Postpartum Complications

Postpartum is the first 6 weeks after delivery of a baby. It is a crucial period which affects maternal morbidity and mortality, thus much health care is necessary during this period.  

Maternal mortality is a major concern worldwide with high prevalence in low-come and developing countries. Most deaths are caused due to postpartum (post-delivery) complications such as severe bleeding and infections. In order to avoid most of these complications, it is essential to understand them and how they affect the health of the mother.

Below are some of the common problems a mother after her first delivery may present with:

  • Infections (including uterine, bladder, lungs, etc.).
  • Excessive bleeding after delivery (postpartum hemorrhage).
  • Pain in the perineal area (the area between the vagina and rectum).
  • Vaginal discharge.
  • Problems of the breast such as swollen breasts, infections, and blocked ducts.
  • Stretch marks.
  • Hemorrhoids and constipation.
  • Urinary or stool incontinence.
  • Hair loss.
  • Postpartum depression.
  • Discomfort during sexual intercourse.
  • Difficulty in regaining initial physique and stature before pregnancy.

Well note to bore you with the details, let us delve more into the major complications.

  1. Postpartum bleeding (hemorrhage): Some amount of bleeding is normal after delivery, however when it is heavy or severe, it is a matter of concern to the health care provider.

Severe bleeding is mostly seen with multiple births such as twins, prolonged labor or when the uterus has become infected.

Postpartum bleeding is currently the third most common cause of maternal deaths. This occurs secondary to a range of causes; failure of the uterus to contract properly retained product of conception, coagulopathies and/or tears in the uterus, cervix or vagina. 

  1. Uterine infections: Usually, separation of the placenta from the uterine wall during delivery occurs within 20 minutes after childbirth. When pieces of the placenta remain in the uterus (retained placenta), it can lead to an infection.

The uterus can also be infected through infections of the amniotic sac (the bag of water surrounding the infant). Uterine infections are usually indicated when there is the presence of a high fever accompanied with a rapid heart rate, abnormally high white blood-cell count, swollen and tender uterus, and foul-smelling discharge from the vagina. 

  1. Kidney infections: These infections occur when bacteria spreads from the bladder into the ureters. Symptoms include urinary frequency, urinary urgency, high fever, malaise (sick feeling), pain in the lower back, constipation, and painful urination. 
  1. Vaginal discharge: The first week after delivery is initially characterized by a bloody heavy discharge from the vagina. This discharge consisting of placental remnants and blood is called lochia. This discharge normally lightens and gradually changes color (red → pink → white or yellow) before it eventually stops. This becomes an issue of concern, when it doesn’t change color and remains bright red for about 10-14 days with an increase in volume. 
  1. Breast infection and engorgement: The breasts are normally swollen particularly after delivery. This is as a result of the breast milk produced for the infant. Breast infection is indicated by a tender, reddish area of the breast. It could involve the entire breast. These infections are accompanied by fever, fatigue, headaches, nausea and vomiting. Stress, exhaustion or cracked nipples can predispose one to these infections. Mastitis or breast infection does not an effect on breast milk. 
  1. Hemorrhoids and constipation: This complication is normally aggravated by pressure from the enlarged uterus and fetus on the lower abdominal veins. This is common not only in pregnant women but postpartum women as well. 
  1. Urinary and stool incontinence: These normally plague a lot of new mothers shortly after childbirth. This inadvertently occurs when laughing, coughing or straining. This is due to the stretching of the base of the bladder and rectum during pregnancy and delivery. 

In view of all these common but complex complications, it is essential to plan your pregnancy and avoid these complications by the following steps:

  • Report any heavy bleeding to your health practitioner immediately.
  • Routine examination and laboratory tests at the hospital to prevent infections and anemia.
  • Surgical removal of placental tissue if present in the uterus on ultrasound imaging.
  • Use of prescribed antibiotics from your health practitioner to prevent fatal complications such as toxic shock.
  • Follow your health practitioner’s instructions in taking care of sutured incision sites, to prevent infection. Seek medication attention, if surgical incision sites are red, swollen or draining with pus.
  • Routine laboratory tests of urine samples by your health practitioner to prevent renal infections.
  • Drink plenty of fluids as instructed by your health care provider.
  • Follow course of antibiotics prescribed by your health care provider.
  • Report any foul-smelling vaginal discharge with heavy bright red bleeding lasting for about 10 to 14 days to your health care provider.
  • Wear well-fitting support brassieres and place ice packs on breasts to reduce swelling.
  • Use of pain relief medication as prescribed by your health care provider to reduce pain in breasts.
  • Use of warm wet towels on affected areas of the breast with mastitis.
  • Rest and drink plenty of fluids to alleviate breast infection.
  • Ensure a regular breastfeeding pattern to prevent clogged ducts, swollen breasts or mastitis.
  • Cold compresses on hemorrhoids to relieve swelling and offer relief.
  • Ensure diet rich in fiber and fluids to reduce constipation and swelling of hemorrhoids.
  • Kegel exercises are recommended to restore muscle sphincter tone of bladder and rectum.
  • Wear protective undergarments or sanitary pads in the presence of urinary and fecal incontinence.

KEY POINTS

  • Improper postpartum care can lead to maternal death.
  • Sexual intercourse can be painful after delivery of the newborn.
  • Bleeding is one of the most common problems during postpartum period.
  • Did you know you can have a vaginal discharge of up to 6 weeks after delivery?
  • It takes a longer time to get back to your normal weight after delivery.
  • Painful urination and a sore vagina are common in postdelivery period.