By Nicole Lamborne, MD, Virtua OB/GYN and Program Director for Women’s Health
Shailen Shah, MD, Medical Director and Lead Physician—Virtua Maternal-Fetal Medicine 

Although infant mortality in the United States continues to decrease, a new report showed shows that U.S. moms have a higher risk of childbirth-related death than moms in other developed nations—and the rate of postpartum death has been increasing for the past 20 years. 

The report, which was issued by the U.S. Centers for Disease Control and Prevention (CDC) and other research partners, highlighted several leading causes of postpartum death, including hemorrhage, infection, heart disease and mental health issues. And, according to the report, many of these deaths may be preventable. 

If you are an expectant mom, these statistics may sound scary. But the truth is that there are things that you can do to lower your risk of deadly postpartum complications. Here’s what you need to know. 

Why do U.S. moms have a higher rate of postpartum death?

The demographics of expectant moms in the U.S. are changing. When compared to expectant moms from 30 years ago and expectant moms in other developed nations,  expectant moms in the U.S. today are more likely to be older and employed outside of the home in jobs that require little physical activity. As a result, expectant moms in the U.S. are more likely to live a more stressful, sedentary lifestyle and have health problems related to age. These issues can lead to chronic conditions such as diabetes, heart disease and obesity. And, these women may be more likely to suffer from mental health conditions such as depression and anxiety.

When expectant moms have uncontrolled chronic health problems before or during pregnancy, it can raise their risk of complications and death after pregnancy. 

What can I do before pregnancy to lower my risk of postpartum complications?

A healthy pregnancy—and a healthy postpartum period—starts with a healthy mom. Making sure that you’re in the best possible health before you become pregnant can help you avoid complications during and after pregnancy. 

If you’re thinking about pregnancy, you should meet with your doctor to discuss your plans. If you have a chronic condition such as high blood pressure or diabetes, you can work with your doctor to make sure it’s well controlled before you try to get pregnant. 

If your doctor thinks you may be at high risk for complications during or after pregnancy, he or she can refer you to a maternal-fetal medicine specialist who’s experienced in high-risk pregnancy management. 

What can I do during pregnancy to lower my risk of postpartum complications?

One of the most important things you can do during pregnancy to lower your risk for postpartum complications is to get proper prenatal care. That means you will need to go to all of your prenatal appointments, take all medications as directed and have tests or procedures that your doctor recommends. 

During your pregnancy, you should also look out for symptoms that could point to a serious health condition, such as: 

• Chest pain, heart palpitations, severe swelling or shortness of breath when lying flat, which could be a sign of heart problems
• Severe headaches, rapid weight gain, high blood pressure or vision changes, which could be a sign of preeclampsia
• Strong feelings of anxiety or wanting to hurt yourself 

Although some mild symptoms such as being more winded during exercise or an occasional headache probably are related to the pregnancy itself, be sure to tell your doctor about new or serious symptoms right away. 

What can I do after pregnancy to lower my risk of postpartum complications?

After your baby is born, be mindful of your physical and mental condition during your hospital stay and when you return home. Continue to take all of your medications as directed. Your partner or other loved ones also should be aware of the signs of postpartum complications so they can help you look out for symptoms. 

Here are a few things you can do to prevent the most common causes of postpartum complications: 

Mental health concerns
Becoming a new mom is stressful, which can cause or worsen symptoms of anxiety and lead to other problems such as substance abuse. New moms also can develop postpartum depression, so you should watch out for symptoms, including: 

• Crying spells
• Feeling sad all the time
• Feelings of panic or needing to escape
• Thoughts of hurting yourself or your baby 

Anxiety, postpartum depression and substance abuse can have heartbreaking consequences for new moms. Be sure to talk to your doctor as soon as possible if you experience any symptoms. After diagnosis, follow your doctor’s instructions, go to your follow-up appointments and, if necessary, take medications as prescribed. 

Because of all the changes that a new baby brings to a household, new moms also can be at an increased risk of domestic violence. If you feel unsafe or are being abused, call the domestic violence hotline (1-800-799-7233) for help. 

Hemorrhage
Hemorrhage, or excessive bleeding, is a well-documented cause of postpartum death. Although there’s not much you can do to prevent hemorrhage, pay close attention to how much you’re bleeding during the two weeks following delivery. If you have heavy bleeding that soaks more than one large sanitary pad per hour, call your doctor or go to the hospital right away. 

Infection
You also should watch for signs of infection, which can occur after a C-section or vaginal delivery and lead to a serious condition called sepsis. Signs of infection include: 

• A bad smell or drainage from the site of the infection
• Elevated heart rate
• Fever higher than 100.4
• Low blood pressure
• Pain at the site of the infection 

Heart disease
Heart disease can cause a range of symptoms that are similar to common pregnancy symptoms, such as mild swelling or shortness of breath. However, signs of trouble could include chest pain, severe swelling, severe shortness of breath or heart palpitations. If these symptoms continue or become worse after your baby is born, go to the hospital or call your doctor right away. 

If you have specific risk factors for postpartum complications, your doctor will provide more information about what to watch for and when to get medical help. 

Your doctors have protocols and procedures in place to help keep you healthy and safe so you can enjoy your new baby. But, you can play an important role in your postpartum health by reducing your risk factors for postpartum complications, watching for worrisome symptoms and managing chronic conditions before and during pregnancy. 

Virtua offers comprehensive resources to support you before, during and after pregnancy:

• Behavioral and mental health resources
• Pre- and postpartum depression care
• Heart disease and pregnancy care
• High-risk pregnancy care
• Postpartum services and support 

For an appointment or referral, call 1-888-847-8823.