Warning signs of postpartum complications

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.

Severe headache

What it feels like:

Postpartum headaches – including migraines – are common. But a severe headache can also indicate that something serious is going on.

A concerning headache may start with sudden pain (like a clap of thunder) and last even after drinking fluids and taking pain-relieving medication. It may throb on one side, above your ear, and you may have blurred vision or dizziness. It may be intense and worsen over time.

A severe headache is especially concerning if you don't usually have headaches, or if it happens in the first few weeks after delivery. It's also worrisome if you have high blood pressure or increased swelling.

Causes:

A severe headache can signal postpartum preeclampsia, a dangerous blood pressure disorder. It can happen up to six weeks after birth, but it usually shows up within the first 48 hours after delivery.

A stroke (a blood clot that prevents oxygen from reaching your brain) can also cause a severe headache. Strokes aren't common in pregnancy, but pregnancy does increase the risk. And the incidence is rising, especially postpartum. Other stroke symptoms include sudden numbness in the face, arm, or leg (especially on one side), confusion, vision problems and dizziness.

Dizziness or fainting

What it feels like:

You may have ongoing dizziness or lightheadedness, or you could have dizziness or lightheadedness that comes and goes for days. You may faint or pass out, and you may experience memory lapses.

These symptoms are especially worrisome if they happen in the first few weeks postpartum, and/or if you also have a headache, blurred vision, slurred speech, a racing heart, chest pain, shortness of breath, or vaginal bleeding.

Causes:

Many complications can cause dizziness or fainting, including:

• Anemia, sometimes caused by postpartum hemorrhage
• Preeclampsia (see above)
• Heart or lung problems
• Blood sugar problems

Changes in your vision

What it feels like:

You may see flashes of light or bright spots. Your vision may be blurry, and you may be seeing double or unable to focus. You may have blind spots or be unable to see at all for a short time.

Vision changes like these are especially concerning if they persist for more than a couple of minutes.

Causes:

The most common serious cause of vision changes is postpartum preeclampsia, particularly if it’s only been a few weeks since you gave birth. A stroke can also cause vision changes.

Fever

What it feels like:

A low-grade fever isn't uncommon during the first 24 hours postpartum. But if your temperature reaches 101 degrees F (38.5 degrees C) or higher, it's a red flag.

A fever is especially concerning if you have other symptoms, such as severe belly or back pain, diarrhea, nausea or vomiting, trouble urinating or changes in your urination, a racing heart or fast breathing, or vaginal discharge that has a bad odor.

Causes:

A fever means that you have an infection someplace in your body. It may be:

• A breast infection (mastitis). If bacteria gets into your milk ducts (via cracked nipples, for example), or if milk isn't fully drained from a breast and becomes stagnant, an infection can develop.
• A uterine infection. These bacterial infections are called puerperal infections, and they include endometritis (an infection of the lining of the uterus), myometritis (infection of the uterine muscle), and parametritis (infection of the areas around the uterus). Uterine infections usually happen two to ten days after delivery, but they can happen up to six weeks postpartum.
• An infection of your incision site for a C-section, or (less commonly) at the site of a tear or episiotomy.
• A urinary tract infection. Urinary tract infections (including bladder infections and kidney infections) usually happen when bacteria travel into your urethra from your skin, vagina, or rectum. Your risk of a UTI increases if you've had a catheter in your bladder during your labor or C-section or have difficulty urinating after your delivery.

Untreated infections can become serious very quickly and start to affect other parts of the body.

Trouble breathing

What it feels like:

You may feel as if you can't breathe deeply, and/or you may feel short of breath. Your throat and/or chest may feel tight. You may be unable to breathe comfortably when you're lying down flat and may need to start propping yourself up to sleep.

Trouble breathing is especially concerning if you have high blood pressure or swelling, or if it happens in the first few weeks after delivery, or if you also have chest or back pain, headache, changes in vision, dizziness, or a fast or skipped heartbeats.

Causes:

Trouble breathing may be caused by:

• Pulmonary embolism (a blood clot in your lungs)
• Postpartum preeclampsia
• Peripartum cardiomyopathy (PPCM). PPCM is a type of heart failure that affects women towards the end of pregnancy or within five months postpartum. It causes your heart to become larger, weakening your heart muscle and making it difficult for your heart to pump blood to your organs. PPCM can happen even to women with no previous heart disease. It's the leading cause of deaths one week to one year after delivery, and the incidence is increasing.
• Lung infection (pneumonia)

Overwhelming tiredness

What it feels like:

Fatigue is totally normal postpartum, as you recover from delivery and adjust to life with your new baby (and very little sleep). But if you suddenly feel very weak and tired, or are tired even when you do get sleep, there may be an underlying cause. You may feel unable to care for your baby and tend to daily tasks, or you may feel sad.

Causes:

Overwhelming tiredness that impacts your ability to do your normal activities can signal a number of illnesses, including:

• Depression
• Anemia
• Diabetes
• Infection
• Heart problems, such as peripartum cardiomyopathy

Chest pain or rapid heartbeat

What it feels like:

You may feel tightness or pressure in the center of your chest, and you may have pain that travels to your back, neck, or arm. Your heart may be beating fast or pounding in your chest, or you may feel irregular or skipped heartbeats.

Chest pain or a rapid heartbeat are especially concerning if they come on suddenly or if you also have swelling in an arm or leg, trouble breathing, dizziness, or a headache.

