Know Your Numbers.
Trust Your Body.

An interactive postpartum warning signs guide

Why this tool exists The 12 weeks after birth are a vulnerable window. Serious complications — hemorrhage, postpartum preeclampsia, blood clots, infection, postpartum psychosis — can come on suddenly and worsen fast. This tool helps you recognize the difference between normal recovery and a symptom that needs attention. It does not replace your provider. If something feels wrong, trust your instincts and call.

Select a category to check your symptoms

🩸 Bleeding (Lochia)

⚠️ Go to the ER now if:

You are soaking through a pad in less than 1 hour — for 2 or more hours in a row

You are passing clots larger than a golf ball

You feel dizzy, lightheaded, or faint along with heavy bleeding

📞 Call your provider if:

Bleeding had slowed, then suddenly got heavier again

You are still soaking more than 1 pad per hour, but for less than 2 hours

✅ This is normal:

Heavy red bleeding in days 1–3, gradually turning pink and brown over 4–6 weeks

Small clots (no bigger than a grape) in the first 1–2 days

💓 Blood Pressure & Preeclampsia

Postpartum preeclampsia can develop for the first time after delivery — even if your blood pressure was normal throughout pregnancy. BP often dips 48 hours after birth, then rises again at days 3–6. Most cases occur within the first 2 weeks, but risk continues to 6 weeks.

⚠️ Go to the ER now if:

Blood pressure reading ≥ 160/110 mmHg on any reading

Severe headache that will not go away with rest — especially with vision changes or upper-right abdominal pain

Vision changes — blurring, flashing lights, or blind spots

Sudden severe facial swelling or swelling of both hands

📞 Call your provider if:

Blood pressure 140–159 / 90–109 mmHg on two readings, 4 hours apart

Persistent headache (not severe), nausea, or swelling that is getting worse

🌡️ Fever & Infection

Infection after delivery can affect the uterus (endometritis), cesarean incision, breasts (mastitis), or urinary tract. Untreated endometritis can progress to sepsis.

⚠️ Go to the ER now if:

Temperature ≥ 101°F (38.3°C) — especially with chills, shaking, or feeling very unwell

C-section wound has opened, has a foul odor, or is draining cloudy fluid

📞 Call your provider if:

Temperature 100.4–101°F (38.0–38.3°C)

Uterine area (lower abdomen) is tender or has a foul-smelling discharge

Burning with urination, needing to urinate frequently, or difficulty emptying your bladder

Breast is red, hard, and painful — with or without fever (possible mastitis)

Cesarean incision edges are separating, red, or increasingly tender

🫁 Breathing & Blood Clots

Pulmonary embolism (a blood clot in the lungs) is one of the leading causes of postpartum death. Deep vein thrombosis (DVT) in the legs often precedes it. Risk is highest in the first 6 weeks — especially after cesarean birth.

⚠️ Call 911 or go to the ER now if:

Sudden shortness of breath — difficulty breathing, or feeling like you can't get enough air

Chest pain — especially sharp pain that worsens with a deep breath

Rapid or irregular heartbeat (heart racing or pounding)

One calf or thigh that is swollen, red, warm, or painful — especially on one side only

Coughing up blood

📞 Call your provider if:

Mild leg swelling that is new, or leg cramps that feel different than usual muscle soreness

⚡ Pain

Some pain is expected. The key question is direction: is your pain getting better day by day, or getting worse?

⚠️ Go to the ER now if:

Sudden severe abdominal or pelvic pain — especially with fever or heavy bleeding

📞 Call your provider if:

Pain is getting worse over several days, rather than improving

You are needing more pain medication than a few days ago to manage the same pain

Perineal pain is increasing, or you notice swelling or a foul smell at the perineum

Pain or inability to urinate for more than 6 hours after delivery (urinary retention is common after epidurals)

✅ This is normal:

Cramping (especially during breastfeeding) as the uterus shrinks back — usually improves in 5–7 days

Soreness at a cesarean incision that gradually improves day by day

🧠 Mood & Mental Health

Baby blues affect up to 80% of new parents — weepiness, mood swings, feeling overwhelmed — peaking at days 3–5 and resolving within 2 weeks. Postpartum depression, anxiety, and psychosis are different. They don't resolve on their own and require treatment. This is medical, not personal failure.

