Urgent warning signs during pregnancy and after birth

If something feels wrong right now, you don’t have to be sure it’s serious before you act. Patient information from the American College of Obstetricians and Gynecologists (ACOG) advises calling your ob-gyn right away if you have a warning sign, and calling 911 or going to the hospital if you can’t reach your ob-gyn or feel you need immediate care.² When you get care, tell them you are pregnant or were pregnant within the last year.³

There is reason for hope: an ob-gyn writing for ACOG says most women recover without serious problems when they and their ob-gyns recognize and treat symptoms quickly.² This page brings together the warning signs that U.S. health agencies and ACOG say should not be ignored, and notes which time period each organization is talking about.

Call 911 or get emergency care for these

ACOG’s patient guide to recovery after birth says to call 911 or seek emergency help right away if you:⁴

• Have chest pain
• Are coughing or gasping for air
• Have seizures
• Have thoughts of hurting yourself or your baby
• Have severe pain in your lower abdomen
• Have pain, swelling, and tenderness in your legs

Other sources name more emergencies:

• Signs of a blood clot in the lungs. The Centers for Disease Control and Prevention (CDC) says to seek immediate medical attention for possible signs of a pulmonary embolism, including difficulty breathing, chest pain that usually gets worse with a deep breath or cough, coughing up blood, or a faster than normal or irregular heartbeat.⁵
• Symptoms of postpartum preeclampsia. CDC says to tell your health care provider or call 911 right away, and that you might need emergency medical care.⁶
• Signs of postpartum psychosis. The National Institute of Mental Health (NIMH) calls postpartum psychosis a psychiatric emergency and says anyone with symptoms should call 911 or go to the nearest emergency room.⁷
• Sudden, severe pain early in pregnancy. ACOG says that if you have an ectopic pregnancy and get sudden, severe pain, shoulder pain, or weakness, you should go to an emergency room, because a ruptured fallopian tube can cause life-threatening internal bleeding.⁸

If you are thinking about suicide, NIMH says to call or text the 988 Suicide and Crisis Lifeline at 988, and to call 911 in life-threatening situations.⁷

CDC’s urgent maternal warning signs

CDC’s Hear Her campaign lists urgent maternal warning signs for pregnancy and the year after delivery.³ CDC says to get medical care immediately if you have any of them, because they can be a sign of a life-threatening condition.³ The list was developed by the Alliance for Innovation on Maternal Health.³

• Headache that won’t go away or gets worse over time
• Dizziness or fainting
• Changes in your vision
• Fever of 100.4°F or higher
• Extreme swelling of your hands or face
• Thoughts about harming yourself or your baby
• Trouble breathing
• Chest pain or fast-beating heart
• Severe nausea and throwing up
• Severe belly pain that doesn’t go away
• Baby’s movement stopping or slowing during pregnancy
• Vaginal bleeding or fluid leaking during pregnancy
• Vaginal bleeding or discharge after pregnancy
• Severe swelling, redness, or pain of your leg or arm
• Overwhelming tiredness

CDC gives more detail for several signs. A headache may feel like the worst headache of your life, start suddenly like a clap of thunder, keep going after medicine and fluids, or come with blurred vision or dizziness.³ Extreme swelling is not the usual slight swelling of pregnancy; it can make it hard to bend your fingers, wear rings, or open your eyes all the way.³ Trouble breathing includes needing to prop your head up with pillows to breathe when lying down.³ Overwhelming tiredness means suddenly feeling very tired and weak, not refreshed no matter how much you sleep, or too tired to get up to care for your baby.³

CDC says the list does not cover every symptom you might have, and that if something just isn’t right or you aren’t sure it’s serious, you should talk to your health care provider.³

Different warning signs, different time windows

Organizations describe different time periods for different problems. Here is what each source says:

