Postnatal symptoms you should never ignore

What precautions should I take during my postpartum recovery period?

It's a good idea to take it easy until you've had your postnatal check-up (usually at around six weeks after birth). Many mums follow traditional confinement for the first 40 days after birth so they get this time to recuperate.

But, you should aim to follow a relaxed routine in the first few weeks even if you choose not to follow confinement.

After you’ve given birth, it’s normal to have some bleeding, discomfort and tiredness. Time, rest and self-help are usually all that's needed for you to feel better. Your body needs time to heal, especially if you've had a c-section.

Most women make a full and uncomplicated recovery after their baby is born, whether they had a normal delivery or a caesarean birth. But occasionally, real medical emergencies happen in the days and weeks following birth. Knowing what the warning signs are, and what you should do if they happen, could make all the difference.

When you are discharged from hospital ask your doctor how and when you can get emergency medical help should you need it. Make sure these details are written in a safe place, and that your husband and other family members also know where they are.

It's important to tell family members where you keep your medical files. In the event of an emergency, these can help ambulance staff to start appropriate treatment straight away.

If ambulance services aren't good in your area, keep the phone numbers of family, friends or neighbours who would be available to help you get to the hospital at short notice. Save the numbers on your phone as well as put up an emergency numbers contact list on your fridge or any other easy to access place. Make sure everyone in the house knows where they are kept.

If you’ve had an emergency home birth, do make sure you get proper medical care immediately after delivering your baby. This way you may be able to minimise any postnatal problems such as retained placenta, which may cause heavy bleeding in the days following your delivery.

It’s important not to take dangerous postnatal symptoms lightly. And self-medication or home remedies, even if recommended by relatives, can sometimes worsen your condition. Always speak to your doctor before trying any kind of treatment on your own.

Also, share this article with your husband, family members and a few close friends. Some of the symptoms may be easier for them to spot. In particular, friends and family may recognise the symptoms of a mental health issue, such as postnatal depression, before you do.

Which postnatal symptoms are an emergency?

You should get immediate medical help if you have any of these symptoms. That means calling an ambulance or going to the emergency department of the nearest hospital.

Sudden and heavy blood loss, or increasing blood loss, including clots (postpartum haemorrhage)
If you have postpartum haemorrhage, you can lose 500ml or more of blood very quickly and will need urgent treatment.

If you bleed heavily in the 24 hours after your baby is born, you’re likely to be in hospital, in which case you’ll be treated quickly by the staff there.

If you’re at home and you start to bleed heavily, call an ambulance or get to the nearest hospital if:

• the bleeding suddenly increases, and soaks more than one pad an hour
• you pass lots of large blood clots
  
• you start to feel faint or dizzy
• your heart starts to race, or your heartbeat becomes irregular
  

Severe or persistent headache
A severe headache after birth could be a symptom of pre-eclampsia. Call an ambulance or go to the hospital if you get a severe headache, and have the other symptoms of pre-eclampsia:

• vision problems such as blurring and flashing lights
• vomiting
• severe heartburn
• swollen ankles

Symptoms of pre-eclampsia usually come on within 72 hours of giving birth.

Upper abdominal pain
There is a rare condition called HELLP syndrome that can develop while you’re pregnant and through until about a week after your baby is born. HELLP stands for haemolysis (H), elevated liver enzymes (EL), and low platelets (LP). It’s a bit like pre-eclampsia. The main symptoms are:

• pain in the top part of your tummy, or on the upper right side of your tummy
• feeling sick and being sick
• feeling weary and worn out
• headache

HELLP affects how well your liver works and how your blood clots. It can be very serious and potentially life-threatening. If you have the symptoms of HELLP you should call your doctor and get urgent medical care.

Shortness of breath and/or chest pain
If you have chest pain and feel short of breath then it could be a symptom of pulmonary embolism. Other symptoms include coughing up blood and feeling faint. If you have any of these symptoms, don’t ignore them. Get medical care right away.

A pulmonary embolism happens when a blood vessel in your lungs gets blocked, usually by a blood clot. If blood isn’t reaching your lungs properly, it can be life-threatening, so getting treatment quickly is vital.

High fever (100.4 degrees F or over)
High fever can be a sign of sepsis, which is an infection that’s spread from just one part of your body to the whole of your body.

As well as having a high temperature, you’ll probably feel shivery and have a fast heart rate and breathing. Depending on where the infection started, you may have other symptoms such as:

• severe abdominal (tummy) or groin pain, which doesn’t get better after you take painkillers
• smelly discharge from your vagina
• sore and tender breasts
• a red and painful caesarean-section wound with smelly fluid coming from it
• pain when you pee, needing to pee quickly or more often than usual and smelly urine

If you develop sepsis you can become very ill, very quickly. If you have these symptoms, you should get to a hospital immediately.

Which postnatal symptoms mean I need to get medical advice the same day?