Causes:

These symptoms may be signs of:

• Heart attack
• Peripartum cardiomyopathy
• Pulmonary embolism
• A blockage of blood flow in your chest, from a tear in a blood vessel, for example
• Anemia. Postpartum hemorrhage can cause you to have pale and clammy skin, and feel confused, faint, or weak.

Severe belly pain

What it feels like:

You may have sudden, severe belly pain that gets worse over time. It may be sharp, stabbing, or cramp-like. You may also have severe chest, shoulder, or back pain.

These symptoms are especially concerning if you also have back pain or pain in the upper part of your belly, severe heartburn, headache, swelling, shortness of breath, or vaginal bleeding.

Causes:

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.

Severe nausea and throwing up

What it feels like:

You may feel very sick to your stomach (not just queasy) and be throwing up. You might be unable to keep water or other fluids down, and you may be unable to drink for more than 8 hours or eat for more than 24 hours.

If you become dehydrated, you might at the same time have a dry mouth, headaches, confusion, a fever, and/or dizziness or lightheadedness.

Causes:

Your nausea may be caused by a viral infection, but it may also indicate:

• A problem with your liver or pancreas
• Food poisoning, which can cause dehydration
• Postpartum hemorrhage
• Heart disease
• Postpartum preeclampsia or HELLP Syndrome
• Appendicitis or bowel obstruction

Severe swelling of hands or face

What it feels like:

Some postpartum puffiness is normal as your body sheds pregnancy fluids. This is called postpartum edema, and it usually goes away on its own in about a week – though it might last longer if you had preeclampsia in late pregnancy. But swelling that persists, or swelling that's severe, is a warning sign. You may have:

• Swelling of the face. Your eyes may be puffy, and you may find it hard to open them all the way.
• Swelling in your hands. It may be hard to wear rings or bend your fingers.
• Swelling or loss of feeling in your mouth or lips
• Sudden weight gain (two or three pounds in a week)

These symptoms are especially concerning if they come on quickly and include your hands and wrists.

Causes:

Swelling of the face and hands – along with severe headaches, dizziness, and vision problems – can be a sign of postpartum preeclampsia.

Swelling, redness, or pain in your leg

What it feels like:

You may have swelling in your leg (often the calf), usually on one side. It may be tender, red, and warm to the touch – or it may not hurt. It might hurt when you flex your foot as you walk. You might also have swelling, tenderness, or pain in one arm.

Swelling is especially worrisome if the swollen side is warmer and/or redder than the other side.

Causes:

Swollen legs and feet can linger after you deliver your baby as your body continues to rid itself of excess pregnancy fluid.

If the swelling doesn't go away, though, or if you have other symptoms, you may have deep vein thrombosis (DVT). DVT is a blood clot that forms in the deep veins, usually in the lower leg (though it can happen elsewhere). The risk of DVT is highest in the first week after delivery. If the clot travels to the arteries of the lungs, it can cause a pulmonary embolism (PE), which can be fatal. If it stops the flow of blood and oxygen to the brain, it can cause a stroke.

Leg swelling that progressively gets worse can also be a sign of peripartum cardiomyopathy.

Thoughts about harming yourself or your baby

What it feels like:

You may feel very sad or hopeless or like you're not good enough. Maybe you feel as if you're not in control of your life, and you may be very worried or anxious all the time. You may cry often and have trouble sleeping at night, have severe mood swings, and have trouble bonding with your baby. You may have scary thoughts that you're unable to get rid of, and you may feel depressed.

Your upsetting thoughts may be mild to very severe, and they may be constant or they may come and go. If they're severe, you may feel out of touch with reality (you see or hear things that those around you don't), and you may have thoughts of hurting yourself or your baby.

Causes:

If you're feeling down after your baby arrives, you're not alone. Up to 80 percent of new moms have postpartum blues, or the baby blues, in the days after childbirth.

While the baby blues usually resolve as hormone levels stabilize, if they don't go away in a couple of weeks or are accompanied by other symptoms (such as not being able to sleep even when you get a chance to, or changes in appetite), you may have postpartum depression (PPD).

According to a large global study published in 2021, postpartum depression affects one out of every five women worldwide after birth. PPD is common, and isn't a sign that you don't care about or love your baby

Some women develop postpartum psychosis, which is a severe mental illness that affects one or two women per 1,000 births. It can develop within days to the first six weeks after delivery.

Postpartum mental health problems are treatable, and the sooner you get help the sooner you're likely to feel better. Talk with your provider right away if you notice any signs of depression, and call 911 if you're having thoughts of harming yourself or your baby.

To see if this could be affecting you, take a postpartum depression screening.

Vaginal bleeding or discharge

What it feels like:

Bleeding and discharge is normal up to eight weeks after delivery, but it should slow and stop over time.

It's cause for concern if you're soaking through one or more pads hourly, and/or you pass clots bigger than an egg. Or, if you have tissue or discharge with an odor that's getting progressively bad or intense.

Causes:

Vaginal bleeding or discharge that smells bad may be caused by:

• Postpartum hemorrhage
• A retained placenta
• An infection, such as endometritis or bacterial vaginosis (BV)
• An unhealed vaginal repair

Learn more:

• Your most common postpartum recovery questions, answered
• Body changes after pregnancy
• Diet for healthy post-baby weight loss
• When you can start having sex after giving birth

Visit the Society for Maternal-Fetal Medicine's websiteOpens a new window for more information.