Rania Habib, DDS, MD (Host): All women should feel empowered to speak up about their health, especially after childbirth. In this episode, we will learn how to recognize symptoms of postpartum complications, including common signs, risk factors, and steps new mothers can take if they suspect a complication.

 Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm your host, Dr. Rania Habib.

Rania Habib, DDS, MD (Host): Joining me today is Dr. Kendra Coles, the Director of Women and Children's Services at UM Baltimore Washington Medical Center. She earned her Doctorate in Nursing Practice and brings over 26 years of nursing experience and 20 years of leadership experience to her position. Welcome Dr. Coles. We are so honored to have you on the podcast today.

Kendra Coles, DNP, RNC-OB, C-EEFM, NEA-BC: Thank you, Dr. Habib. Thank you for this opportunity to talk about the warning signs and complications after childbirth.

Host: What are some common complications that might occur after childbirth, and how soon or long after childbirth might these complications occur?

Kendra Coles, DNP, RNC-OB, C-EEFM, NEA-BC: The most common complications a woman can experience after childbirth include vaginal bleeding, breast engorgement, swelling in their legs or arms. They may have some abdominal cramps or pain that's usually due to the uterus shrinking back to its original size. And women also experience periods of depression.

It's important to keep track of these symptoms and to alert the care provider if they continue to increase in severity, as they may indicate severe levels of complications. Some of the complications that we also see in women that are rare, but they are indicative of a more severe complication; may include hemorrhage, cardiac conditions, women may experience pulmonary edema, and infections.

If a patient also had complications or high risk conditions during their pregnancy like hypertension or diabetes, just because after they have the baby, it doesn't mean those conditions immediately go away. So they should continue to seek care with their provider, both the obstetric provider and their primary care physician.

Host: How soon or long after childbirth might these common complications that you mentioned actually occur?

Kendra Coles, DNP, RNC-OB, C-EEFM, NEA-BC: Great question. So the majority of postpartum complications usually occur between seven days up to six weeks postpartum is when we tend to see some of these conditions occur. But when we talk a little bit more about high risk or severe complications of childbirth that usually relates to maternal morbidity and mortality; we think about the what CDC considers a maternal death.

So according to the CDC, a maternal death is associated with pregnancy related complications up to one year after giving birth.

22 percent of maternal deaths occur during pregnancy, 25 percent occur at the day of delivery and up to seven days. But 53 percent of postpartum complications and maternal deaths is seen 7 days and up to 1 year is how the CDC is looking at maternal risk factors. So we're encouraging our patients at Baltimore Washington Medical Center to continue to look for symptoms and complications of pregnancy up to 1 year, notifying their providers right away.

The greatest risk of maternal complications is usually within that first seven days up to six weeks, but we still know the risk can linger on with severe complications and risk factors up to one year.

Host: That's incredible. I think even as physicians, we don't often realize that that can continue up until that year and they're still considering that associated with the postpartum complication. So that's a really great reminder about that timeframe.

Kendra Coles, DNP, RNC-OB, C-EEFM, NEA-BC: Absolutely.

Host: How can mothers differentiate between normal postpartum symptoms and signs of potential complications?

Kendra Coles, DNP, RNC-OB, C-EEFM, NEA-BC: The severity of symptoms will differ for each patient. We like to say when in doubt, check it out. If patients have blood pressure cuffs at home, then monitor your blood pressure and immediately report any readings that are above 140 over 90, that is not actively being managed by your obstetrician or primary care provider.

Vaginal bleeding is normal after delivery, but if the mom is soaking more than one pad an hour, call your provider. If you've had a C-section and there's drainage at your incision site, this may be normal, but if the drainage becomes green, discolored, has a foul smell; you want to make sure that you contact your provider.

Also be on the lookout for what we call baby blues or postpartum depression. So feelings of sadness and being overwhelmed may be common after your delivery. But if it shifts to feelings of hopelessness, or you have a desire to hurt yourself or others, then you need to seek immediate care.

Host: Thank you. That was such a comprehensive list, and especially paying attention to those postpartum blues versus depression, because I think mental health is often overlooked as well.

What red flags or warning signs should new mothers look out for that may indicate a serious complication?

Kendra Coles, DNP, RNC-OB, C-EEFM, NEA-BC: So the red flags that we often tell our patients to look out for can be complex and they vary amongst women. So, we like to teach our patients the post birth warning signs, and it's an acronym that we adopted from AWHONN, which is the Association of Women's Health Obstetrics and Neonatal Nursing, and it stands for POST and BIRTH.

So, POST is pain in the chest, so the P is pain in the chest, O is for obstructed breathing or shortness of breath, S is for seizures, T is for the thoughts of hurting yourself, usually associated with depression. We think about the B is for bleeding and risk factors, bleeding and hemorrhaging, soaking pads or passing large clots. The I is for incisions that may not be healing, whether that's an abdominal incision or a vaginal incision from a vaginal birth. The R is for redness or swelling in the legs that may be associated with a blood clot. Patients may experience a temperature, which is the T, greater than 100.4, and they may experience the H, which is for headaches that often aren't relieved with medications usually associated with hypertensive disorders of pregnancy.

