The Postpartum Series Part 1: Common Postpartum Conditions

Crystal Alvarez, MD
February 21, 2020
The Postpartum Series Part 1: Common Postpartum Conditions

The postpartum period starts immediately following birth and lasts approximately 6 weeks. For most women, this is a time of mixed emotions that can include happiness, anxiety, exhaustion, and a general feeling of being overwhelmed. A new mother goes through both emotional and physical changes during this period, all while having a brand new little one to care for. With all these changes going on, it is also important for new mothers to know what is normal and what might require a phone call or trip to the health care provider.

Postpartum Preeclampsia

Preeclampsia is diagnosed when there is a new onset of elevated blood pressure in pregnancy and protein in the urine. This condition is concerning because it can be associated with severe maternal/fetal complications. However, preeclampsia can also occur after delivery—postpartum preeclampsia. Some factors that increase the risk for postpartum preeclampsia include chronic hypertension (elevated blood pressure before pregnancy), gestational hypertension (elevated blood pressure in pregnancy that was not diagnosed as preeclampsia), and a diagnosis of preeclampsia during pregnancy. However, postpartum preeclampsia can also develop without any of the above risk factors.

The typical symptoms, which usually occur 2-3 days postpartum, are persistent or severe headache, visual disturbances and/or pain in the upper abdomen. The treatment for postpartum preeclampsia requires a hospital admission and administration of magnesium sulfate which is given to help decrease the risk of seizures. A doctor may also start a new mother on medications to control her blood pressure. Typically, elevated blood pressure resulting from preeclampisia during pregnancy or the postpartum period resolves by 6 weeks postpartum.

Breast Engorgement/Mastitis

One of the most challenging aspects of being a new mother is breastfeeding. Breastfeeding can cause many mothers to feel anxiety and distress, especially if they are unable to adequately breastfeed or maintain milk production. Problems with breastfeeding can be the result of many personal factors ranging from having an infant in the ICU to an early return to work, which can result in a mother stopping breastfeeding altogether.

The added breast and nipple pain and soreness from breast engorgement can cause frustration as well. Symptoms of breast engorgement are breast fullness, firmness and nodularities that occur around the nipple or in the breast tissue. Breast engorgement most commonly occurs during initiation of breastfeeding when the infant may be having difficulty latching on or nursing. It can also occur when attempting to wean the infant from breastfeeding. During times of engorgement, the breasts should be supported with a well-fitting bra.

For pain relief, breastfeeding mothers can apply ice packs and use over-the-counter pain medications. For many breastfeeding mothers, frequent nursing or pumping can bring relief, especially if the engorgement is a result of an overproduction of breast milk or a newborn who is having difficulty nursing. It is also not uncommon for breast engorgement to be accompanied by a low grade fever that rarely persists past 24 hours. If fever does persists past this time, one should contact their doctor who can help identify causes for the fever.

In some instances, one breast may be come severely painful, hard and red; this condition is termed mastitis. Mastitis is accompanied by fever and chills and typically occurs 3-4weeks postpartum. Severe breast engorgement almost always precedes the condition. Treatment for this condition is antibiotics and continued breastfeeding. However, if the breast is too tender or the infant has difficulty suckling due to swelling, pumping may be a better solution. If mastitis goes untreated, a breast abscess may form which can require needle aspiration or surgical drainage.

Postpartum Blues/Depression

After giving birth, a new mother is dealing with a sudden drop in hormone levels, fatigue, anxiety, fear and all the other common discomforts that start after delivery. The combination of all these factors frequently results in new mothers reporting mood fluctuations. Although these fluctuations are common, a condition termed postpartum blues can develop. A new mother dealing with postpartum blues may be predominately happy yet have periods of crying for no reason, be irritable or angry, have problems with sleep and appetite and even question whether she can handle her newborn. This condition is quite common; in fact, some research suggests that up to 80% of new mothers will experience postpartum blues. These problems usually begin within 2-3 days of having a baby and typically resolve within 2 weeks.

Another condition that is related to but distinct from postpartum blues is postpartum depression. Postpartum depression will typically start about 2-3 weeks postpartum, however some reports suggest it can occur up to a year after giving birth. This condition is accompanied by intense feelings of sadness or anxiety which prevent a new mother from doing her normal daily tasks and is present more days than not for a period of at least 2 weeks. Postpartum depression affects approximately 10-20% of new mothers. Risk factors including young maternal age, single marital status, smoking/drug use, and a history of depression prior to or during pregnancy. Treatment is usually with an antidepressant and counseling. If a new mother is concerned about taking a medication and breastfeeding, this can be discussed with a doctor who will review the risks and benefits of starting any medication.

Knowing what is normal and not normal during the postpartum period can make this time a little easier. As a new mother, one should make an effort to be well informed about the changes so that more energy can be spent on enjoying the newest addition to the family. New mothers should never be afraid to ask for help from their spouse, family members, friends, or health care providers. More importantly, new mothers should always know when to call on their doctors for help and/or information and advice. Remember, this is not only important for the health of the mother, but also the health of the new baby and family.

Check out the Postpartum Series Part 2: What’s Going On Down There?

Crystal Alvarez, MD

Crystal Alvarez, MD

Dr. Crystal Alvarez is an Ob/Gyn physician with the UTMB Women’s Health Care Group in League City/Victory Lakes, TX. She is committed to addressing all aspects of women’s health with special interests in family planning, menstrual disorders, high-risk obstetrics, and minimally invasive surgery. Dr. Alvarez graduated Cum Laude from Baylor University in 2006 with her Bachelor’s degree in Biology. She went on to receive her medical degree from the University of Texas Health Science Center at San Antonio in 2011 and did her residency training in Obstetrics and Gynecology at The University of Texas Medical Branch where she received multiple resident teaching awards and served as Administrative Chief Resident her final year. Dr. Alvarez is married and has a young daughter. She is currently taking new patients.

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