⚠️ Psychiatric emergency — call 911 or go to ER immediately:

Hearing, seeing, or smelling things others cannot (hallucinations)

Severe confusion, rapid or jumbled thinking, or not knowing where you are

Thoughts of harming yourself or your baby

Staying awake for days without any feeling of tiredness (a sign of mania)

📞 Call your provider if:

Low mood, crying, or feeling numb — and it has lasted more than 2 weeks, or is getting worse

Anxiety or panic attacks that are interfering with daily life or your ability to care for your baby

Feeling little or no bond with your baby — beyond the first few days

Intrusive, unwanted thoughts about harm coming to your baby (even if you would never act on them)

✅ Usually normal (baby blues):

Tearfulness, mood swings, feeling overwhelmed — starting days 3–5, resolving within 2 weeks

If you are in crisis:
Call or text 988 (Suicide & Crisis Lifeline) · 1-800-944-4773 (Postpartum Support International) · Text HOME to 741741 (Crisis Text Line)

👶 Baby Monitoring

⚠️ Go to the ER or call your pediatrician immediately if:

Baby appears yellow (jaundiced) — yellow skin, yellow whites of the eyes — especially in the first 3 days or if deepening

Baby has not had a wet diaper in 6 or more hours (possible dehydration)

Baby lost more than 10% of birth weight or has not returned to birth weight by 2 weeks

📞 Call your pediatrician or lactation consultant if:

By day 4, baby is having fewer than 4 wet diapers per day

Every feeding is under 5 minutes or over 45 minutes — consistently

Breastfeeding pain is severe, getting worse after the first week, or nipples are cracked or bleeding

✅ Normal in the first weeks:

Weight loss up to 7–10% of birth weight in first 3–5 days, back to birth weight by 14 days

Feeding 8–12 times per day (roughly every 2–3 hours)

📋 Postpartum Follow-up Checklist

These are evidence-based follow-up items that are often missed. Bring this list to your postpartum visit.

If you had gestational diabetes (GDM):

I have NOT had a glucose test at 4–12 weeks postpartum — ACOG recommends a 75g, 2-hour oral glucose tolerance test. Up to 50% of women with GDM develop Type 2 diabetes within a decade

Thyroid — often overlooked:

I am experiencing extreme fatigue, weight changes, heart palpitations, or hair loss at 1–6 months postpartum — these can be signs of postpartum thyroiditis (affects ~5–10% of women)

Vaccines — protect you and your baby:

I have not received Tdap (whooping cough) this pregnancy or postpartum — and/or Flu shot if in season

Contraception — if relevant:

I have discussed postpartum contraception with my provider before discharge or at my early postpartum visit

If you had hypertension or preeclampsia:

I was not given a follow-up blood pressure check within 7–10 days of discharge — SMFM recommends this for all patients with hypertensive disorders

Your Summary

Go to ER

Call Provider

Normal

Clinical decision support tool. Does not replace clinical judgment. This tool is for educational purposes only. It does not constitute medical advice or replace evaluation by a qualified clinician. If you believe you are having an emergency, call 911.

📋 Quick Reference: Normal vs. Warning Signs

A one-page overview of normal postpartum findings versus symptoms that warrant a call or ER visit.

