The mother's own injuries and recovery

What can happen to you

Postpartum hemorrhage. Heavy bleeding after birth, defined as 1,000 mL or more or bleeding with signs of low blood volume. ³

Obstetric tears and pelvic floor injury. Tears are described in four degrees. Third and fourth degree tears involve the anal sphincter. Pelvic floor muscles and nerves can also be injured with no visible tear at all. ²

Preeclampsia and eclampsia. High blood pressure with effects on other organs, which can appear or worsen after birth. ⁵

Placental abruption and uterine rupture. Emergencies with lasting physical and emotional effects. ⁶

Infection. Including infection of the uterine lining, wound infection and sepsis, which can escalate fast after discharge. ¹

Anesthesia complications. Including a spinal headache and, rarely, nerve injury. ⁷

Anemia, which is very often left untreated and which causes exhaustion out of proportion to new parenthood. ¹

Psychological injury. Post-traumatic stress after a traumatic birth, and perinatal depression and anxiety. ^{8 9}

The warning signs after you go home

Ordinary recovery gets gradually better. These do not.

Call the same day for:

• Heavy bleeding that soaks a pad in an hour or less, or large clots. ³
• Fever, or shaking chills.
• Pain that is getting worse rather than better.
• Foul-smelling discharge.
• A wound that is red, hot, swollen or leaking.
• Severe headache, visual changes, or pain under the ribs on the right. ⁵
• Breathlessness, chest pain, or a racing heart at rest.
• Swelling, pain or redness in one leg.
• Not passing much urine.
• Feeling much worse rather than gradually better.
• Thoughts of harming yourself or your baby.

What to insist on

An actual follow-up plan

Guidance describes postpartum care as an ongoing process, with contact within the first three weeks and a comprehensive visit by 12 weeks, and earlier contact for those at higher risk. ¹

Ask before you leave hospital: when am I being seen, by whom, and what is being checked.

A blood count if you bled

Anemia after significant blood loss is common and under-treated. Oral iron works slowly. Ask directly whether intravenous iron is appropriate, particularly if you are exhausted and caring for a newborn. ¹

To know what degree of tear you had

Many people are never told. It is in your record. It matters for your treatment now and for any future birth. ²

Pelvic floor physiotherapy, by name

If you are leaking urine, wind or stool, or having pain during sex, ask for it specifically. In many places you will not be offered it unless you ask. ²

Blood pressure follow-up if you had preeclampsia

And a note in your permanent record, because a history of preeclampsia is associated with higher lifetime cardiovascular risk. ¹

A birth debrief

A meeting with the team to go through what happened, with the record in front of you. Many people describe it as the single most useful thing for intrusive memories. Ask for it, in writing if necessary.

The things people do not mention

Leaking urine or stool. Common, treatable, and the thing people are least likely to raise. It is a pelvic floor injury, not a normal consequence of having a baby. ²

Pain during sex. Also common, also treatable.

A sensation of something bulging. Prolapse. Assessable and manageable.

Exhaustion that is not ordinary tiredness. Often anemia, often a thyroid change, sometimes depression. All three are testable.

Fear of a future pregnancy. A legitimate reason for a planned conversation, not something to carry alone.

Anger. At the hospital, at your partner, at the situation. Common and worth talking about.

Feeling invisible. Every appointment is about your baby. Nobody asks how you are. If nobody asks, say it anyway.

Your own records

Your records are separate from your baby's, and you have the same federal right to them. ¹⁰

Ask for:

• Your prenatal record.
• The labor and delivery record and nursing notes.
• The operative note, including the type of uterine incision if you had a cesarean, which matters for any future birth. ⁶
• The anesthesia record, which is usually filed separately. ⁷
• The degree of any tear and how it was repaired. ²
• Your measured blood loss. ³
• All blood results.

The records request builder writes this letter for you.

Read how to get your medical records first. It applies to your own records as much as to your child's, and families frequently request only the baby's.

Looking after two people at once

Recovering from a significant injury while caring for a newborn who also needs care is more than most support systems are built for.

Say it out loud. Tell your doctor that you are recovering and caring for a baby with medical needs. It changes what they offer.

Ask for specific help. People want to help and do not know how. A meal on Tuesday. An hour so you can sleep. A lift to an appointment.

Take your own appointments seriously. They are the ones that get cancelled first, and they are the ones that stop this becoming permanent.

Get your history written into your permanent record, not just your maternity notes. Preeclampsia, hemorrhage, a severe tear, a uterine scar and a previous rupture are all relevant to your care for the rest of your life, and to any future pregnancy.

See the parent's own health for the emotional side.