Postpartum and Birth Complication Care

Symptoms

• Heavy bleeding: Soaking through more than one pad an hour, or passing clots larger than an egg, may signal postpartum hemorrhage.
• Severe or worsening headache: A pounding headache, sometimes with vision changes or upper-belly pain, can point to postpartum preeclampsia.
• Fever: A temperature of 100.4°F (38°C) or higher can indicate a uterine, wound, breast, or bladder infection.
• Chest pain or trouble breathing: Sudden shortness of breath or chest pain can signal a blood clot in the lungs or a heart problem.
• Leg swelling or pain: Redness, warmth, or pain in one calf or thigh may be a deep vein blood clot.
• Signs of wound or uterine infection: Increasing pain, redness, drainage, or foul-smelling discharge from a C-section incision, tear, or the uterus.
• Severe mood changes: Overwhelming sadness, severe anxiety, or thoughts of harming yourself or your baby need urgent help.

When it's an emergency

Call 911 immediately if, within the year after delivery, you have heavy bleeding (soaking more than one pad an hour or passing large clots), chest pain, trouble breathing, a seizure, fainting, or thoughts of harming yourself or your baby. These can be signs of postpartum hemorrhage, a blood clot in the lungs, eclampsia, or a mental health emergency, and they need immediate treatment.

Come straight to Bellaire ER for a severe or constant headache, especially with blurred vision, swelling of the face or hands, or pain in the upper right belly. After delivery these can be signs of postpartum preeclampsia or dangerously high blood pressure, which can develop even in women who had normal blood pressure during pregnancy.

Seek emergency care for a fever of 100.4°F (38°C) or higher, worsening belly or pelvic pain, redness or drainage from an incision or tear, or foul-smelling discharge. Postpartum infections can spread quickly and progress to sepsis if not treated promptly.

Red swelling, warmth, or pain in one leg, or new calf pain, can be a deep vein clot and should be checked the same day, because a clot can travel to the lungs.

Bellaire ER evaluates and stabilizes postpartum emergencies on-site 24/7 with labs, ultrasound, and CT, and arranges hospital transfer when admission is required.

When it's not an emergency

Some discomfort is a normal part of recovery and does not require the ER. Mild afterpains, gradually decreasing light bleeding or discharge, breast fullness, and soreness at a healing incision or tear can often be managed at home or reviewed with your OB or midwife at a routine visit.

For questions about normal healing, breastfeeding, mild mood swings (the temporary "baby blues"), or how much bleeding is expected, a telemedicine visit or a call to your OB, midwife, or primary care provider is a reasonable first step.

When you are unsure whether a symptom is serious, treat bleeding, severe headache, chest pain, trouble breathing, fever, or thoughts of self-harm as an emergency and be seen in person. When in doubt, it is always safer to come in.

What else could be causing this

Postpartum hemorrhage

Heavy bleeding after delivery, most often because the uterus has not contracted down firmly, or because placental tissue has been retained, or from a tear. Soaking more than one pad an hour, passing clots larger than an egg, or bleeding that gets heavier rather than lighter. It can occur in the first day or appear up to twelve weeks later, and it is the complication that can deteriorate fastest.

Postpartum preeclampsia and eclampsia

Dangerously high blood pressure developing after delivery, often in women whose blood pressure was normal throughout pregnancy. A severe or constant headache, blurred vision or seeing spots, swelling of the face or hands, and pain in the upper right abdomen. Most commonly in the first week but possible up to six weeks after birth. A seizure means eclampsia and is a emergency care call.

Endometritis and uterine infection

Infection of the lining of the uterus, more common after a caesarean delivery or a prolonged labor. Fever, worsening lower abdominal or pelvic pain, a tender uterus and foul-smelling discharge, usually in the first week or two. It responds well to antibiotics and progresses to sepsis if it is left.

Pulmonary embolism

A blood clot that has travelled to the lungs. Sudden breathlessness, chest pain that is worse breathing in, a racing heart, faintness, or coughing up blood. Pregnancy and the postpartum period raise clotting risk substantially, and the weeks after a caesarean delivery are the highest-risk window of all. It is among the most common causes of sudden postpartum collapse.

Deep vein thrombosis

A clot in a deep leg vein. Swelling of one whole leg, with calf or thigh pain, warmth and discoloration, the asymmetry is the point, since both legs often swell after birth. It matters because it is the source a pulmonary embolism travels from, so it is treated urgently rather than monitored.

Wound and perineal infection

Infection of a caesarean incision or of a tear or episiotomy repair. Increasing rather than settling pain after the first few days, spreading redness, warmth, swelling, drainage or separation of the wound edges, with or without fever. The direction of travel, better or worse, is more informative than how it looks at one moment.

Mastitis and breast abscess

Infection in breast tissue, usually from a blocked duct. A wedge-shaped red, hot, painful area of one breast with fever and flu-like aching. It is treated with antibiotics and continued milk removal rather than by stopping feeding. A firm, tender lump that persists after treatment may be an abscess needing drainage.

