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Postpartum symptoms: when to call us

As you enter your “4th trimester,” you may notice changes in your body as you heal. We’ll be checking in with you a week after your birth, and again a few weeks later. Though you will be busy caring for your new baby, we encourage you to check in with yourself and monitor how you are feeling physically and emotionally. We are here to help you navigate this phase and answer your questions and, in particular, please reach out to if you are experiencing any of the below warning signs.

Postpartum bleeding

You can expect to have vaginal bleeding for about six weeks after the birth of your baby.  The bleeding will taper from dark red to brown to yellow.  In the first few days after the birth, you might notice that you pass some small blood clots.  As you recover, you will notice that the bleeding might get heavier if you’ve had a busy day.  This is normal.  This bleeding is called “lochia.” Lochia has an earthy smell. 

It is also normal to notice a return to bright red bleeding at about 7 to 10 days after the birth, this is called eschar.  Eschar happens when the scab over the placental site breaks down – in much the same way that a scab on your knee might bleed if you disrupted it, the scab in your placenta can cause a day or two of red bleeding a week or two after the birth.  

When to call us: If you notice that your bleeding is heavy, bright red, and soaking through more than two pads per hour, or if you are passing clots the size of a lemon or larger.

Fever or Infection

Fever can be a sign of infection. Other signs of uterine infection include severe abdominal pain or foul-smelling discharge.  

When to call us: If you have a fever higher than 100.4F, or severe pain and foul-smelling discharge.

Cramping

Cramping in your uterus is normal after birth. You might notice that the cramping is more intense when you are breast/chest feeding, especially if this is not your first baby.  You can take Tylenol or Ibuprofen to help with the cramping.

When to call us: If you have pain that is severe or that does not respond to medication.

Symptoms of Postpartum Preeclampsia / Headache

As your hormones fluctuate postpartum, headaches can be common. The lack of sleep can contribute as well! Make sure you are well hydrated.

However, a headache (especially a headache that does not resolve with ibuprofen or tylenol) can be a symptom of preeclampsia.  Other signs of preeclampsia include swelling (you might notice it in your hands, your feet, or your face), visual changes such as flashing lights or blank spots in your field of vision, nausea/vomiting, or pain on the upper right side of your abdomen. 

When to call us: If you have a headache that does not respond to Ibuprofen or Tylenol or any other signs of postpartum preeclampsia. 

Breast Changes

Your body will make milk regardless of whether you are breast/chest feeding.  Your breasts are likely to become engorged (full of milk) three or four days after the birth.  Engorgement can also cause you to have a low-grade fever (less than 100.4F).  

If you are breastfeeding, it is important to put the baby to the breast, or otherwise drain the breast (pump, hand-express) every 2-4 hours, round the clock.  This will give your body signals to make milk in the right amount for your baby. 

It is possible to develop plugged milk ducts, and plugged ducts can lead to infection, also known as mastitis. If you notice that you have any lumps in your breast, you need to get that milk moving – stand in the shower and let the warm water run on the breast while you massage the lump.  You can also try feeding the baby in alternative positions like the football hold or dangle feeds. Some women who are prone to plugged ducts also benefit from soy lecithin supplements (take one 1200 mg capsule 3-4 times per day, reduce dosage by one capsule per day when the blockage has resolved for one week). 

If you have hard, painful areas in the breast that look red & feel warm to the touch, you may be developing mastitis.  It is important to stay very well hydrated, take Ibuprofen for its anti-inflammatory properties, and drain the breast completely.  

When to call us: If you develop symptoms of mastitis along with fever over 100.4F and malaise (you feel unwell), as you may need antibiotics.  

Blood Clots

If you notice that you have one leg that is more swollen than the other, especially if the affected leg is dusky or grey/purple colored, or if you have pain in your calf or the back of your thigh, you might have developed a blood clot.

Go to the emergency room: If you have these symptoms and are also experiencing shortness of breath.

Mood Changes

Mood changes are very common in the first few weeks postpartum.  About 85% of women experience the “baby blues” after birth.  You might notice that you are laughing one moment and crying the next.  These mood swings are caused by hormone changes combined with the sleep deprivation and role changes that you experience as the parent of a newborn.  Your mood should feel more stable by the time the baby is one month old.  

Postpartum depression and anxiety are less common than the baby blues, but can cause mood changes up to a year after your birth.  Please don’t discount mood changes that are causing issues for you, these issues are real and treatable. 

When to call us: if you’d like to discuss what you’re feeling or if you’d like a referral to mental health therapist that specializes in postpartum. But if you have any thoughts of doing harm to yourself or the baby, you need emergency attention.  

Wounds that aren’t healing

If you have an abdominal incision or perineal wound, you will need to keep those areas clean & dry as they heal. Let soapy water run over them in the shower and pat to dry. Be sure to expose the incision to good air-flow (don’t keep it covered all day). 

Our c-section patients will come to the office two weeks after the birth so we can look at your incision and remove any remaining dressings.

If you have a perineal or vaginal laceration, the stitches will dissolve and do not need to be removed.  You might notice pieces of the stitch material on your toilet paper about a week after the birth.  Use the peri-bottle to spray the area to clean it and pat dry with toilet paper.  You can keep ice on the area for the first 24 hours, and do warm sitz baths (shallow baths that dunk your perineum in warm water) 2-3 times per day until the area feels better.  Sitz baths provide cleaning and improved circulation to this delicate area. They are soothing and therapeutic — don’t skip them! You can add healing herbs or epsom salts to the water in the sitz bath, but even plain warm water has the desired effect. 

When to call us:  If you notice that the incision is bleeding, opening, leaking pus, if areas of redness on the edges are getting larger, or if you are not able to manage your pain with the medications you were given.