756. doi:10.3238/arztebl.2008.0751
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696941/

Peripartum Cardiomyopathy (PPCM). American Heart Association. Retrieved on August 18, 2019 from
https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults/peripartum-cardiomyopathy-ppcm

What’s Normal (and Not) After You Give Birth? The Cleveland Clinic. (2019) Retrieved on August 14, 2019 from
https://health.clevelandclinic.org/whats-normal-and-not-after-you-give-birth/

Thromboembolism in pregnancy. ACOG Practice Bulletin No. 196. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;132:e1–17. Retrieved on August 22, 2019 from
https://www.pregnancyexpert.info/wp-content/uploads/2018/08/Thromboembolism-in-Pregnancy.pdf

Save your life: Get care for these post-birth warning signs. Association of Women’s Health, Obstetric, and Neonatal Nurses. Retrieved on August 14, 2019 from
https://cdn.ymaws.com/www.awhonn.org/resource/resmgr/pdfs/pbws/pbwssylhandoutenglish.pdf

Kimberly Langdon M.D. is a retired University-trained obstetrician/gynecologist with 19-years of clinical experience. She graduated from The Ohio State University College of Medicine and then completed her OB/GYN residency program at The Ohio State University Medical Center. Recently, she founded a medical device start-up company that focuses on non-drug treatment for common maladies.