Postpartum depression, anxiety and psychosis

Distinct from the brief low mood of the first week or two. Persistent overwhelming sadness, severe anxiety, inability to sleep even when the baby does, or inability to care for yourself or the baby. Thoughts of harming yourself or the baby, confusion, hallucinations or losing touch with reality is a psychiatric emergency requiring immediate care, not something to wait out until the next appointment.

Peripartum cardiomyopathy

Weakening of the heart muscle in late pregnancy or the months after delivery. Breathlessness lying flat or on mild exertion, waking at night breathless, swelling of the legs, a racing heart and fatigue well beyond what is expected. Easily attributed to normal recovery, which is why breathlessness in a new mother is examined rather than assumed.

Urinary retention and urinary infection

Difficulty passing urine after delivery, particularly following an epidural or an instrumental birth, or a bladder or kidney infection. Burning, frequency, lower abdominal pressure, inability to empty the bladder, or fever with flank pain. Uncomfortable and straightforward to treat, and worth distinguishing from the more serious causes of postpartum fever.

What happens when you arrive

When you arrive at Bellaire ER after childbirth, a board-certified emergency physician will see you quickly and check your blood pressure, temperature, heart rate, and oxygen. Your evaluation may include lab work to look for anemia, infection, or clotting problems, and imaging such as ultrasound to assess bleeding or CT to look for a blood clot, depending on your symptoms.

Treatment is tailored to what we find: medication to control bleeding and firm the uterus, IV fluids and antibiotics for infection, blood pressure medication for postpartum preeclampsia, or blood thinners for a clot. We can perform these evaluations and start treatment on-site, in a single visit.

Most patients are diagnosed and treated without needing a hospital transfer. If a condition requires admission or specialty care, we stabilize you first and coordinate the transfer. Before you leave, your physician explains your results and gives you a clear follow-up plan.

Tests we can run on site

Blood pressure and vital signs

Blood pressure, heart rate, temperature, respiratory rate and oxygen saturation, with repeated blood pressure readings. This is the most important measurement of a postpartum visit: it identifies preeclampsia, which has no other reliable sign, and it shows the early changes of hemorrhage and of sepsis.

Blood work

A blood count for anemia and for signs of infection, platelets, liver and kidney function, and clotting studies. The liver and kidney results are specifically how preeclampsia is confirmed and graded, and the blood count establishes how much blood has actually been lost.

Urine testing

Urinalysis for protein, which supports a diagnosis of preeclampsia, and for infection. A urine culture identifies the organism when an infection is found.

Pelvic ultrasound

Sound-wave imaging of the uterus, without radiation. It shows retained placental tissue or clot inside the uterus, the common, treatable cause of bleeding that continues or returns after delivery, and assesses the uterus and ovaries.

Leg ultrasound (venous Doppler)

Imaging of the deep veins of the leg to find a clot. It is the test for a swollen, painful leg, and it identifies the source that a pulmonary embolism would travel from.

CT scan

Cross-sectional imaging, used when a clot in the lung is a possibility, or to look for an abscess or a collection of blood inside the abdomen or pelvis. It is the test that confirms or excludes pulmonary embolism, which cannot be settled on examination.

EKG and cardiac testing

A recording of the heart's electrical activity, with a troponin blood test where appropriate. Used for chest pain, breathlessness or palpitations, to identify rhythm disturbance, heart muscle injury, and the strain pattern that can accompany a large clot in the lung.

Blood cultures

Drawn when there is fever or signs of a spreading infection, to detect bacteria in the bloodstream. They identify the organism and guide antibiotic treatment when the source is not obvious.

Mood and safety assessment

Direct questions about mood, sleep, intrusive thoughts and thoughts of harming yourself or the baby. It is asked routinely, not because of anything you have said, and answering honestly is what makes help available. It is the only way these conditions are found.

Treated here, or transferred

Bellaire ER is a licensed freestanding emergency room: board-certified emergency physicians and nurse practitioners, on-site CT, X-ray, ultrasound and laboratory, medication administered on site, open 24 hours a day, 365 days a year for adults and children. It is equipped for emergency evaluation, stabilization and treatment, and it is not a hospital. It has no labor and delivery unit, no operating room, no intensive care unit and no inpatient beds. Which is worth stating plainly on this page, because what an obstetric emergency needs is often exactly those things.

A great deal is nonetheless done here. Blood pressure that is dangerously high is treated with medication immediately rather than after arrival somewhere else, which is what protects against a seizure. Bleeding is assessed and treated with medication to contract the uterus, with IV fluids and with blood tests to establish the loss. Infections: endometritis, wound infection, mastitis, urinary and kidney infection, are diagnosed and treated with oral or IV antibiotics, given on site where that is needed and prescribed for you to fill at your pharmacy to continue at home. A clot in the leg or lung is identified by ultrasound or CT and anticoagulation is started. Urinary retention is relieved. Pain and nausea are treated. And the evaluation itself: blood pressure, bloods, ultrasound, CT, is what determines which of the serious causes is present.