Host: That's a really great acronym to remember. So POST BIRTH. Thank you for really going into detail on that. Now, are there differences in symptoms that might indicate complications for vaginal births versus C-section births?

Kendra Coles, DNP, RNC-OB, C-EEFM, NEA-BC: Absolutely. So C-sections are surgical procedures, and thus the increased risk of surgical complications will exist, so you may experience infections or bleeding. You may also, uh, have abdominal herniations or complications from the anesthesia, since it's a surgical procedure. Vaginal delivery complications may have a rare occurrence of vaginal lacerations or hematomas that exist on the perineum.

So the different symptoms that may be experienced is usually associated with the mode of delivery. However, the complications post delivery based on chronic conditions like hypertension and diabetes aren't necessarily affected with the method of delivery.

Host: That makes a lot of sense. Dr. Coles, are there specific complications that might not be immediately obvious but can develop later postpartum?

Kendra Coles, DNP, RNC-OB, C-EEFM, NEA-BC: Most symptoms can be identified early on, but unfortunately it's not until the symptoms are at its worst or the mom's conditions begin to deteriorate, that patients begin to take actions. So early in that postpartum window, those symptoms are there, they develop, but often women will minimize those complications and it's not until it exacerbates a little further. So we would recommend seeking care very early.

Rania Habib, DDS, MD (Host): What should a woman do if she is having post childbirth complications?

Kendra Coles, DNP, RNC-OB, C-EEFM, NEA-BC: When in doubt, I would say contact your obstetric provider, notify them at least, most obstetric service providers are available either 24/7 or you can contact your emergency department especially with some of the severe complications that we've discussed in the POST BIRTH acronym. You can also follow up with your primary care provider.

As some pregnancies are complicated with other underlying conditions, you can reach out to your primary care provider and their collaboration and partnership will help moms improve their outcome.

Host: Absolutely. I think that's a good, important reminder that it's not always just the OB GYN, that they may also need to involve the primary care physician as well. So that's a great reminder. Dr. Coles, we know that women are not giving birth isolated, you know, in a bubble for most patients. So how can family members or their partners support new mothers in recognizing and addressing postpartum complications?

Kendra Coles, DNP, RNC-OB, C-EEFM, NEA-BC: Having a newborn at home can be life changing, mentally, physically, and socially. It's important for families to offer the mom support in caring for her newborn and offer the support in caring for herself. Because the family dynamics will change, it's often helpful to support the change family responsibilities as well.

But more importantly, family members need to know the physical symptoms and the warning signs of complications and encourage the patient to seek care. Families often see the childbearing patient in her normal state. And so they can recognize when their loved one is not feeling well. So when families know the warning signs, they are better positioned to call for help, get the help the patient need, become their advocate, and communicate those changes to the health care team.

Host: Dr. Coles, you've given us so much great information about how family members can help, this wonderful acronym for patients to help really understand what complications they're having. What role do routine postpartum checkups play in identifying and addressing complications early on?

Kendra Coles, DNP, RNC-OB, C-EEFM, NEA-BC: Routine postpartum checkups is so important. They offer a scheduled time for the mother to follow up with her obstetric provider and give that opportunity for full physical patient evaluation, as well as to address some of her mental health needs. The health care team use that time to get vital signs, to get lab work, to do an overall physical and psychological assessment and identify trends that may be getting worse and also identify resources to help the patient to cope.

Host: What advice do you have for mothers who may be hesitant or unsure about reporting symptoms or seeking out medical attention?

Kendra Coles, DNP, RNC-OB, C-EEFM, NEA-BC: Don't delay care. When in doubt, check it out. I also recommend wear your I Gave Birth bracelets, and these bracelets have been designed and are being offered across University of Maryland's system for our moms to wear that says, I gave birth and I'm still at risk; as a symbol to healthcare teams and into the community that this patient is at risk of a potential childbearing complication.

I would also recommend that you seek out, get education. Seek early recognition of what the warning signs are. Have prompt management to help save lives and improve maternal outcomes.

Host: You are such a wealth of knowledge. I love the fact that you guys started this program with the bracelets so that it really gives a visual warning sign to other providers, to emergency, EMS services, and even just to the general public that this mother is just gave birth and might have other complications. So what a wonderful project that you guys started.

Kendra Coles, DNP, RNC-OB, C-EEFM, NEA-BC: Thank you.

Host: Dr. Coles, thank you so much for this helpful information for postpartum mothers and their families. Once again, that was Dr. Kendra Coles from the University of Maryland, Baltimore, Washington Medical Center. I'm your host, Dr. Rania Habib, wishing you well. Thank you for listening to Live Greater a Health and Wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again, and please share this on your social media, find more shows just like this one at umms.org/podcast and on YouTube.