Infection in pregnancy and after birth

How does this happen?

Pregnancy and birth create several routes for infection.

During pregnancy and labor, bacteria can travel up from the vagina into the uterus, particularly once the membranes have ruptured. Infection of the membranes and fluid, called chorioamnionitis, affects both mother and baby, and it is one of the recognized contributors to newborn brain injury. ³

After birth, the inside of the uterus is a large wound with an open route to the outside. Infection of the uterine lining, called endometritis, is the most common postpartum infection.

Surgical wounds, including cesarean incisions and perineal repairs, can become infected. ⁵

Retained tissue inside the uterus gives bacteria something to grow on and prevents the uterus from closing down. ⁶

The breast, where mastitis can progress to an abscess.

The urinary tract, where infection is more common in pregnancy and can ascend to the kidneys.

Sepsis develops when the response to any of these becomes systemic. Blood vessels leak, blood pressure falls, and organs receive less blood. In a young, previously healthy person the body compensates well until it suddenly does not, which is why postpartum sepsis can look mild and then deteriorate fast. ²

What causes it?

Two different questions get mixed together here. The first is what leads to this injury in the body. The second is whether anyone could have prevented it. They are not the same question, and the answer to the first does not settle the second.

Happens even with perfect care

• Group B strep or other organisms reaching the uterus despite correct prevention. ¹
• Prolonged rupture of membranes, which increases risk and often cannot be avoided.
• A long labor with many examinations, where each was clinically indicated.
• Cesarean delivery, which carries a higher infection risk than vaginal birth even with prophylactic antibiotics. ⁴
• Retained placental tissue that was not visible or detectable at delivery. ⁶
• Mastitis, which is common and usually not caused by anything anyone did wrong.
• Underlying conditions such as diabetes that raise infection risk. ⁷

Associated with gaps in care

These are situations where published standards say what the care team should watch for and do. A gap here does not prove anyone caused your child's injury. It points to where the medical records will have an answer.

• Group B strep screening not done, or a positive result not acted on in labor. ¹
• Antibiotics in labor not given, given late, or the wrong choice in someone with a penicillin allergy without appropriate testing. ¹
• chorioamnionitis not recognized or not treated, which affects both mother and baby. ³
• Prophylactic antibiotics not given before a cesarean. ⁴
• Fever in labor not acted on, including not informing the newborn team, since it changes the evaluation of the baby. ¹
• Retained tissue not identified. ⁶
• Postpartum symptoms dismissed. Fever, worsening pain, foul discharge or feeling much worse rather than better after discharge should be assessed, not reassured over the phone. ²
• No postpartum follow-up arranged for someone at higher risk, when guidance describes contact within the first three weeks. ²

Whether any of this amounts to a departure from the standard of care takes a physician expert reading the whole record.

What are the signs, by age?

Signs change as a child grows. A newborn cannot show you a walking problem. Some children look fine at first and show differences months later.

At birth and the first hours

In labor

• Fever.
• A fast maternal heart rate.
• A fast fetal heart rate, which is often the first sign of intraamniotic infection. ⁸
• Uterine tenderness.
• Foul-smelling amniotic fluid.

The first week

After birth. These are the ones that get missed.

• Fever, or feeling cold and shivering uncontrollably.
• Pain that is getting worse rather than better.
• Foul-smelling vaginal discharge.
• Heavy bleeding that restarts.
• A wound that is red, swollen, hot, or leaking.
• Breathlessness, or a fast heart rate at rest.
• Feeling much worse rather than gradually better.
• Confusion, or a sense that something is badly wrong.
• Not passing much urine.

Around 3 months

• Continued fatigue after significant infection.
• Chronic pelvic pain in some people after severe infection.
• Wound healing problems.
• Post-traumatic stress after a critical illness. ⁹

Around 6 months

• Most recovery is complete.
• Fertility questions after severe pelvic infection, which are worth raising.

