Just as every childbirth is different, so is postpartum recovery.
Some new parents seem to be back on their feet in no time at all after birth, while others require a longer rest period. And even though many first-time parents take childbirth classes, most don’t have a whole lot of information about what to expect regarding recovery during the postpartum period.
How long should I be bleeding? Are these blood clots too big? Why am I so swollen? Should my scar hurt this much? Is it normal to be crying all day? I’m having weird headaches. Is something falling out of my vagina? Googling my symptoms makes me even more confused. How do I know when to call my doctor?
These questions are perfectly legitimate after a major physical event, and in an ideal world, you would have frequent, scheduled access to your healthcare provider for answers that are specific to your situation. The World Health Organization recommends routine follow up postpartum care at 3 days, 1-2 weeks, and 6 weeks after birth, and according to the American College of Obstetricians and Gynecologists (ACOG), all postpartum individuals should have contact with their medical provider within three weeks of giving birth.
Unfortunately, many American women do not have a postpartum follow up visit until around 6 weeks after birth. On top of that, as many as 40% of new moms do not attend this postpartum follow up appointment for a wide variety of reasons, including childcare limitations, work commitments, transportation, financial barriers, and more.
The fact is that most new mothers are not receiving the routine postpartum care that would allow us to get answers and guidance from a professional we know and trust. It’s natural to want to reach out, and a quality provider will welcome your questions and concerns. However, there are some signs and symptoms that might seem “normal” during this postpartum adjustment period that may actually be related to more serious health concerns. Allowing these signs and symptoms to continue unchecked can have devastating results on women's health.
The Center for Disease Control (CDC) has outlined a list of postpartum issue “warning signs” to indicate that a call to your healthcare provider is not only warranted, but urgent.
These warning signs include:
- Severe headache
- Dizziness or fainting
- Changes in your vision
- Trouble breathing
- Overwhelming tiredness
- Chest pain
- Severe belly pain
- Severe nausea and throwing up
- Severe swelling
- Thoughts about harming yourself or your baby
If you are experiencing any of the above signs and symptoms, call your healthcare provider right away. It never hurts to let them know what’s going on, and it may be important to get help sooner rather than later.
According to the Mayo Clinic, the most common postpartum-related health concerns include cardiovascular conditions, infection, excessive bleeding or hemorrhage, and mental health.
Cardiovascular conditions can include anything involving your heart or circulation. Pregnancy brings a 40% increase in your cardiovascular output, which essentially means your heart is having to manage a whole lot more fluid than it’s used to. For this reason, pregnancy and postpartum are challenging times for the cardiovascular system.
If you have a history of cardiovascular disease or high blood pressure, your provider will carefully monitor your systems to make sure they balance out appropriately after birth. Occasionally, postpartum women with no significant cardiovascular history can experience a shift after birth as well.
High blood pressure that is left unchecked can quickly take a turn into pre-eclampsia which impacts the liver, and may even progress into the more sinister conditions of eclampsia and HELLP syndrome, which can be deadly. Postpartum pre-eclampsia generally begins after birth, and often with no signs or symptoms during pregnancy. The symptoms of postpartum pre-eclampsia that you might notice at home are elevated blood pressure over 140/90, severe headaches, blurred vision or light sensitivity, pain in your upper belly, nausea and vomiting, shortness of breath, or decreased urine output. Some postpartum women experience swelling which can be normal, but if swelling progresses suddenly or becomes severe or is coupled with any of the above symptoms, call your doctor to let them know. Because high blood pressure can quickly turn into a more serious concern when pregnant and postpartum, it’s important to call your doctor right away if you’re noticing any of these symptoms.
Extremely high blood pressure is also a risk factor for blood clots and stroke. If your blood pressure is elevated after birth, your provider will likely monitor you more closely and may even offer some treatments to reduce your risk of a blood clot or a stroke. The best treatment is prevention, so stay moving with ankle pumps, getting up for short periods regularly throughout the day, and seek care immediately by calling 911 if you notice any sudden changes in function, such as the ability to walk or produce symmetrical facial and arm movements.
Infections can occur both internally and externally, and may not be visible to the eye. A cesarean-section scar may become infected even if you take care to clean it properly, though you may or may not see overt signs of infection like redness, heat, or foul-smelling discharge. With an infection that is not visible, such as within a deeper layer of your c-section incision or a uterine infection, you may notice other symptoms such as fever, chills, sweating, pain, or just a general feeling of malaise or illness. Call your doctor right away if you are experiencing any of these signs or symptoms, as infections can progress and become systemic if left unaddressed.
Postpartum blood loss is normal, usually bright red, containing some small clots, and heaviest during the first few days after birth, but excessive bleeding is referred to as postpartum hemorrhage. Postpartum hemorrhage is most common within the first 24 hours after birth, but it can occur up to 12 weeks postpartum. Most providers will let you know when to be concerned by heavy bleeding, with cues such as “filling up a large pad within an hour” or “passing a clot that’s larger than an egg." If you’re noticing a significant increase in blood loss after that initial few days that doesn’t slow down, you’re passing clots that are larger than an egg, or you’re noticing signs or symptoms of low blood pressure or shock including lightheadedness, blurred vision, chills, clammy or pale skin, rapid heartbeat, feeling dizzy or weak, nausea or vomiting, it may be a medical emergency. Call 911 or your doctor right away, depending on the severity of your symptoms.
Postpartum mental health disorders affect one in ten women after birth. The first few days through about 2 weeks postpartum may bring emotional swings that don’t ultimately require treatment, such as tearfulness, mood swings, and mild anxiety. This is often referred to as the “baby blues," and is a normal part of hormonal fluctuation after childbirth. However, not everyone benefits from “waiting it out." A more severe and longer-lasting form of these baby blues might actually be postpartum depression, and more rarely, postpartum psychosis.
Postpartum depression is distinguishable from the baby blues in that it generally doesn’t fade after the first 1-2 weeks, and symptoms may worsen with time. Call your provider if your symptoms are lingering beyond the first 1-2 weeks or are getting worse, or if you are noticing difficulty caring for your baby, completing basic household tasks, significant sadness, anxiety, or anger, or if you are having thoughts of harming yourself or your baby even with no plans to act on them. It’s important to get help for postpartum depression as soon as you or a partner, friend, or family member recognizes it, because it can affect the health of both you and your new baby in the long term.
Though it’s rare, postpartum psychosis can include confusion and disorientation, obsessive thoughts or frequent intrusive thoughts, hallucinations, paranoia, excessive energy or agitation, and/or attempts to harm yourself or your baby. If you or a loved one are experiencing symptoms that may indicate postpartum depression or psychosis, call your doctor for guidance, or call 911 if you are concerned for the safety or wellbeing of mom or baby.
Postpartum Support International’s HelpLine may offer immediate support for mental health concerns that are not life-threatening.
In summary, you know your body best. The details of postpartum recovery can be overwhelming at times, but if you’re noticing a change in your body that is unexpected or hindering your progress with postpartum healing or breastfeeding, don’t hesitate to call your doctor to let them know what’s going on and get support. You and your doctor both know the single 6-week postpartum visit isn’t really enough. While we wait for healthcare policy to change, we can lean on our healthcare providers. They want to hear from you if you have concerns.
Your doctor may advise a trip to the emergency room or an in-person office visit, or they may be able to make recommendations by phone or over a telemedicine appointment depending on your symptoms. If you know something is wrong or different, don’t wait. Get the support you need to remain healthy and happy during this major life transition.