Much of it then needs a hospital. Significant hemorrhage requiring transfusion or a procedure to empty the uterus, retained placental tissue, severe preeclampsia or eclampsia requiring magnesium and obstetric management, a large pulmonary embolism, sepsis, peripartum cardiomyopathy, a wound needing surgical repair, or a mental health emergency requiring psychiatric admission will be stabilized here and transferred. In obstetric emergencies the treatment started in the first minutes: blood pressure control, uterine medication, fluids, antibiotics, anticoagulation, is what determines the outcome, and all of it continues without interruption during transfer to the obstetric, surgical or psychiatric service that will take over. Transfer here is not a shortfall of the visit; for a postpartum emergency it is frequently the whole point of coming in, and arriving somewhere with treatment already running is better than arriving without it.

If you have delivered within the past year, say so on arrival, even if your symptom seems unrelated. It changes which conditions are considered first, and it is the single most useful thing you can tell the person assessing you.

Children

This page is about the person who gave birth, but the newborn is usually in the room, and the warning signs in a baby are worth carrying alongside your own. Any temperature of 100.4°F or higher in an infant under three months is an emergency evaluation in its own right, however well the baby looks, because a newborn's immune system cannot contain an infection locally.

Bring a newborn in for poor feeding or taking less than about half their usual volume, unusual sleepiness or difficulty waking, floppiness, persistent inconsolable crying, fast or labored breathing, skin pulling in between the ribs, grunting, pauses in breathing, bluish or grey lips or skin, a temperature that is low rather than high, fewer wet diapers than expected, a sunken soft spot, deepening jaundice or jaundice appearing in the first 24 hours, vomiting that is green or forceful, or a swollen, tender abdomen. Newborns show serious illness non-specifically, so not seeming right is itself a reason to be seen.

Some maternal conditions bear directly on the baby. An untreated maternal infection matters for a newborn; maternal mastitis does not harm a breastfed baby and feeding should continue; and most antibiotics and anticoagulants given to a mother are compatible with breastfeeding, which is worth confirming rather than assuming the opposite and stopping. If you are admitted or transferred, ask about keeping the baby with you and about expressing to maintain supply. These are reasonable things to ask for and they are usually accommodated.

Maternal mental health is a newborn's health. Severe anxiety, intrusive thoughts, inability to sleep when the baby sleeps, or thoughts of harming yourself or the baby need immediate help, and seeking it protects both of you.

Bellaire ER treats adults and children, including newborns, with on-site laboratory, ultrasound, X-ray and CT, open 24 hours a day with no appointment needed. A newborn requiring admission, a neonatal unit or specialist pediatric care is stabilized here and transferred to a hospital with that service, and a mother and baby who both need inpatient care are transferred to a facility that can take both.

After you leave

Say it to every clinician you see for the next year: I gave birth on this date. Postpartum complications are routinely missed because the connection is not made, and the window for several of them: preeclampsia, clots, cardiomyopathy, hemorrhage, depression, extends weeks to months beyond the six-week check. You are the one most reliably able to make that connection.

Take what you were prescribed exactly as directed and finish antibiotic courses even once you feel better. If you were started on a blood thinner, do not stop or skip doses, and ask specifically about breastfeeding compatibility, most postpartum medications including common antibiotics and anticoagulants are compatible, and you should be told which yours is rather than left to guess or to stop feeding. If you were given blood pressure medication, keep taking it and get a home blood pressure monitor if you were advised to; blood pressure after preeclampsia needs following for weeks.

Call 911 for heavy bleeding, chest pain, trouble breathing, a seizure, fainting, or thoughts of harming yourself or your baby. Come back immediately for bleeding that soaks more than one pad an hour or clots larger than an egg, a severe or constant headache, blurred vision or seeing spots, swelling of the face or hands, pain in the upper right abdomen, a temperature of 100.4°F or higher, worsening abdominal or pelvic pain, foul-smelling discharge, a red or swollen incision or one that is opening, swelling or pain in one leg, breathlessness lying flat or waking you at night, or a racing heart.

Bleeding should get lighter over the weeks, not heavier. Pain should settle, not increase. An incision should look better each day. Any of those reversing direction is the signal to be seen rather than to wait for the next appointment.

Keep your postpartum appointments, and ask for an earlier one if you need it. For mood: low mood and tearfulness in the first two weeks is common and usually passes, while symptoms that persist beyond that, or that stop you functioning, are postpartum depression and they are treatable. Tell someone. The 988 Suicide and Crisis Lifeline is available by call or text at any hour. Asking for help is not a failure of motherhood, and the conditions on this page are not caused by anything you did.

Lowering your risk

Not every postpartum complication can be prevented, but knowing the warning signs and acting early makes a real difference. Attend your scheduled postpartum checkups, keep taking any prescribed blood pressure or other medications, and monitor your bleeding, temperature, and mood at home.

Stay hydrated, move gently as your provider advises to reduce clot risk, and keep any incision or tear clean and dry. Do not ignore a symptom because you feel you should be recovering. Call your provider or seek care whenever something feels wrong.