Call your doctor at the earliest if you have any of the following:

Calf pain
If you develop pain in your lower leg, usually just in one leg, then it could be a sign of deep vein thrombosis (DVT). Your leg may also look red and swollen and feel warm to touch.

DVT is a blood clot in the deep veins of your leg. It can be life-threatening if the clot moves and travels through your body to your lung (a pulmonary embolism).

Many women get sore and tired legs after pregnancy, and DVT can also develop without any symptoms at all. But, if you develop the symptoms of DVT you should always get it checked.

Sudden changes to mental health, such as being agitated, depressed, confused or having manic behaviour
In the month after having a baby, some mums experience a dramatic change in their emotional and mental health. If you have hallucinations and delusions, or become confused or depressed, it could be the beginning of a rare condition called postpartum psychosis.

Common symptoms of postpartum psychosis include:

• Hearing voices and seeing things that aren’t there (hallucinating).
• Rapid and extreme mood swings.
• Manic behaviour, such as cleaning the house in the middle of the night.
• Feeling disconnected from reality.
• Feeling confused, perhaps not recognising friends or family.
• Having delusions, and believing things that are untrue or illogical.

However, each case of postpartum psychosis is different, so if you, your husband, or your friends and family have any concerns over how you're feeling and behaving, be sure to tell your doctor. It's quite likely that other people will notice that you’re not well before you notice it yourself.

Postpartum psychosis can happen to any woman, whether they’ve had mental illness before or not. Mild symptoms can develop into serious mental illness within a matter of hours, so it’s important that you get treatment as soon as you can.

Postpartum psychosis can be a frightening experience for everyone involved, but women usually make a full recovery.

Suicidal thoughts
If you’re having thoughts about harming yourself, including thinking about suicide, get help as soon as you can. You may have severe postnatal depression, which can be serious for you and your baby if it’s not treated.

Having thoughts like this doesn’t mean that you are a bad mum, or that your baby will be taken away from you if you tell someone.

Contact your doctor, or talk to a friend or member of your family, so they can get help for you. Doing so will help you get the support you need to look after yourself and your baby.

Unable to pass urine within six hours of your baby’s birth
If you haven’t been able to pass urine in this time, you may have urinary retention. This is when your bladder doesn’t empty and you can’t pee. It can be extremely uncomfortable, and if it’s not treated it can cause severe pain, infection and damage to your kidneys.

If you've had your baby in hospital, your doctor will keep an eye on how much urine you pass. If you’ve had a home birth, having a warm bath or shower may help. If you still can't pee, seek medical advice on the same day.

Severe headache after an anaesthetic
Having an epidural or spinal during labour and birth can sometimes cause a severe headache within the week after birth.

The headache is caused by the needle containing the anaesthetic accidentally puncturing the membrane around your spinal cord.

The headache can feel like a bad migraine that’s worse when you sit up or stand, and you may also have neck pain, feel sick and dislike bright lights.

Your doctor will monitor you while you're in the hospital. If you experience these symptoms when you get home, let your doctor know.

Which other postnatal conditions are urgent and shouldn't be ignored?

Give your doctor a call if you have any of the following:

Symptoms of an infection, without a fever (high temperature)

• Unpleasant, smelly vaginal discharge. This could be an infection in your womb (uterus) or vagina.
• A painful and red caesarean section wound. You may have smelly liquid coming from the wound too.
• A tender tummy, which could be a symptom of an infection in your womb.
• Pain in your side and problems peeing, such as needing to go urgently and pain when you pass urine. This could be a urine infection.
• Swollen and tender breasts, which could be mastitis (breast infection).
• Pain, swelling and discharge in the area between your vagina and anus (your perineum). This could be an infected tear or episiotomy wound.

Leaking from your bottom
When you have a normal delivery (vaginal birth), sometimes the ring of muscles that controls your bowels can get damaged. If this happens, it can cause faecal incontinence. This is when you can’t control your bowel movements, so you’re leaking poo before you get to the loo.

Severe, swollen or prolapsed piles
Many women develop piles when they’re pregnant, but these can become more painful after your baby is born.

Piles are varicose veins just inside the anus, but they can pass outside (prolapsed piles). If you have severe, swollen or prolapsed piles, or any bleeding from your rectum, talk to your doctor.

Baby blues that don’t go away within a few days
It's common to feel moody, weepy, tired or anxious two days to three days after giving birth. These baby blues usually pass within a few hours or days. But if you continue to feel very low, and aren’t enjoying being a mum, you could be suffering from postnatal depression.

If you’re feeling very anxious and worried all the time, feeling panicky, obsessing about things, or you can't concentrate because you're feeling so down, speak to your doctor. She can give you the help and support that you need.

Visit our community

If you have any concerns about your emotional or physical symptoms, always speak to your doctor.

But in the meantime, you may find it helpful to talk over your worries in the friendly BabyCenter community.

You can also connect with other mums who are in the same stage as you in your Birth Club.


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