What You Need to Know About Postpartum Complications

By OBGYN Dr. Kenosha Gleaton

The postpartum period, sometimes referred to as the fourth trimester, is the period of time after giving birth. This period is vital for recovery, bonding, and long-term health and well-being. [1] Unfortunately there can be many complications for both mom and baby in the weeks after childbirth, so it’s important to be informed about potential complications and how to prevent them. [1] Many postpartum complications can appear and worsen quickly, but prompt treatment and comprehensive care can help treat and prevent any issues in a timely manner. [2] It’s estimated that around 40% of women don’t attend their postpartum visit, which is a crucial time to discuss chronic conditions, postpartum contraception, breastfeeding concerns, and more. [3] It’s strongly encouraged for families to attend these postpartum appointments to promote overall health and wellness after giving birth. 

How long does it take to heal after childbirth?

Everyone’s pregnancy and postpartum journey is different, but most can expect to be physically healed around week six for both vaginal and cesarean section delivery. [4] This means that any incisions should be healed around a month and a half after giving birth, and you should be able to resume most activities. It may take longer to notice other changes in the body, or to feel as though you’ve fully “bounced back” from giving birth. In fact, there are many changes still occurring internally for months after delivery. [4] Just remember that healing is not a race!

There are a few different phases of postpartum that involve different stages of recovery. [4] The initial period refers to the first six to twelve hours postpartum. This is a period of rapid change where the potential for multiple complications is the highest. The second phase of postpartum lasts about two to six weeks and involves most of the physical healing associated with childbirth. The third phase is the delayed postpartum period which can last up to six months. Changes during this time are gradual and involve restoring muscle tone, connective tissue, etc. 

Postpartum care

Postpartum visits are a vital part of a comprehensive care plan. The American College of Obstetrics and Gynecology (ACOG) recommends postpartum patients receive 12 weeks of support, including an evaluation within a few weeks after birth, a comprehensive visit 12 weeks after birth, and ongoing care in between visits as necessary. [1,3] These visits can be beneficial for getting more information or support with breastfeeding, pain management, nutrition and exercise counseling, vaginal bleeding, contraception, and postpartum blues or postpartum mood and anxiety disorders. [1] Read about the importance of prenatal and postnatal care. 

Postpartum complications and symptoms

Now let’s talk about some potential postpartum complications and what signs and symptoms you should watch for. Although it can be intimidating to read about everything that can go wrong, keep in mind that 80% of women have healthy pregnancies and deliveries. [11] This list isn’t intended to scare you, but to inform and encourage you to take postpartum care as seriously as prenatal care. 

Mood and anxiety disorders 

Feeling depressed, anxious, sad, irritable, and having mood swings after giving birth is fairly common the first two weeks after childbirth. [1] There is something called the postpartum blues, which is transient or temporary, and usually resolves within a few weeks. Any noticeable changes in mood or emotional state should still be taken seriously as postpartum mood and anxiety disorders (PMAD), such as postpartum depression, are very serious conditions. If a parent is having a difficult time caring for themselves, their child, or has thoughts of harming themselves or their child, they should seek professional help immediately. [1]

Symptoms of postpartum mood and anxiety disorders

Symptoms of PMAD may include feeling sad or depressed, irritable or angry, anxious, or experiencing mood swings. [5] Some may also have a hard time bonding with their child, feeling regret, or having upsetting thoughts about harming themselves or their child. Those with postpartum OCD may have repetitive, upsetting, unwanted thoughts, compulsions, or mental images. [5] If you are experiencing these or other upsetting symptoms, you should speak to a healthcare provider immediately. 

Treatments

Postpartum depression and other disorders can be managed with therapy, medication, and other interventions. Treatment will depend on the patient and healthcare provider. For more helpful information, read 5 Postpartum Depression Self Care Tips.

Postpartum hemorrhage

Hemorrhaging may occur after giving birth and is most likely to happen within a day or so after delivery, but can occur up to 12 weeks later. [2] Hemorrhaging is most often caused by abnormal uterine contractions (uterine atony) that lead to blood vessels not tightening after delivery. Bleeding may also occur if small pieces of the placenta remain attached to the uterus after childbirth, or if there is an issue with blood clotting or tearing of the internal organs. 

