Most of what happens after birth is slow, uncomfortable and normal. A few things are not, and they can show up days, weeks or even months later, often after everyone has gone home and stopped watching. In the U.S., about half of pregnancy-related deaths happen between one week and one year after the birth, and most of them are preventable. Knowing the signs is not about expecting the worst. It is how families catch the rare serious problem early.

Share this with whoever is at home with you. The person who is unwell is often the last to notice, or the first to say "I'm probably fine."

Call 911 now

• Chest pain, or a racing or pounding heart that won't settle.
• Trouble breathing or catching your breath, especially if it is new or getting worse.
• Signs of a stroke: a face that droops, weakness or numbness on one side, trouble speaking, sudden loss of vision, or a sudden, severe headache that feels like the worst of your life.
• A seizure.
• Fainting, or being very hard to wake.
• Heavy bleeding with dizziness, a racing heart or feeling faint.
• Thoughts of hurting yourself or the baby, or of ending your life. (Unwanted, frightening thoughts you know you would never act on are common and different; they still deserve a call to your provider.)
• Confusion, seeing or hearing things others don't, or behavior that seems out of touch with reality.

Call your OB, midwife or doctor right away

Today, not at the next appointment. If you can't reach anyone quickly, or it is getting worse, go to an emergency department or call 911.

• Bleeding that soaks through a pad in an hour, or clots the size of an egg or bigger.
• A fever of 100.4°F (38°C) or higher.
• A headache that won't go away with medicine or keeps getting worse.
• Changes in your vision, like blurriness, flashing lights or seeing spots, even without a headache.
• Sudden or severe swelling of the face or hands.
• Needing extra pillows to breathe at night, or swelling in your feet or ankles that keeps getting worse.
• One leg that is swollen, red, warm or painful, especially in the calf.
• A C-section wound or tear that is red, swollen, oozing or opening.
• Belly pain that is severe or getting worse, or discharge that smells bad.
• Severe nausea and vomiting.
• Dizziness, or tiredness so extreme it feels different from ordinary new-parent exhaustion.
• A red, hot, painful area on the breast with a fever or chills.

Why these matter

Some of the most serious complications after birth start quietly. High blood pressure (postpartum preeclampsia) can begin days or up to six weeks after birth, even if blood pressure was normal in pregnancy, and often shows up first as a headache or vision changes. A blood clot can show up as one swollen, painful leg, or as sudden shortness of breath if it moves to the lungs. A weakened heart (peripartum cardiomyopathy) can look like being out of breath when lying down, swollen ankles and exhaustion, which is why it gets mistaken for ordinary tiredness. Infections show up as fever, redness or a wound that won't heal. All of these are treatable, and all of them are easier to treat early.

Mind, too

Feeling low, anxious, panicky or numb most days for more than two weeks, or not being able to sleep even when someone else has the baby, is worth a call to your provider this week. It is common and treatable. So are scary thoughts of harm coming to the baby, or of hurting yourself, even ones you would never act on: tell your provider today, or call or text 988. The guide "Mental health after birth" explains what is common and what needs help.

What to say when you call

Start with the birth, every time, including at an urgent care or emergency department that isn't your usual place: "I gave birth on [date]. I have [the symptom], and it started [when]." Postpartum complications can be missed when staff don't know about the birth, which is why the CDC's Hear Her campaign asks people to say they were pregnant in the last year.

• Say exactly what is happening and how long it has lasted: "This headache hasn't gone away with medicine since last night," not "I have a bit of a headache."
• If you had high blood pressure, preeclampsia, a C-section or heavy bleeding at the birth, say so.
• If you feel brushed off, it is okay to ask: "Could this be related to the birth? What else could it be?" and "Please note in my chart that I asked about this."
• Bring someone if you can. A second person can listen, take notes and keep asking.
• Black mothers in the U.S. are about three times as likely as white mothers to die from a pregnancy-related cause, and many describe not being listened to. If that is your experience, you can ask for another clinician, and bring an advocate who will speak up with you.

For dads, partners, family and friends

• Learn the two lists above. You are often the one who notices first, because the person who gave birth is busy, exhausted or used to discomfort.
• Trust your gut. If they seem off in a way that scares you, that is reason enough to call.
• Make the call for them, or with them, and go along. Say the birth date first.
• Put the OB or midwife's after-hours number in your phone now, and in your Village under Plan at home.
• If they say "I'm fine" but have one of the 911 signs, call 911 anyway.

And for the baby

• Trouble breathing, a pause in breathing of 20 seconds or more, or lips or face turning blue or gray: call 911.
• Limp or floppy, can't be woken, or having a seizure: call 911.
• A temperature of 100.4°F (38°C) or higher, taken rectally, in a baby under 3 months: call the pediatrician right away, day or night.
• Very few wet diapers, or refusing to feed: call the pediatrician now.
• Yellow skin or eyes that is spreading or deepening: call the pediatrician today. Yellow in the first 24 hours, or with poor feeding or unusual sleepiness: call right away.

The first year counts

Some problems are most likely in the first days and weeks, but nearly a third of pregnancy-related deaths in the U.S. happen more than six weeks after the birth. Keep these signs in mind for the whole first year, and if you are ever unsure, call. Being reassured is a good outcome, not a wasted call.