• Any urgent maternal warning sign: during pregnancy and in the year after delivery, according to CDC’s Hear Her campaign.³
• Leg or arm swelling, redness, or pain: anytime during pregnancy or up to 6 weeks after birth, in the Hear Her list.³ CDC’s blood clot program describes a longer period of higher risk: pregnancy, childbirth, and the 3 months after delivery.⁵
• Postpartum preeclampsia: CDC says it is typically diagnosed within 48 hours after delivery but can happen up to 6 weeks later.⁶ In ACOG’s patient information, it most often happens within a few days after delivery but can occur up to 6 weeks later.²
• Heavy bleeding after birth (postpartum hemorrhage): usually within 24 hours of delivery, but it can occur up to 12 weeks later, per ACOG.²
• Infection of the uterus (endometritis): usually 2 to 10 days after delivery, but up to 6 weeks after birth for some women, per ACOG.²

If you have a symptom and aren’t sure whether it fits one of these windows, or whether it’s serious, CDC’s advice is to talk to your health care provider.³

Heavy bleeding

During pregnancy. CDC’s warning signs include any vaginal bleeding that is more than spotting, like a period, and fluid leaking from the vagina.³ ACOG says to contact your ob-gyn about bleeding at any time in pregnancy.⁹ It says bleeding in early pregnancy is common and often not a sign of a major problem, while bleeding later in pregnancy can be more serious; if you have any bleeding late in pregnancy, contact your ob-gyn right away or go to the hospital.⁹ In early pregnancy, ACOG says vaginal bleeding is sometimes the only sign of an ectopic pregnancy, and that other symptoms can include abdominal, pelvic, or shoulder pain.⁹

After birth. Some bleeding and discharge after delivery is normal; ACOG says it may start bright red and should become lighter and pinker within a few days.² The two organizations describe “heavy” differently:

• CDC’s warning signs include soaking through one or more pads in an hour, passing clots bigger than an egg or passing tissue, and vaginal discharge that smells bad.³
• ACOG describes heavy bleeding as soaking through two pads an hour for more than an hour or two, and says to call your ob-gyn right away if that happens.^2,4

ACOG lists other signs of postpartum hemorrhage: heavy or gushing blood, large clots, pale or clammy skin, feeling faint, dizzy, or weak, confusion, a rapid heart rate, and pain and swelling near the vagina or perineum.²

High blood pressure and preeclampsia

Preeclampsia is a serious disorder that can affect all the organs in the body; it usually develops after 20 weeks of pregnancy but can also develop in the weeks after childbirth.¹⁰ It can develop quietly without you being aware of it.¹⁰ ACOG lists these symptoms: swelling of the face or hands, a headache that will not go away, seeing spots or changes in eyesight, pain in the upper abdomen or shoulder, nausea and vomiting in the second half of pregnancy, sudden weight gain, and difficulty breathing.¹⁰

Eclampsia, when someone with preeclampsia has seizures, is a medical emergency.⁶ The National Institute of Child Health and Human Development (NICHD) lists seizures, severe headache, vision problems such as temporary blindness, pain in the upper right belly, nausea and vomiting, and urinating less often as cause for immediate concern.¹¹ ACOG calls HELLP syndrome, a condition preeclampsia can cause that damages red blood cells and interferes with blood clotting, a medical emergency.¹⁰

After birth, if your ob-gyn asks you to check your blood pressure at home, ACOG’s patient information says to call your doctor right away for a top number of 140 or higher or a bottom number of 90 or higher.² Our guide After preeclampsia or gestational diabetes covers postpartum preeclampsia and the long-term heart risks in more depth.

Blood clots

CDC says women are especially at risk for blood clots during pregnancy, childbirth, and the 3 months after delivery.⁵ A clot in a leg or arm, called deep vein thrombosis (DVT), can cause swelling, pain or tenderness not caused by an injury, and skin that is warm, red, or discolored; CDC says to alert your doctor as soon as possible if you have these signs.⁵ A clot can break off and travel to the lungs, which can be life-threatening.⁵ The signs of a clot in the lungs are listed in the emergency section above.

