I had a totally uneventful second pregnancy. I grew a baby, went to prenatal appointments, got hemorrhoids, went to the birth center and gave birth, drove home, and had a 24-hour home visit from my midwife. There were a couple of nonstress tests during the last week of pregnancy, but I just used those appointments as an opportunity to eat at my favorite Indian restaurant down the street from the hospital. I was low-risk and full of matar paneer.
Around the fifth day postpartum, I felt mild pain and warmth on my inner left leg at the calf. Then I noticed that there was also pain and warmth on my inner thigh, so I called the birth center. The midwife told me to get to a doctor immediately.
I made an urgent-care appointment and told them about my leg pain. The doctor wrapped a measuring tape around one calf and then the other. He looked up at me with a concerned expression on his face and told me the circumference of my left calf was one inch larger than the other and that I'd need to head over to the ER.
During the eight hours in the ER, most of which was spent waiting for someone who could do an ultrasound of my leg and for a vascular specialist to diagnose it remotely, I was stressed out about my baby. I finally convinced them to let my mom bring her in from the waiting room to nurse while waiting (and waiting and waiting) for the sonographer, who noticed a problem.
"It's not winking," the sonographer said while pressing the transducer into my leg. "A vein winks when everything is fine. You have a clot."
We know now that over half of maternal deaths occur after birth.
A leg-length clot had developed in a superficial vein that extended from my ankle all the way up to the groin, where the smaller veins meet up with the larger deep veins. I was at risk for DVT, deep vein thrombosis, which can be life-threatening if the clot breaks free and travels through the blood to the vital organs.
I called La Leche League friends during my time in the ER to ask that they please check their copy of Medications and Mother's Milk because I had a large clot that might require blood thinners but was worried about their impact on breastfeeding. In hindsight, it's obvious that they were trying to find a nonalarming way of explaining to me that babies do much better with a mom who has not died from a venous thromboembolism (VTE) and that I should just go ahead and take any blood thinners if they prescribe them.
Over the next few months, a vascular specialist monitored the clot, which luckily resolved on its own without medication. I have no idea where I had read or heard the warning signs of DVT and what made me press on my inner thigh after noticing calf pain, but I have to assume that I read it in a pregnancy book or in my discharge paperwork, or maybe a nurse or midwife along the way relayed it to me.
The lesson I learned was: clots don't care how low-risk your pregnancy and birth were.
We know now that over half of maternal deaths occur after birth in the following hours, days, weeks, and months. According to the CDC, the most common — and often preventable — causes of severe maternal morbidity and maternal mortality are obstetric hemorrhage, severe hypertension, infection, cardiac disease, and venous thromboembolism. These conditions don't discriminate.
They don't care if you bought all of the right baby equipment.
They don't care if you gave birth in a hospital or at home.
They don't care if you gave birth effortlessly or if it was the worst pain of your life.
But there are ways to ensure that nurses have the knowledge they need to make moms and their partners aware of signs that mom might need medical attention. According to work previously developed by Dr. Patricia Suplee, Dr. Debra Bingham, Anne Santa-Donato, and Lisa Kleppel and published by the Association of Women's Health, Obstetric and Neonatal Nurses, the acronym POSTBIRTH is a way for all of us — moms, partners, friends, grandparents, nurses — to remember the warning signs and know which steps to take.
Pain in chest
Obstructed breathing or shortness of breath
Thoughts of hurting yourself or your baby
Bleeding, soaking through one pad/hour, or blood clots the size of an egg or bigger
Incision that is not healing
Red or swollen leg that is painful or warm to touch
Temperature of 100.4°F or higher
Headache that does not get better, even after taking medicine, or bad headache with vision changes
It's simple. If you see a sign in the POST section, call 911.
If you see a sign in the BIRTH section, call your healthcare provider.
If you can't reach them, call 911 or go to the emergency room.
Inform anyone you call — 911, emergency room, urgent-care provider, or your healthcare provider—that you have given birth in the last year.
We can all do something to keep ourselves and new moms safe. Learn these warning signs and watch for them. Have a partner, friend, or family member familiarize themselves with them in case you are so exhausted and focused on your newborn and other children in those first days that you neglect yourself.
Even if it seems weird or morbid to message a list of warning signs to your friends and family who have just given birth, you should. And you might save a life.
Jill Arnold is a consultant specializing in consumer engagement with maternity care data and a cofounder of the National Accreta Foundation, which aims to eliminate preventable maternal mortality and morbidity attributable to placenta accreta.