Postpartum Infections

What postpartum infections are

After birth, the inside of the uterus is a large raw area where the placenta was attached, the cervix is open, and there may be surgical or tear wounds. Bacteria from the vagina, skin or bowel can invade these tissues. Most infections start in the first week, but some appear up to 6 weeks after birth, often after you have gone home.

Historically called puerperal fever or childbed fever, these infections killed many women before handwashing and antibiotics. They remain a major cause of maternal illness and a leading cause of maternal death worldwide, mainly through sepsis.

Types of postpartum infection

Endometritis

The most common uterine infection after birth. It usually involves several types of bacteria. It is much more common after cesarean delivery, particularly after long labor. Signs include fever, pain and tenderness low in the belly, heavier or smelly lochia and feeling unwell. Group A streptococcus can cause a fast-moving, severe form, sometimes with fever and severe pain within the first day or two.

Wound infections

Cesarean incision infections cause redness, warmth, swelling and drainage at the scar. Deeper infections can form abscesses or cause the wound to separate. See wound infection for general wound signs. Perineal infections cause pain that worsens rather than improves after a tear or episiotomy.

Mastitis

Breast inflammation, sometimes with infection, in breastfeeding parents. Our mastitis page explains feeding and treatment advice. An abscess can form if it is not treated, felt as a firm, very tender lump.

Urinary tract infections

Catheters during labor or cesarean, and swelling of the bladder outlet, increase the risk of urinary tract infection. Fever, back pain and vomiting suggest the infection has reached the kidneys.

Risk factors

• Cesarean delivery, especially unplanned after labor
• Long labor or a long time since the waters broke
• Many vaginal exams during labor
• Infection during labor (chorioamnionitis)
• Manual removal of the placenta, or retained placenta or membranes
• Heavy bleeding after birth
• Group B strep carriage, bacterial vaginosis
• Obesity, diabetes, anemia, smoking, weakened immunity

Diagnosis

Your doctor or midwife will check your temperature, pulse, blood pressure and breathing, examine the belly, wound, breasts and perineum, and may do a pelvic exam. Tests can include:

• Blood count, inflammation markers, lactate and blood cultures if sepsis is a concern
• Urine test and culture
• Swabs of the wound, vagina or cervix
• Ultrasound to look for retained tissue, an abscess or a collection of fluid
• CT scan if deep abscesses or pelvic vein clots are suspected

Treatment

• Antibiotics: endometritis and severe infections are treated with intravenous antibiotics in the hospital until fever has gone for 24 to 48 hours. Milder wound infections, mastitis and bladder infections are often treated with oral antibiotics at home. Most antibiotics used are compatible with breastfeeding.
• Drainage: opening and cleaning an infected wound, or draining an abscess with a needle or small procedure.
• Removal of retained tissue from the uterus if found on ultrasound.
• Sepsis care: fluids, antibiotics within the first hour, and intensive care if needed.
• Supportive care: fever relief with acetaminophen (paracetamol) or ibuprofen at the label dose, fluids, rest and continued breastfeeding where possible.

Preventing postpartum infection

• Preventive antibiotics before cesarean delivery (standard practice)
• Treating group B strep in labor
• Handwashing by everyone caring for you, and by you before touching your wound, perineum or breasts
• Changing pads often and washing the perineum with water after using the toilet
• Keeping the cesarean wound clean and dry
• Breastfeeding often with a good latch, and not skipping feeds to reduce breast engorgement
• Knowing the warning signs and calling early

Frequently asked questions

What are the signs of infection after giving birth?

The main sign is a fever of 38 °C (100.4 °F) or higher. Others include belly pain or tenderness, foul-smelling or increasing discharge, a red, hot or leaking wound, a painful red area on the breast, burning when you urinate, chills and feeling generally very unwell. Call your provider promptly.

What is the most common postpartum infection?

Endometritis, an infection of the uterine lining, is the most common, especially after cesarean delivery. Urinary tract infections, wound infections and mastitis are also common. Each has its own pattern, but all can cause fever and need assessment.

How long after birth can you get an infection?

Most postpartum infections appear in the first 10 days, but they can develop up to 6 weeks after birth. Mastitis can occur any time while breastfeeding. Any fever, wound change or unusual pain in the weeks after birth should be checked, even if you felt well at discharge.

Is a fever after giving birth normal?

A low fever in the first 24 hours can occur without infection, for example after an epidural. After that, a fever of 38 °C (100.4 °F) or higher is not normal and needs prompt assessment, because it may signal an infection that needs antibiotics.

Can I keep breastfeeding with a postpartum infection?

Usually yes. Most antibiotics used for postpartum infections are safe while breastfeeding. With mastitis, continuing to feed is encouraged. Tell your doctor you are breastfeeding so they choose compatible medicines. In rare cases, such as a breast abscess draining near the nipple, temporary changes may be advised.