Written by

Roxanne Albert, BSN, RNC-OB

September 16, 2022

9 Postpartum Warning Signs: When to Seek Help After Birth

Postpartum

When to see your provider for help in the postpartum period!

There are a number of reasons to be seen postpartum that range from non-urgent needs to emergency. Knowing the postpartum warning signs — when to seek care immediately and what reasons could wait till you see your provider, or till the morning — can be helpful!

Below are reasons to seek care quickly!

Postpartum Warning Signs: The POST-BIRTH Acronym

The acronym POST-BIRTH was created by AWOHNN (Association of Womens Health, Obstetric, and Neonatal Nurses). This was created to help those who are postpartum understand when to seek care during the first few days to weeks postpartum. It is separated into emergency reasons and urgent reasons.

POST = EMERGENCY, SEEK CARE IMMEDIATELY

BIRTH= Urgent, call provider ASAP, in unable to reach them call 911

Pain in chest
Obstructed breathing or shortness of breath
Seizure
Thoughts of harming yourself or others

Bleeding
Incision not healing
Red or swollen legs
Temperature
Headache

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POST

Below are the reason to seek care IMMEDIATELY by either going to an ER or calling 911

1. Pain in Chest

Any sudden onset pain in the chest that is not relieved by anything. This could be a sign of some sort of heart issue postpartum, to include a heart attack. It could be due to the stress of labor and birth on your body or other interventions.

Or pain in the chest, with or without #2 below, can be a sign that a blood clot that had formed in your deep veins has dislodges and traveled to your lungs. This is know as a pulmonary embolism, or PE. During pregnancy and postpartum we are the highest risk of developing these clots in our legs because of the changes in our body during pregnancy.

Both of these reasons are an EMERGENCY need to seek help.

2. Obstructed breathing or shortness of breath

Any difficulty breathing, or even could just feel like you either have trouble catching your breath or can take a deep breath. This could mean that a blood clot has traveled to your lungs and needs to be addressed ASAP!!

3. Seizure

Any sort of seizure is an emergency, but when it occurs postpartum this is usually due to a condition called Eclampsia. This is caused when blood pressure in elevated to a high number and it has started affecting the body as a whole.

Usually there are signs before this occurs, but sometimes the eclamptic seizure occurs without any symptoms.

4. Thoughts of harming yourself or others (to include baby)

This could be a sign of Postpartum Depression, or potentially something more sever called Postpartum Psychosis. Read more about Postpartum Mood Disorders in our blog here.

If there are thoughts of harming others, this is an emergency! We want to avoid any harm to yourself or baby, while getting you the help you need to feel like yourself again!

Sometimes you may not be able to see it in yourself, but friends and family should know what to look for to seek help for you!!

Birth

These are reasons to seek care urgently, but try calling your provider first!

5. Bleeding

For Postpartum bleeding complications there are two reasons to seek help.

1. If you are soaking a menstrual pad completely in 1-2 hours, or having any clots larger than an egg. This is a sign of a Postpartum Hemorrhage (Read more on PPH Here). Postpartum Hemorrhage is a medical emergency, so seeking help ASAP is advised. This can occur anytime postpartum, but highest risk is the first 24-48 hours.

2. If you are having the bright red bleeding for a long period of time, like weeks. It could fluctuate between heavy bleeding and light bleeding. Normally the red (rubra) bleeding only lasts for for 1-2 weeks. If it surpasses that timeline, then reaching out to your provider to be assessed for retained placenta fragments. This could cause prolonged bleeding and inhibit recovery.

6. Incision not healing

When your incision, episiotomy site, or laceration site has redness, pus discharge/drainage, or does not seem to be healing. This could be a sign of an infection this needs to be treated urgently, but usually not an emergency. So being see by your OB in office or at the ER if they are not available.

If at your episiotomy or laceration site has healed, but it is still sensitive, painful, or bleeding. This could be what is called granulation tissue. This is an overgrowth/overhealing of tissue at that site. This can be treated in the office and not an emergency. It is VERY uncomfortable though, so seeking care is helpful.