Symptoms of postpartum hemorrhage

Excessive bleeding after birth is the main symptom of hemorrhage. Note that some bleeding and discharge after delivery is normal, but consistent heavy bleeding for days on end may be a sign of something more serious. [2] Continuously soaking through multiple pads within an hour or so, passing large blood clots, low blood pressure, clammy skin, feeling dizzy or weak, confusion, rapid heart rate, and pain or swelling near the vagina are all signs of hemorrhaging. 

Treatments

Treatment for postpartum hemorrhage will vary depending on the cause. [2] Some may require medication or abdominal massage to help the uterus contract, while others may require surgery to stop the bleeding and remove pieces of placenta. Sometimes, blood and fluids may be needed to replenish what was lost. 

Postpartum endometritis and infections

Endometritis is the inflammation of the lining of the uterus. This may occur if bacteria make their way into the endometrium during childbirth. If endometritis is left untreated, it may lead to sepsis, shock, or organ failure. [2] Endometritis typically occurs two to ten days after childbirth, but can occur weeks later. Other types of infections can also occur from a c-section site or general trauma to any part of the reproductive tract. [6]

Symptoms of an infection

If you do develop endometritis or another infection, you may experience fever and chills, abdominal pain or tenderness, you may feel tired or sick, or notice foul-smelling vaginal discharge. [2] Be sure to reach out to your healthcare provider if you notice any signs of an infection. 

Treatments

Treating infections is often done through antibiotics, sometimes given through an IV. If the infection spreads and causes damage to other parts of the body, more extreme treatments may be necessary. 

Postpartum preeclampsia and cardiovascular problems

Preeclampsia is a condition characterized by high blood pressure during or after pregnancy. Preeclampsia can impact many organs in the body and if untreated, may lead to stroke, seizures, or other serious complications. [2] Preeclampsia most often occurs during pregnancy, but its also common to develop it up to six weeks after giving birth, which is referred to as postpartum preeclampsia. Other cardiovascular conditions such as cardiomyopathy, pregnancy-induced heart failure, can also occur postpartum and may lead to severe health effects. [7]

Symptoms

The main symptom of preeclampsia is increased blood pressure. A systolic reading of 140 mm Hg or higher or diastolic reading of 90 mmHg or higher may be indicative of postpartum preeclampsia. You may also notice changes in your vision, shortness of breath, nausea or vomiting, weight gain, swelling, pain, or prolonged headaches. Other symptoms of pre-eclampsia or potential heart problems include swollen veins, feet, or ankles, dry cough, frequent urination, fatigue, heart palpitations, etc. [7]

Treatments

Various medications may be used to help treat cardiovascular conditions. Drugs that help manage blood pressure are often used to treat preeclampsia. 

Incontinence and constipation

Incontinence, or the loss of bladder control, is another relatively common postpartum complication. It’s estimated that a quarter of women experience some form of incontinence during the first year postpartum. [1] Stress incontinence occurs after extensive stretch or injury to the pelvic floor muscles during labor. Postpartum constipation and hemorrhoids are also common issues after giving birth. [8]

Symptoms

Incontinence is the loss of bladder control, which can vary from complete inability to control urination to slight loss of urine after coughing, laughing, sneezing, etc. Constipation is typically pain, discomfort, or straining when trying to use the bathroom, or having hard stool. Hemorrhoids are usually painful and may cause swelling or bleeding. 

Treatments

Incontinence may be treated through strengthening the pelvic floor. This may be done through Kegel exercises. In some cases, bladder training and weight loss may also be helpful for treating incontinence. [1] Treating constipation and hemorrhoids may be done through fiber supplements or stool softeners, laxatives, sitz baths, and various creams or ointments. [8] Explore our collection of postpartum vitamins and supplements to support your postpartum recovery.