Category	✅ Normal	⚠️ Warning Sign
Bleeding	Heavy red → pink → brown over 4–6 weeks	Soaking pad/hr × 2 hrs; golf-ball clots
Temperature	Under 100.4°F (38°C)	≥ 100.4°F → call; ≥ 101°F → ER
Blood pressure	Under 140/90 mmHg	≥ 140/90 → call; ≥ 160/110 → ER now
Breathing	No sudden shortness of breath at rest	Any sudden SOB or chest pain → 911
Baby weight	Back to birth weight by day 14	Loss >10%; below birth weight at 2 wks
Wet diapers (day 4+)	4–6 per day	Fewer than 4; none in 6+ hours → ER
Mood	Baby blues: tearful, peaks day 3–5, gone by wk 2	Persists >2 wks; hallucinations → ER
Pain	Gradually improving day by day	Worsening; needing more medication

Source Publications

Every clinical threshold, warning sign, and recommendation in this tool is drawn from peer-reviewed publications or official guidelines. Listed below in Vancouver format.

Reference 1 · Postpartum Care Framework

American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 736: Optimizing postpartum care. Obstet Gynecol. 2018;131(5):e140–e150.

doi:10.1097/AOG.0000000000002633

Foundational framework for the "fourth trimester." Informs postpartum visit timing, chronic disease follow-up, and the rationale for extended monitoring beyond 6 weeks.

Reference 2 · Perinatal Mental Health Screening

American College of Obstetricians and Gynecologists. ACOG Clinical Practice Guideline No. 4: Screening and diagnosis of mental health conditions during pregnancy and postpartum. Obstet Gynecol. 2023;141(6):1232–1261.

doi:10.1097/AOG.0000000000005200

Basis for postpartum depression thresholds, postpartum psychosis recognition (hallucinations, mania, confusion as emergencies), and the 2-week baby blues resolution timeline.

Reference 3 · Postpartum Hypertension Checklist

Society for Maternal-Fetal Medicine. SMFM Special Statement: Checklist for postpartum discharge of women with hypertensive disorders. Am J Obstet Gynecol. 2020;223(4):B7–B10.

doi:10.1016/j.ajog.2020.07.027

Source for the 7–10 day BP recheck recommendation and the BP trajectory pattern (dip at 48h, rise at days 3–6).

Reference 4 · Preeclampsia Thresholds

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 222: Gestational hypertension and preeclampsia. Obstet Gynecol. 2020;135(6):e237–e260.

doi:10.1097/AOG.0000000000003891

Defines the 140/90 and 160/110 mmHg thresholds. Confirms postpartum preeclampsia can develop de novo after delivery and establishes 6-week risk window.

Reference 5 · Postpartum Hemorrhage & Endometritis

American College of Obstetricians and Gynecologists. 3 Conditions to Watch for After Childbirth [patient education]. Washington (DC): ACOG; 2023.

acog.org/womens-health/experts-and-stories/the-latest/3-conditions-to-watch-for-after-childbirth

Source for PPH definition (soaking 2 pads/hour for 1–2 hours), uterine atony as leading cause, and endometritis progression to sepsis.

Reference 6 · Anemia / Bleeding Thresholds

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 233: Anemia in pregnancy. Obstet Gynecol. 2021;138(2):e55–e64.

doi:10.1097/AOG.0000000000004477

Context for postpartum blood loss thresholds and clinical indicators of significant hemorrhage.

Reference 7 · GDM Postpartum Follow-up

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 190: Gestational diabetes mellitus. Obstet Gynecol. 2018;131(2):e49–e64.

doi:10.1097/AOG.0000000000002501

Source for 75g 2-hour OGTT at 4–12 weeks postpartum for GDM, and the statistic that 15–50% develop Type 2 diabetes within a decade.

Note on DOI verification
All DOIs were current at time of tool creation. Verify against PubMed or the publisher's website for the most current citation details. Built by Amos Grünebaum, MD using guidelines current as of 2024.

Know Your Numbers.Trust Your Body.

Your Summary

📋 Quick Reference: Normal vs. Warning Signs

Source Publications

Know Your Numbers.
Trust Your Body.