7. Red or swollen legs

This is a sign of a blood clot in your leg, especially if felt in your calf muscle. One leg may be more swollen than the other. It could also be painful in the calf when dorsiflexing your foot (bringing the foot towards your body), this is called the homan sign.

This is something called a Deep Vein Thrombosis (DVT). It is important to get this assessed and treated to avoid the clot from dislodging and traveling to the lungs (See Reason #1)

Avoid massaging it if you are concerned!

8. Temperature of 100.4F or higher

Any fever is a sign of an infection! There are different types of infections you can get in the postpartum that range from an infection of the milk ducts in the breast (mastitis) to an infection of the uterus (endometritis). Being treated promptly to avoid any further complications is recommended!

9. Headache, or headache with vision changes

A headache not relieved with Tylenol or other measures or vision changes with or without a headache are signs of something called Pre-eclampsia. This is related to blood pressure issues related to the pregnancy. Even if you did not have any issues with blood pressure during pregnancy, it can have a new onset develop in the postpartum! So be aware o the symptoms to look for in the postpartum can help prevent it from going untreated and progressing to Eclampsia (see #3)

There are other reasons to seek out care from your provider postpartum that may be important to you, trusting your gut in the postpartum is important. You are the only one that knows your body the best, if you feel like something is off, SEEK HELP!!

Learn more about What to Expect Postpartum in our webinar on Sept 27th at 730pm EST

Frequently Asked Questions

What are concerning symptoms after birth?

The most serious postpartum warning signs are pain in your chest, obstructed breathing or shortness of breath, a seizure, and thoughts of harming yourself or others — these are emergencies, so go to an ER or call 911 right away. Other signs are urgent rather than emergent: heavy bleeding (soaking a pad in 1–2 hours or clots larger than an egg), an incision that isn't healing, red or swollen legs, a fever of 100.4°F or higher, or a headache that won't go away. You know your body best — if something feels off, trust your gut and seek help.

When does PPD start?

Postpartum depression usually becomes apparent when symptoms like extreme sadness, anxiety, and fatigue persist past 2–4 weeks postpartum — beyond the window of the "baby blues," which affect around 85% of people and typically resolve within the first two weeks. PPD can also begin during pregnancy (called prenatal depression), and some people report it developing later in their postpartum year. It can last from a few months up to a year, and the earlier it's treated, the quicker symptoms usually resolve — learn more in our guide to postpartum mood disorders and when to get help.

What to expect in the first two weeks postpartum?

By the second week, bleeding should be lighter and shifting from bright red to darker red or brown — though a brief return of bright red blood around days 7–10 is normal as the placental scab comes off. You may experience night sweats as your body sheds extra fluid, headaches from sleep deprivation or hormone changes, and most first- and second-degree tears are largely healed by the end of week two. Gentle movement like diaphragmatic breathing and short 10–15 minute walks can support healing — we break it all down in our week two postpartum guide.

What does your body feel like after giving birth?

In the first days after birth, expect heavy bright red bleeding (lochia), cramping as your uterus contracts back down — often stronger while nursing — and breast engorgement around days three to five as your milk comes in. You may also feel some heaviness in your pelvic floor, which is often tension rather than prolapse, and emotionally you're navigating "matrescence" — the identity shift into parenthood alongside big hormone changes. Rest is the priority, but gentle movement like diaphragmatic breathing can support healing — see our full week one postpartum guide.

What are the first signs of postpartum depression?

The key is watching what happens after the baby blues window (roughly the first three weeks): symptoms should be improving, not staying the same or getting worse. Early signs include still feeling really teary, difficulty regulating your emotions, trouble feeling connected to baby, feelings of guilt or worthlessness, loss of interest in activities you usually enjoy, and scary intrusive thoughts. Postpartum rage is another sign that isn't talked about enough — we explore all of these in our conversation with perinatal psychologist Chelsea Bodie.