Postpartum Complications: Warning Signs After Birth

When postpartum complications happen

ACOG now describes postpartum care as an ongoing process, the "fourth trimester", rather than a single 6-week visit. Complications can appear:

• in the first 24 hours: heavy bleeding, high blood pressure, eclampsia
• in the first 1 to 2 weeks: infection, preeclampsia (which can start after birth), blood clots, baby blues
• in the first months: cardiomyopathy, depression, psychosis, thyroid problems

Serious complications

Postpartum hemorrhage

Heavy bleeding after birth is a leading cause of maternal death worldwide. The most common cause is the uterus not contracting well (uterine atony). Others include retained placenta, tears and clotting problems. Warning signs: soaking a pad an hour, large clots, dizziness, a fast heartbeat. See postpartum hemorrhage.

Postpartum infections

• infection of the uterus (endometritis): fever, belly pain, foul discharge
• wound infection after cesarean or tears
• breast infection (mastitis)
• urinary tract infections
• sepsis, which can progress quickly

See postpartum infections.

High blood pressure and postpartum preeclampsia

Preeclampsia can begin or worsen after delivery, usually within the first week but up to 6 weeks later. Warning signs include severe headache, vision changes, upper belly pain, swelling and breathlessness. It can lead to eclampsia (seizures) and stroke. Blood pressure checks in the first 3 to 10 days after birth are recommended for people with high blood pressure in pregnancy.

Blood clots

The risk of blood clots in the legs and lungs is highest in the first 6 weeks, especially after cesarean birth. Signs include a swollen, painful calf, sudden breathlessness or chest pain. See pregnancy thrombosis.

Heart problems

Peripartum cardiomyopathy is weakening of the heart muscle in late pregnancy or the months after birth. Symptoms are breathlessness, especially lying flat, swelling, fatigue and palpitations, which are easily mistaken for normal new-parent tiredness.

Mental health conditions

• baby blues: tearfulness and mood swings in the first 2 weeks, very common and short-lived
• postpartum depression: low mood, anxiety, guilt or inability to enjoy things lasting more than 2 weeks, affecting about 1 in 8
• postpartum anxiety and OCD
• postpartum psychosis: rare, sudden confusion, hallucinations or paranoia, usually within 2 weeks. A psychiatric emergency

Suicide and overdose are leading causes of pregnancy-associated death in the first year in the US.

Common, less dangerous problems

• perineal pain and stitches
• afterpains (cramping) and lochia (bleeding), which last up to about 6 weeks
• urinary leaking and pelvic floor weakness
• hemorrhoids and constipation
• breast engorgement, cracked nipples and blocked ducts
• hair shedding around 3 to 4 months
• postpartum thyroiditis: a temporary overactive then underactive thyroid

Who is at higher risk

• cesarean birth or a complicated delivery
• high blood pressure, preeclampsia or gestational diabetes in pregnancy
• obesity, chronic heart or kidney disease
• age over 35
• multiple pregnancy
• history of depression or other mental health conditions
• limited access to care, and in the US, Black and American Indian and Alaska Native women face substantially higher pregnancy-related death rates

Prevention and follow-up

• postpartum visit within 3 weeks and a comprehensive visit by 12 weeks, per ACOG
• blood pressure checks in the first week for those with hypertension in pregnancy
• depression screening at visits, including the baby's pediatric visits
• know the warning signs and keep the POST-BIRTH or CDC Hear Her checklist handy
• say "I had a baby in the past year" whenever you seek care for any symptom
• plan contraception and spacing of future pregnancies

Frequently asked questions

What are the most common postpartum complications?

The most common serious complications are heavy bleeding, infections, high blood pressure including postpartum preeclampsia, blood clots and postpartum depression. More common minor problems include perineal pain, urinary leaking, hemorrhoids and breast issues.

What are the warning signs after giving birth?

Urgent warning signs include heavy bleeding, chest pain, trouble breathing, a severe headache with vision changes, seizures, fever, a swollen painful leg, extreme swelling, and thoughts of harming yourself or your baby. Call 911 or seek care immediately.

Can preeclampsia happen after birth?

Yes. Postpartum preeclampsia usually develops within 48 hours to a week after delivery but can occur up to 6 weeks later, even in people who had normal blood pressure in pregnancy. Severe headache, vision changes and breathlessness need urgent care.

How long is the postpartum period?

Medically, the postpartum period is often defined as 6 weeks, when most body changes resolve. However, complications such as cardiomyopathy, depression and thyroid problems can occur up to a year after birth, so ACOG treats the whole year as part of postpartum care.

When should I worry about bleeding after birth?

Some bleeding is normal for up to 6 weeks, getting lighter over time. Seek emergency care if you soak a pad every hour or more, pass clots larger than an egg, feel dizzy or faint, or if bleeding suddenly becomes heavy again after slowing.