Breastfeeding problems

It’s common for many new moms to struggle with breastfeeding or have issues arise while trying to breastfeed. [9] Some common problems include clogged ducts, mastitis, milk production, and difficulty latching. It’s not uncommon for new parents to get discouraged by breastfeeding issues and begin formula feeding. While there are a lot of benefits to breastfeeding, a fed baby should always be the priority! If you have concerns about your breastfeeding technique or if you believe you may have an infection or clogged duct, reach out to your healthcare provider. [9]

Symptoms

Signs of breastfeeding problems or infections may include pain, swelling, fever, lumpy or hard breasts, fatigue, flu-like symptoms, etc. It’s normal to experience some discomfort when you begin breastfeeding, but the pain shouldn’t be bad enough to prevent you from breastfeeding. [9] 

Treatments

If you’re having difficulty breastfeeding or believe you have an infection, you should speak to your healthcare provider about appropriate treatments. Treating mastitis and other issues can be done through milk removal, lymphatic drainage, warm or cold compresses, anti-inflammatory drugs, and in some cases, antibiotics. A lactation consultant may also be able to help you find techniques to encourage breastfeeding or proper latch. Some products such as nipple balm may also be helpful for treating dried or cracked nipples and are a great way to prevent further breastfeeding problems. 

This isn’t a comprehensive list, and there are a number of other conditions or issues that may arise after giving birth. Be sure to speak to your healthcare provider about setting up postpartum appointments, and don’t be afraid to reach out to your provider with any concerns or questions. Postpartum life involves a lot of adjustment, especially for first-time mothers. 
It can be intimidating to read about all the things that can go wrong, but keep in mind that 80% of women have healthy pregnancies and deliveries, and not all postpartum complications are life threatening. [10] Being educated on potential warning signs is a great way to take charge of your health and catch any problems early. Your main job is to ensure you’re getting adequate rest, eating a balanced diet, staying hydrated, and bonding with your little human!

Urgent warning signs 

Your healthcare provider should be screening for various complications at your postpartum checkups, but don’t be afraid to reach out to them if you’re concerned about any specific symptoms. There are some urgent warning signs to be aware of that may indicate a serious, life-threatening situation. If you experience any of these symptoms, you should see a healthcare provider immediately. [11]

• Severe headache that gets worse or doesn’t go away
• Dizziness or fainting
• Vision changes
• Swelling of the hands or face
• Fever over 100.4°F (38°C)
• Abdominal or chest pain that doesn’t go away
• Nausea or vomiting
• Difficulty breathing or feeling short of breath
• Rapid heart beat
• Thoughts of harming yourself or your child
• Extreme fatigue
• Swelling or pain in the arm or leg
• Heavy bleeding that does not get lighter within a day or so 

Important takeaways

You took great care of your body before and during pregnancy, and postpartum care should be no different! Allow yourself time to heal and rest while getting an adequate amount of nutrients and water. There are a lot of different conditions that may arise during the postpartum period. Most physical external healing should be complete around six weeks postpartum; however, conditions may still arise for weeks after giving birth. Fortunately, most complications can be resolved and treated fairly easily if they’re caught quickly enough. You should see your healthcare provider for postpartum checkups at least once or twice, and reach out to them if you notice any concerning symptoms. Postpartum checkups are also a great time to get more information on breastfeeding, contraception, postpartum depression, and more. 

References:

1. Lopez-Gonzalez DM, Kopparapu AK. Postpartum Care Of The New Mother. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK565875/
2. Ogunyemi D. 3 Conditions to Watch for After Childbirth. ACOG. January 2022. URL. 
3. Optimizing postpartum care. ACOG Committee Opinion No. 736. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e140–50.
4. Romano M, Cacciatore A, Giordano R, La Rosa B. Postpartum period: three distinct but continuous phases. J Prenat Med. 2010;4(2):22-25.
5. Perinatal Mental Health Disorders. Postpartum Support International. Accessed April 2023. URL. 
6. Boushra M, Rahman O. Postpartum Infection. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560804/
7. Peripartum Cardiomyopathy. Cleveland Clinic. June 8 2022. URL. Accessed April 2023. 
8. Turawa EB, Musekiwa A, Rohwer AC. Interventions for preventing postpartum constipation. Cochrane Database Syst Rev. 2015;2015(9):CD011625. Published 2015 Sep 18. doi:10.1002/14651858.CD011625.pub2
9. Wagner EA, Chantry CJ, Dewey KG, Nommsen-Rivers LA. Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months. Pediatrics. 2013;132(4):e865-e875. doi:10.1542/peds.2013-0724
10. Trends in Pregnancy and Childbirth Complications in the U.S. Blue Cross Blue Shield. June 17 2020. URL. 
11. Urgent Maternal Warning Signs. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health. November 17 2022. URL.