Around 12 months

• For the baby, effects follow from any infection they acquired or from prematurity if infection triggered early delivery. ¹⁰

Toddler years

• For the baby, effects follow any brain injury from infection. ³

School age

• For the baby, effects follow any brain injury or hearing loss. ¹¹

How is it diagnosed?

Vital signs. Temperature, heart rate, breathing rate and blood pressure. A fast heart rate and fast breathing in someone who feels unwell are more alarming than a temperature reading.

Blood tests, including blood count, inflammatory markers, lactate and blood cultures. A raised lactate is a marker of poor tissue perfusion. ¹

Cultures from the likely source: urine, wound swabs, vaginal swabs, breast milk in suspected abscess.

Imaging where a collection or retained tissue is suspected, usually ultrasound first. ⁶

For infection in labor, the diagnosis is clinical, based on maternal fever together with other findings, and it changes management for both mother and baby. Ask whether the newborn team were told. ¹

placental pathology after delivery, which can confirm infection of the membranes and is often the clearest evidence of what happened. Ask whether the placenta was sent and request that report separately. ³

What is the treatment?

Antibiotics, promptly. In suspected sepsis, antibiotics are given early rather than after results return, and delay is associated with worse outcomes. ¹

Fluids and support for blood pressure.

Source control, which means dealing with whatever is causing it: removing retained tissue, draining an abscess, opening and cleaning an infected wound. Antibiotics alone do not fix a collection.

Intensive care where organs are affected.

For infection in labor, antibiotics for the mother and evaluation of the baby afterward, since the baby has been exposed. ¹

For mastitis, continued milk removal, antibiotics where indicated, and assessment for an abscess if a firm painful lump persists.

Follow-up. Postpartum care should be an ongoing process, with earlier contact for those at higher risk, rather than a single visit at six weeks. Ask what your follow-up plan is. ²

What is the long-term outlook?

Most people treated promptly recover fully. Speed of treatment is the main determinant. ¹

Severe sepsis can cause organ damage and requires intensive care, and recovery from that takes months rather than weeks.

Long-term consequences of severe pelvic infection can include chronic pain and, in some cases, effects on fertility. Both are worth raising rather than accepting.

Post-traumatic stress after a critical illness in the postpartum period is common, and it is compounded by separation from the baby. It is treatable. ^{9 12}

For the baby, where infection occurred during labor, the relevant pages are neonatal sepsis and, where brain injury followed, HIE. ³

What does daily life look like?

Recovery from infection while caring for a newborn is genuinely hard, and the exhaustion is not the same as ordinary new-parent tiredness.

If you were separated from your baby during treatment, that separation has its own effects and deserves acknowledgment.

Practical steps: finish the antibiotic course, keep the follow-up appointment, and get a clear list of what should prompt you to call again.

Write down what happened while it is fresh. Infection records are detailed, with timed observations, and the timeline matters if you later want to understand the sequence.

What does care cost over a lifetime?

No agency publishes a lifetime cost estimate for maternal infection and this site does not invent one.

Costs are the hospital care and, where intensive care was needed, substantially more.

See paying for care for the programs that cover maternity care and follow-up.

What can you do this week?

1. Learn the postpartum warning signs and act on them the same day.
2. Ask whether the placenta was sent to pathology, and request that report.
3. Ask what organism was found and whether the antibiotic course is complete.
4. Ask whether the newborn team were told about any fever or infection in labor.
5. Ask what your follow-up plan is and when you will be seen. ²
6. Ask about iron if there was also bleeding.
7. Say something if you are struggling emotionally. ¹³

What should you ask each specialist?

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the obstetrician

• What infection did I have, and what organism?
• Was there a source that needed removing or draining?
• Was there infection during labor, and were the newborn team informed?
• Was the placenta examined?
• What follow-up do I need, and when?

For the newborn team

• Was my baby evaluated for infection?
• What tests were done, and was a lumbar puncture needed?
• What are we watching for?

For your own recovery

• What should make me call again, and who do I call?
• Is my blood count normal now?
• Could this affect future pregnancies?

You can also build a printable list with the question generator.