When to see a provider: 5 postpartum conditions that new families should be aware of

During pregnancy, a woman’s body undergoes significant changes in order to create and sustain itself and the developing child. Organs change and shift constantly throughout the 10 months of pregnancy. While it is important to have consistent, regular checkups with a provider throughout a pregnancy, it is also equally important to be vigilant about the changes the body goes through during the recovery stage after giving birth. Dr. Tapti Panda, board-certified obstetrician and gynecologist at Crystal Run Healthcare, explains the post-birth recovery process and what to look out for.

“The post-birth recovery occurs gradually in three stages: acute stage recovery, which is a few hours after birth, sub-acute stage recovery or two to six weeks following birth, and the delayed recovery, which can last up to six months after delivery,” said Dr. Panda.

Every person’s birthing experience is different. Multiple factors can affect how long the recovery process will last and dictate complications. While both physical, mental, and emotional changes can be anticipated and expected during and after pregnancy, there are some symptoms or conditions that should be seen by a provider immediately.

1. Physical changes

Normal: Stretch marks and dark areas of skin around nipples, neck, cheeks, armpits, and genitalia develop during pregnancy and remain the first few weeks after delivery. They will slowly fade away, while any vertical lines across the stomach can remain for months or years postpartum. Women may also experience temporary hair loss around six months after birth and rapid weight loss around six weeks postpartum if they are breastfeeding.

When to seek care: Redness and excessive pallor (or pale appearance) accompanied by leg swelling may indicate the formation of a blood clot. Women should seek immediate medical attention if they see signs of a blood clot.

2. Bleeding after delivery

Normal: Bright red, heavy, period-like bleeding will last for up to two weeks following the birth, becoming lighter over the next few weeks. If women are nursing, their periods will likely stop until the newborn is weaned or they switch to supplemental formula. Women may also initially experience a heavier, longer, and sometimes more painful period.

When to seek care: It is not normal to be passing clots that are larger than the size of a quarter or to be changing more than two pads in one hour due to bleeding. Women who experience heavy bleeding or large blood clots postpartum should speak to a provider and seek immediate medical attention.

3. Pain & discomfort

Normal: Swelling of legs, hands, and face is normal in the first week of postpartum, especially if medications or IV fluids were used during labor. Muscle soreness, back pain, and fatigue can also last up to six weeks as the body recovers from the strenuous activity of labor and adjusts to constantly caring for a newborn. Pain at any surgical site, such as an episiotomy site or cesarean site, will gradually improve each week.

“Increasing your mobility, rest, and hydration, as well as using medications as advised at discharge, helps with alleviating pain,” said Dr. Panda. “Kegel exercises help improve pelvic floor pain and weakness in all women irrespective of the route of delivery. If you experience pain with intercourse it may be from tears or excess dryness from lower estrogen levels and it should abate with time.”

When to seek care: While some pain and discomfort after birth are normal, it can also be a sign that something is wrong. This could look like increasing pain with redness, swelling, or drainage from stitches, which indicates an infection, or persistent dizziness while walking may indicate anemia due to excessive blood loss. Chest discomfort, an inability to breathe, or sudden swelling of the hands and legs may indicate blood clot formation, embolism, or even heart failure. Headaches with visual changes and uneasiness with swelling of extremities may indicate high blood pressure. If intercourse is still painful three to six months later, consult an OBGYN to ensure there is no extensive tearing or damage.

4. Pelvic floor

Normal: The inability to hold urine or leaking of urine may occur the first few days after birth. Retraining the bladder, frequent bathroom intervals, and Kegel exercises will strengthen the pelvic floor muscle and helps regain control over bladder and bowel function.

When to seek care: If women cannot pass urine or if they are unable to hold their bladder after three months postpartum it is time to get an evaluation with a provider as this may be a sign of a prolapsed uterus. It is important to be aware of loosing stool through the vagina or passing stool without one's knowledge as it could indicate a fistulous tract between the vagina and rectum. This can occur if extensive repair was done postpartum or if nerve injuries occurred during labor.

5. Emotional changes

Normal: “Labor is a very emotional experience and the reality of caring for a newborn can exacerbate emotional responses during this time,” said Dr. Panda. “Crying spells, feeling overwhelmed, frustrated and helpless are common symptoms of postpartum blues and can occur in all moms, especially first-time moms. Moms with a large or consistent support network often experience less depression than those without.”

When to seek care: If a persistent depression occurs, such as feeling low, not wanting to eat, unable to sleep, or harboring ideas of harming yourself or your baby, then it is important to seek qualified help immediately. Symptoms of Postpartum Depression (PPD) tend to last longer and be more intense than baby blues and can interfere with one’s ability to care for a baby. PPD affects 1 in 7 parents and is a common and treatable condition.

It is important to schedule and attend a postpartum OBGYN visit with a provider and discuss postpartum experiences and symptoms. Inadequate postpartum care can negatively affect one’s health, especially those with chronic medical conditions, which can result in poor family planning in the months following a child’s birth. Unplanned pregnancies or inadequately spaced pregnancies can lead to compounded issues for new mothers. 

Obstetricians and gynecologists at Crystal Run Healthcare are committed to all aspects of women’s health. Crystal Run’s OBGYN providers offer a full range of gynecological care for women of all ages, including routine exams, Pap smears, prenatal and obstetrical care, as well as in-office procedures and minimally invasive surgeries. Our OBGYNs provide comprehensive postpartum care to new moms and their families, thereby facilitating a full range of services including referrals to other specialties, postpartum exam lab checks, contraception counseling, newborn feeding issues, and more.

Tapti Panda, MD, is a board-certified obstetrician and gynecologist. She earned her medical degree from Rajah Muthiah Medical College and completed her residency and internship in obstetrics and gynecology at Bronx Lebanon Hospital Center, Bronx, New York. Her clinical interests include gynecology, reproductive endocrine, and pediatric gynecology. Dr. Panda provides care to patients in Warwick and Rock Hill, New York.