It’s normal to not feel your physical best in the days after giving birth. Your body is undergoing major changes as it transitions to no longer being pregnant, and whether you delivered vaginally or via C-section, you likely have sore wounds that are healing. To top it all off, you’re (over-the-moon happy but) exhausted.
If you start to feel really lousy or uncomfortable, however, or have pain that gets worse instead of better, you could be dealing with a postpartum or puerperal infection.
These bacterial infections, which can develop in the days after giving birth, are rare but potentially harmful. So it’s worth knowing what postpartum warning signs to watch for and how to seek help.
What are the different types of postpartum infections?
Postpartum infections can stem from open sores in your uterus (at the site of the placenta), lacerations in your cervix, vagina or perineum (especially if you had an episiotomy), or an incision if you've had a C-section.
Some of the most common places infections can form are the uterine lining, the uterine muscle, or spots around the uterus. But not all postpartum infections are in the pelvic area — they can also occur in your bladder or kidneys if you were catheterized.
The World Health Organization announced 63 recommendations to improve postpartum and newborn care, including guidance on the treatment for perineum tears, vaginal bleeding, and blood pressure tests, placing particular emphasis on the importance of care within the first 24 hours after giving birth and in the weeks after.[1]
“The first six weeks are so important — it’s a time of great physiologic change,” says Sarah Obican, M.D., a board-certified OB/GYN who specializes in maternal fetal medicine at Tampa General Hospital in Florida and a member of the What to Expect Medical Review Board. “It’s also a time when women are more likely to take care of themselves and come to appointments, so it is a good opportunity to put them into care.”
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What are the signs of a postpartum infection?
Symptoms of postpartum infection can be vague at first and vary depending on where the infection is. But in general, they’re marked by signs including:[2]
- Fever and flu-like symptoms. Fevers higher than 100.4 degrees Fahrenheit that occur within three days after delivery can signal that your body is trying to fight an infection. You might also feel weak, have chills, get a headache, or feel less hungry than usual.
- Abdominal or pelvic pain that doesn’t get better. The pain could be intense and it might hurt or burn when you pee.
- Redness, discharge or swelling around your C-section incision, perineal tear or episiotomy. The discomfort will get worse instead of better with an infection.
- Foul-smelling vaginal discharge. This can also be an indication that something is wrong.
- Persistent bleeding or bleeding that gets heavier, along with blood clots.
What causes postpartum infections?
It’s estimated that between 5% and 7% of women develop an infection postpartum, with higher rates among those who delivered via cesarean section.
While many infections would likely be discovered during a postpartum visit to an OB/GYN, the American College of Obstetricians and Gynecologists reports that a staggering 40% of new moms don’t go for a first visit.[3]
Unfortunately, if women are doing well and don't have medical concerns (or think they don't), they may not keep or make appointments, Dr. Obican notes. She says that women who deliver after a C-section “are more likely to see their provider at the one-week mark to have their incision checked, which is very helpful.”
Postpartum infections aren’t typical, but they can develop when harmful bacteria enter the reproductive tract or lacerated tissue (like a vaginal tear or C-section cut) after giving birth.
Many infections form from C-section incisions. Laboring before undergoing an unplanned C-section — which can cause additional trauma to the uterus, cervix, vagina or perineum — raises the risk even more.
But C-sections aren’t the only culprits behind postpartum infections. Women who had premature rupture of membranes, also known as PROM, are also at greater risk.
What's more, infections are more likely to occur in women with a retained placenta, those who had cervical or vaginal lacerations, and those who had repeated vaginal examinations during labor or experienced excessive bleeding after birth.
How are postpartum infections treated?
Postpartum infections can quickly become serious or even life-threatening, so they almost always require treatment with antibiotics. The drugs might be given orally or through an IV, depending on the infection and its severity.
Most of the antibiotics used to treat postpartum infections are safe to take while breastfeeding. But if you’re nursing, you should still confirm with your doctor that the recommended treatment is breastfeeding-compatible and find out about any possible risks.
For instance, antibiotics like ciprofloxacin and ofloxacin, while safe for nursing moms to take, aren’t usually recommended as a front-line treatment since women are encouraged to pump and dump for at least three hours after dosing with ciprofloxacin and four hours after ofloxacin.
Your practitioner will work with you to find the best treatment option that allows you to keep feeding your baby safely.
Can you prevent a postpartum infection?
It’s not always possible to avoid a postpartum infection, but there are steps you can take to reduce your risk as much as possible. If you do get sick, seek help sooner rather than later, when the infection is easier to treat.
- Be vigilant about wound care and cleanliness after delivery. Wash your hands before touching the perineal area, wipe from front to back after going to the bathroom and only use maxi pads — not tampons — for postpartum bleeding.
- Know the symptoms — and your risk factors. Keep in mind that you’re more prone to infection if you’ve undergone a C-section, especially an unplanned one. And no matter how you gave birth, pay attention to any warning signs or unusual discomfort. Pain that gets worse instead of better is generally a red flag, so don’t ignore it.
- Contact your doctor ASAP if something seems wrong. The sooner your infection can be diagnosed and treated, the sooner you’ll get better.
- Take preventive antibiotics, if they’re prescribed to you. Your doctor may prescribe antibiotics if you’ve delivered via C-section as extra insurance against infection. Take each dose exactly as instructed.
When to call the doctor
You should let your doctor know right away if you notice any signs of a possible infection. In rare cases, infections can trigger a life-threatening reaction called sepsis.
You should seek emergency medical attention right away if you have any possible symptoms, including fever, chills, clamminess, rapid breathing, rapid heart rate, feelings of confusion or extreme pain.
Even though postpartum infections are rare, the thought of getting one can be nerve-wracking. Be proactive by keeping wounds clean and talking to your doctor about concerning symptoms instead of trying to tough it out. Seeking help quickly is the best way to feel better — so you can get back to enjoying your new bundle.
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