Complications After Childbirth: Warning Signs That Need Urgent Care

You are home from the maternity unit, baby is asleep, relatives come and go. Then one evening something feels wrong: bleeding that picks up again, a shiver, a migraine unlike any other. Serious complications after childbirth are rare, but some move fast. Knowing them means you can act in time, for yourself and for those who depend on you.

The WHO reminds us that the first days and weeks after birth are when most maternal and newborn deaths occur, and that more than three in ten women and babies worldwide do not receive postnatal care at that point. Here are the signs to know, who to call, and what can wait for your next appointment.

Postpartum haemorrhage: when bleeding becomes dangerous

Bleeding after birth is normal: these are the lochia, which lighten over the weeks (all explained in our article on bleeding after birth). What should alert you is bleeding that picks up instead of tapering off.

The benchmarks are the same in the UK, Ireland and Quebec:

• a pad soaked within an hour, two hours in a row;
• clots bigger than an egg (or a golf ball);
• bleeding with dizziness, a feeling of faintness or palpitations.

In these cases you do not wait for morning and you do not drive yourself. Lie down, have someone call 141 or get driven to the maternity unit. In a Moroccan study published in 2023, women interviewed in Essaouira, Settat and Salé described haemorrhage, lfayda, as a danger that belongs in hospital. They were right.

Fever after birth: looking for the infection

A fever of 38 °C or more is a signal to take seriously. British hospitals point out that a serious infection, sepsis, can set in very quickly after a birth. Take your temperature if you shiver, if you feel "not well" for no clear reason, or if your heart is beating fast.

A fever often has an entry point you can spot:

Endometritis is an infection of the womb lining, where the placenta was attached. Like other postpartum infections, it needs prompt treatment prescribed by a doctor. For the scar, our guide to caesarean scar infection details the signs; for the breast, see mastitis and engorgement.

Pre-eclampsia after the birth: it happens too

This is the least known complication. Pre-eclampsia, the blood pressure condition that is monitored during pregnancy, can also appear after the birth. According to the Mayo Clinic, it most often starts within 48 hours of delivery, but sometimes up to six weeks later. It can affect women who never had high blood pressure.

The signs to know:

• a severe headache or one that will not go away;
• vision changes: blurred vision, flashing lights, sensitivity to light;
• a band of pain at the pit of the stomach or under the ribs on the right;
• nausea or vomiting, ankles or face that swell suddenly;
• shortness of breath, passing less urine.

These symptoms are easily mistaken for the tiredness of the first weeks. If you had high blood pressure in pregnancy, ask before discharge how to monitor it at home and who to call.

Postpartum blood clots: the leg and the breath

After a birth, blood clots more easily: it protects against haemorrhage, but it raises the risk of clots in the veins. The CNGOF puts this risk at around 1 in 1,000 after a vaginal birth and describes it as higher after a caesarean, a haemorrhage or prolonged immobility.

• A clot in a leg vein (deep vein thrombosis) usually affects one leg only: a painful, red, warm or swollen calf.
• A pulmonary embolism, when a clot travels to the lungs, causes chest pain and shortness of breath, sometimes coughing up blood or fainting. That means 141, immediately.

Getting up and walking a little each day, as soon as you can, is part of prevention. The rest of the nfissa (the forty days after birth) is not bed rest: you take care of yourself, but you move.

Your mood: what cannot wait

Crying easily in the first days is common: it is the baby blues, which passes in about ten days. Our article on the baby blues and postpartum depression helps you tell them apart.

Some signs, however, are emergencies. NHS hospitals describe, mostly in the first month, sudden changes: confusion, bizarre ideas, seeing or hearing things others do not, unusual excitement, or thoughts of suicide. They can worsen within hours. If you or your family notice this, call 141 or go to the emergency department the same day. It is neither weakness nor shame: it is an illness that can be treated.

What to report the same day, and what can wait

Not everything is an emergency. Here is how to sort, based on Irish, British and Quebec guidance.

Call your gynaecologist, midwife or the maternity unit the same day:

• fever of 38 °C or more, even with no other sign;
• discharge that smells foul or does not look like before;
• intense belly pain, or pain that does not ease;
• a perineum or scar that hurts more and more, is red, swollen or oozing;
• a red, warm, painful breast with fever;
• burning when you pee;
• a painful calf on one side;
• sadness that settles in, anxiety that keeps you awake even when baby sleeps.

Can wait for the six-week postnatal check, as long as you note it down:

• small urine leaks (to mention if they last beyond six weeks);
• pain during sex;
• tiredness with no other sign, hair loss, a belly that stays round.

Why we hesitate to call (and why we should not)

"It will pass", "I don't want to bother anyone", "it's normal, we all bled". You hear these phrases often during the forty days. The 2023 Moroccan study also notes that some women consider a check-up after birth pointless as long as they feel well.

Yet most of these complications are very treatable when caught early, and much less so when you wait. A fever treated on day one is nothing like an infection left for three days. A doctor will always prefer to see you for nothing than too late. For a full picture of what is normal during these weeks, reread our article on your body in the six weeks after birth.