Fever and infection

CDC’s warning signs include a temperature of 100.4°F (38°C) or higher.³ ACOG says to call your ob-gyn right away after birth for a fever of more than 100.4°F, vaginal discharge that smells bad, red streaks or painful new lumps in your breasts, redness or discharge from an episiotomy, tear, or cesarean incision, or pain or burning when you urinate that is severe or lasts more than a few days after delivery.⁴

An infection of the lining of the uterus after birth is called endometritis; ACOG says that without quick treatment it can lead to sepsis, shock, and organ failure.² Its signs include fever and chills, feeling tired or sick, belly pain or tenderness, and foul-smelling vaginal discharge.²

Changes in your baby’s movement

CDC lists your baby’s movement stopping or slowing during pregnancy as an urgent warning sign.³ It says there is no specific number of movements that is considered normal; a change in your baby’s movement is what is important.³

Thoughts of harming yourself or your baby

CDC includes thoughts about harming yourself or your baby among its urgent warning signs, whether they come from feeling very sad, hopeless, or constantly worried, or arrive as scary, unwanted thoughts that are hard to get rid of.³ The Office on Women’s Health says that if you are thinking about hurting yourself or your child, get help immediately by calling or texting the 988 Suicide and Crisis Lifeline.¹² The National Maternal Mental Health Hotline, 1-833-TLC-MAMA (1-833-852-6262), offers free, confidential support by call or text 24 hours a day, 7 days a week, in English and Spanish.⁷

The Office on Women’s Health notes that women with perinatal obsessive-compulsive disorder (OCD) know their thoughts are disturbing and are unlikely to ever act on them.¹² Our guide to postpartum anxiety and intrusive thoughts explains the difference and how to get help now.

Postpartum psychosis is a serious mental illness that can occur after childbirth, with symptoms that can include delusions, hallucinations, mania, paranoia, and confusion.⁷ NIMH says it requires hospitalization, and that recovery is possible with professional help.⁷ Read more: Postpartum psychosis is an emergency.

What to say when you get care

CDC suggests telling the health care provider that you are pregnant or were pregnant in the past year, describing other health conditions such as high blood pressure or diabetes, and mentioning any complications during your pregnancy or delivery.¹³ Its conversation guide suggests giving the date of your last period or your delivery, your symptoms, what they feel like, and how many hours or days they have lasted.¹³ CDC also suggests telling the provider what medicines you take or recently took, and bringing a friend or family member if you can.¹³

ACOG says health care professionals should listen to you and take your concerns seriously.² CDC puts it simply: you know your body best, and if something seems unusual or is worrying you, don’t ignore it.¹³ If you feel dismissed, our guide When women’s pain is dismissed has ideas for being heard.

If you’re a partner, friend, or family member

CDC asks loved ones to learn the urgent maternal warning signs, listen to her concerns, and encourage her to get medical help; if she has a warning sign, she should get care right away.¹⁴ CDC suggests making sure she says she is pregnant or was pregnant within the last year, offering to go with her to appointments to help ask questions, and supporting her through follow-up care.¹⁴ ACOG also encourages family and friends to learn the signs so they can help notice a problem.²

What we don’t know yet

• No list covers everything. CDC says its warning-sign list is not meant to cover every symptom.³ Some women with preeclampsia have no symptoms at all.⁶
• Sources draw lines in different places. CDC and ACOG use different thresholds for heavy bleeding after birth, and CDC’s warning-sign list and its blood clot program give different time windows for clot symptoms, as described above. Advice on how fast to act also varies: ACOG’s recovery guide lists pain, swelling, and tenderness in the legs as a reason to call 911, while CDC’s blood clot page says to alert your doctor as soon as possible about signs of a clot in a leg or arm.^4,5 We show each organization’s advice rather than choosing one.
• Some pages are older. NICHD’s preeclampsia symptoms page was last reviewed in 2017, and ACOG’s postpartum recovery guide in 2022.^4,11 Guidance can change as research does.

Questions to ask your doctor

CDC’s Hear Her campaign suggests asking:¹³

• What could these symptoms mean?
• Is there a test I can have to rule out a serious problem?
• At what point should I consider going to the emergency room or calling 911?

You might also ask:

• Which warning signs matter most for me, given my health history and how my pregnancy or birth went?
• Should I check my blood pressure at home after birth? If so, what readings should make me call?
• Am I at higher risk for blood clots? What signs should I watch for, and for how long?
• How much bleeding is expected after birth, and when should I call about it?
• Who do I call after hours, and which hospital should I go to?

This article summarizes published research and official health information. It has not been reviewed by a clinician and is not medical advice. How we source.

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