Print this page. Stick it on the fridge. The warning signs below send postpartum patients to labor and delivery or the ER in Jacksonville every week. Providers consistently wish families had called sooner. Use this list.
TL;DR: Call 911 or go to the ER for chest pain, shortness of breath, seizure, or thoughts of harming yourself or the baby. Go to your delivering hospital's labor and delivery triage for heavy bleeding or severe headache with vision changes. Call your OB the same day for fever over 100.4, severe incision pain, or calf pain.
The thirty-second list
- Heavy bleeding. Soaking one pad per hour for two hours, or passing clots larger than a lemon. Labor and delivery.
- Fever. 100.4 F (38.0 C) or higher after the first twenty-four hours. Call your OB.
- Severe or new headache. Especially with vision changes, upper right belly pain, or swelling in face or hands. This can be postpartum preeclampsia up to six weeks after delivery. ER.
- Calf pain, swelling, or redness. Usually one leg. Possible deep vein thrombosis. ER.
- Chest pain or shortness of breath. Possible pulmonary embolism. 911.
- Seizure. 911.
- Thoughts of harming yourself or the baby. 988 or ER.
- Incision pain getting worse, not better. Redness, pus, or opening at a cesarean or perineal repair. OB same day.
- Painful red area on a breast with fever. Likely mastitis. OB same day.
- Severe belly pain not relieved by ibuprofen and Tylenol. OB same day.
Heavy bleeding
Normal postpartum bleeding (lochia) is heavy for the first three or four days and tapers. A small gush when you stand is normal. Steady soaking of a pad in under an hour is not. Postpartum hemorrhage can happen at the birth, in the first twenty-four hours, or rarely up to six weeks later due to retained placenta.
If you are soaking a pad in less than an hour, passing clots the size of a lemon or larger, or feeling lightheaded, do not wait it out. Labor and delivery at your delivering hospital is the right place, not urgent care and not the ER. Call on the way.
Jacksonville triage lines to know (ask your hospital for the direct number at discharge):
- Baptist Medical Center South L and D triage.
- Baptist Downtown L and D triage.
- Mayo Clinic Florida L and D triage.
- UF Health Jacksonville L and D triage.
- Ascension St. Vincent's Riverside and Southside L and D triage.
- Memorial Hospital Jacksonville L and D triage.
Program the number for your delivering hospital into your phone before discharge.
Fever
Your temperature can wobble in the first twenty-four hours after birth. A fever of 100.4 F or higher after the first day, or any fever with pain, is a call to your OB. Common sources:
- Infected cesarean incision or perineal tear repair.
- Endometritis (uterine infection).
- Mastitis.
- Urinary tract infection or pyelonephritis (kidney infection).
Do not try to figure out the source at home. Call.
Postpartum preeclampsia and severe headache
Postpartum preeclampsia is a condition that shows up after the birth, sometimes as late as six weeks. It kills postpartum women in Florida every year. The warning signs:
- Severe or new headache, especially one that does not respond to acetaminophen.
- Vision changes, flashing lights, blurriness, spots.
- Upper right belly pain (where the liver sits).
- Sudden significant swelling in the face or hands.
- Home blood pressure reading of 140/90 or higher.
If you have any of these, go to the emergency room, not urgent care. Say the words: "I am postpartum and I am worried about preeclampsia." That sentence gets you seen fast. Mention your delivery hospital and date.
Home blood pressure monitoring is worth it for the first six weeks if you had any gestational hypertension, preeclampsia in pregnancy, or a borderline reading at discharge. An Omron arm cuff from a local pharmacy costs about forty dollars.
Blood clots: calf, chest, breath
Postpartum is the highest-risk period for blood clots in an adult woman's life. The risk is about five times baseline in the first six weeks.
Deep vein thrombosis (DVT) signs: pain, swelling, warmth, or redness in one leg, usually the calf. Go to the ER.
Pulmonary embolism (PE) signs: sudden shortness of breath, sharp chest pain that worsens with a deep breath, coughing up blood, rapid heart rate. 911. Do not drive yourself.
Risk factors that raise your baseline include cesarean delivery, pre-pregnancy obesity, smoking, prolonged bed rest, and a previous clotting history. If you had any, your discharge instructions should include clot prevention (early walking, hydration, sometimes a blood thinner).
Mental health emergencies
Medical-emergency level postpartum mental health includes postpartum psychosis (rare but serious), active suicidal thoughts with a plan, and thoughts of harming the baby.
Postpartum psychosis affects roughly 1 to 2 per 1,000 births according to peer-reviewed literature. Signs include hallucinations, paranoia, rapid mood swings, confusion, and an inability to sleep with active racing thoughts. It usually appears in the first two weeks. It is a medical emergency. ER.
Active suicidal thoughts with a plan or a timeline: 988 or ER.
Thoughts of harming the baby: 988 or ER. The clinicians on the other end of the line are trained for this. They will not judge you. They will not automatically take your baby. They will help you find care.
For less acute postpartum anxiety or depression, see postpartum anxiety vs baby blues.
Infection at a cesarean or perineal repair
A cesarean incision should look mildly red on day two and progressively better each week. Signs of infection:
- Increasing redness spreading outward from the incision.
- Swelling, warmth, or increased tenderness past week one.
- Opening of any section of the incision.
- Leaking fluid, pus, or blood from the incision past the first few days.
- Fever accompanying any of the above.
Same pattern for a perineal tear repair. Call your OB the same day. Antibiotics and sometimes an urgent OB-clinic visit, not an ER trip, is usually the right next step.
Mastitis
Mastitis is breast tissue inflammation, sometimes with infection. Signs: a red, hot, painful area on one breast, often with fever, body aches, and a general flu-like feeling.
First-line treatment: continue to nurse or pump on that side, cold compresses, ibuprofen, rest, fluids. If you are febrile, call your OB. Most antibiotics prescribed for mastitis (like dicloxacillin or cephalexin) are compatible with breastfeeding.
Retained placenta
Rare but serious. Signs at two to six weeks postpartum: heavy bleeding returning after it had slowed, passing of large clots, fever, strong pelvic pain. This usually requires a return to labor and delivery for ultrasound and sometimes a D and C.
What I see in practice
The single most common reason postpartum patients delay calling is the thought "I do not want to be dramatic." Being dramatic is not a medical category. Your OB triage nurse will not roll her eyes. She would rather you called three times and been wrong than waited once and been right. Err on the side of calling.
FAQ
Is it okay to call my OB on a weekend or at night?
Yes. Every OB practice has a twenty-four hour line. If voicemail, leave a message and also call the L and D triage line directly.
Should I go to the ER or to L and D?
For the first six weeks postpartum, L and D triage is usually the right place for obstetric symptoms (bleeding, blood pressure, incision). For chest pain, shortness of breath, seizure, or clearly non-obstetric emergencies, ER.
What if I have a question but no clear symptom?
Call the triage line and ask. That is what it is for.
Where can I get a printable version of this list?
The Mom to Emotion Digital Pregnancy Planner has this as a magnet-ready one pager for the fridge.
What about the baby?
A fever of 100.4 F or higher in a baby under three months old is an ER visit. Poor feeding, extreme sleepiness, significantly fewer wet diapers, or breathing fast warrants a same-day pediatrician call.
If you are still pregnant and want help planning for postpartum before the baby comes, book a free consult with me. See also the fourth trimester survival guide for the week-by-week picture.
