Postpartum warning signs every Black mother should know

The most dangerous part of having a baby is often not labor or delivery. It is the days and weeks that follow. CDC maternal mortality review data show that about two-thirds of pregnancy-related deaths happen after the day of delivery, and roughly 3 in 10 happen between 43 days and one year postpartum. That is why clinicians and the CDC now describe these as urgent maternal warning signs that can appear at any point in the year after you give birth, even if you felt fine during pregnancy and labor.

These deaths are not inevitable. CDC maternal mortality review committees determined that about 84% of pregnancy-related deaths are preventable. The most common causes after childbirth are heavy bleeding, blood pressure conditions like preeclampsia and eclampsia, blood clots, infection, and heart problems. Most of them give warning signs first. Recognizing those signs and acting on them is the single biggest thing you can do to protect yourself.

Black women in the United States are about three times more likely to die from a pregnancy-related cause than white women. The most recent national data make the gap even starker: in 2023 the maternal mortality rate for Black women was 50.3 deaths per 100,000 live births, compared with 14.5 for white women, 12.4 for Hispanic women, and 10.7 for Asian women. That is roughly 3.5 times the white rate.

This gap holds across income and education levels. It is driven in large part by delayed recognition of warning signs and by Black women's concerns being dismissed or downplayed. The takeaway is not fear. It is preparation. When you know the signs and insist on being checked, you change the odds. Building a care team that listens also matters, which is why many Black families look for a Black OB-GYN or work with a doula who can advocate alongside them.

Use the simple rule below. You only need one sign to act. Do not wait to see if it gets worse, and do not wait for a second symptom.

• Chest pain. May mean a blood clot in your lung or a heart problem.
• Trouble breathing or shortness of breath. Same risks, a clot or your heart.
• A seizure. May mean eclampsia, a life-threatening blood pressure emergency.
• Thoughts of hurting yourself or someone else. This is a medical emergency too.

If you cannot reach them, call 911 or go to an emergency room.

• Heavy bleeding: soaking through more than one pad in an hour, or passing a clot the size of an egg or larger. This can mean an obstetric hemorrhage.
• A severe headache that does not ease even after medicine, or a bad headache with vision changes. With upper-right belly pain, this can mean high blood pressure or postpartum preeclampsia.
• A fever of 100.4°F or higher, or foul-smelling vaginal discharge. This can mean an infection.
• A red, swollen leg that is warm or painful to the touch. This can mean a blood clot in the leg.
• An incision, C-section site, or tear that is not healing, or has increasing redness or pus. This can mean an infection.
• Extreme swelling of your hands or face, dizziness or fainting, severe belly pain that will not go away, severe nausea and vomiting, or overwhelming tiredness.

Preeclampsia is most often thought of as a pregnancy condition, but it can develop for the first time after delivery, even in women who had normal blood pressure throughout pregnancy. It is most common within 48 hours of birth but can occur up to six weeks afterward. Untreated, it can lead to seizures and stroke.

The warning signs to watch for: a headache that will not go away, changes in your vision such as blurriness or seeing spots, swelling in the face and hands, pain in the upper right side of your belly, and sudden weight gain. If you have a blood pressure cuff at home and get a top number of 140 or higher or a bottom number of 90 or higher, call your provider right away. Many women who later have a postpartum seizure or stroke had warning symptoms for hours or days first. Do not talk yourself out of a headache. Get checked.

Pregnancy and the postpartum period raise your risk of dangerous blood clots. A clot in the leg, called a deep vein thrombosis, shows up as a red, swollen, warm, or painful leg, often on one side. If a clot travels to the lung, it causes chest pain and trouble breathing, which is why those two symptoms are 911 emergencies. Do not assume leg pain is just soreness from delivery. One-sided leg swelling and pain warrant a same-day call.

Infection is one of the leading causes of death after childbirth. The classic sign is a fever of 100.4°F or higher, but not every serious infection comes with a fever, so AWHONN now flags a lower temperature trigger as worth discussing with your provider too. Other signs include foul-smelling vaginal discharge and a C-section incision or vaginal tear that is increasingly red, painful, or oozing pus. Trust changes in how you feel, not just the thermometer.

Black women report having their pain and symptoms minimized more often than other patients. You are allowed to be persistent. You are allowed to be a "difficult" patient. Your life is worth it.

The CDC's Hear Her campaign puts it plainly: "You know your body best. If something seems unusual or is worrying you, don't ignore it." Practical ways to make sure you are heard:

• Name the timeframe. Tell every clinician, including paramedics and ER staff, "I gave birth within the last year." Many providers do not connect new symptoms to a recent delivery unless you say so.
• State the danger directly. Use the script: "I gave birth on [date] and I am having [symptom]. I am worried this is an emergency."
• Ask the ruling-out question. "Is there a test I can have to rule out a serious problem?"
• Bring someone. A partner, friend, family member, or doula can ask questions and back you up when you are exhausted or in pain.
• Repeat yourself. If you are sent home and the symptom continues or worsens, call back or return. One conversation is not a final answer.

If a provider will not take your concern seriously and you believe something is wrong, go to the emergency room or call 911. You do not need anyone's permission to seek emergency care.

The dividing line is simple. Call 911 for chest pain, trouble breathing, a seizure, or thoughts of harming yourself or someone else. These can kill within minutes and need an ambulance, not a phone appointment.

Call your provider the same day for heavy bleeding, a bad or vision-altering headache, fever, a hot swollen leg, or a wound that is not healing. If you cannot reach your provider quickly, treat it as an emergency: call 911 or go to the ER. When you are unsure which category you are in, err toward 911 or the ER. Overcaution costs you a few hours. Waiting can cost far more.

Planning ahead helps. Keep your provider's after-hours number and your nearest hospital saved in your phone before you give birth. If you are still building your care team or looking for a clinician who will listen, start with our pregnancy and maternal health hub and search the provider directory.