After Delivery, Watch for Fever and Infection
In my retirement, I’ve been visiting social media, something I never anticipated I would do. To my surprise, I read a lot about young moms and dads who were having problems after their babies come home, problems they should have been prepared for before they left the hospital. Infection is one of them.
Once Home, Monitor Your Temperature
Once you’re home, mothers should check your temperature at 8 AM and 8 PM for at least seven days. The times you take your temperature are not set in stone, so if you’d rather take your temperature at 9 o’clock or 7 o’clock it doesn’t matter. The point is that you should check it about 12 hours apart for at least seven days, especially if you have aches, chills, and pains.
Your morning temperature is likely to be your lowest, while your evening temperature is likely to be your highest. Regardless, you should not have a fever over 100 degrees. Pregnant and postpartum women do not run fevers easily. If your thermometer reads over 100 degrees, recheck your temperature in half an hour to an hour. If your temperature remains above 100 degrees, you should probably call your doctor, or for that matter, go to the emergency room. Remember, labor and delivery, once the go-to source for solutions during pregnancy, will probably not be available postpartum. If they say, “No, don’t go to the ER” you should probably still go to the emergency room.
Some people can be very sick and have a normal temperature except for an hour or two a day when their temperatures could go up to 104 degrees. If you check your temperature and it’s low or normal, but you feel terrible, you should probably recheck your temperature again in an hour.
The same holds true for your visit to a doctor or emergency room. If they check the temperature and it’s normal, it doesn’t necessarily mean that your temperature is normal throughout the day. You should check your temperature any time you feel cold. The urge to put on extra clothes, crawl under another blanket, turn up the heat, or take a hot shower are warning signs you are running a fever or your temperature is beginning to go up.
Having chills is a very important signal to watch with a high fever. It can mean you have sepsis, a blood infection. It’s difficult to know the difference between a blood infection with a bacterium and a blood infection with a virus. One thing to remember is that even if you have a viral infection in pregnancy, it can lead to serious complications.
Years ago, a young patient was referred to me from the emergency room. She had seen her doctor for several days in a row complaining of fever and pain in her left lower abdomen. Every time she went to the emergency room, her temperature was normal. With infections, doctors look for a higher level of white count in the blood as an indication your body is trying to fight off infection. This patient’s white blood count wasn’t over 11,000, which is considered normal. She didn’t appear to be sick. We began checking her temperature every hour. Her temperature would go up 104 degrees, but go back down in a few hours and she felt better, as if she were back to normal. We treated her for infection and she returned home.
Most young women respond very well to treatment for infection, especially if it’s timely.
What Can Cause Fevers in Postpartum Women?
There are four primary causes of infection in postpartum women. Unfortunately, these problems often don’t appear until women have left the hospital, so I recommend women become aware of the symptoms so they can seek help quickly.
1. Infection in the Uterus
If this is your first pregnancy, you don’t always know how sore your uterus is supposed to be after you deliver and go home. If your abdomen is sore, or you have a fever, or you have a malodorous discharge, or are passing chunks of tissue, it is likely that you have myometritis, an infection in the muscle of uterus.
This infection is most often caused by a retained placental fragment. I have always been a proponent of letting your uterus push out your placenta by contraction rather than pulling the placenta out by the cord. When the placenta is expelled by your uterus, there is less opportunity for pieces of the placenta to remain attached to your uterus than when the placenta is physically detached by pulling on the cord.
Uterine infection can also be caused by Group B strep as well as other infections such as Chlamydia, Ureaplasma, or Mycoplasma.
2. Mastitis
The second most likely cause of infection after delivery is mastitis, or infection of the breast. Usually only one breast becomes infected. Postpartum women are at greater risk for developing mastitis than women who have not been pregnant.
Mastitis appears as a spot about an inch and a half or two in diameter on your breast, in the dark areas around the nipple. It’s red, hot, hard and sore. A blocked milk duct is often the source of the infection. The safest way to avoid blocked milk ducts is to continue to breastfeed. Yes, it is safe to breast-feed a baby on an infected breast. The baby has a good ability to neutralize any bacterium that might be found in the breast milk. And that’s the point of having the baby continue to nurse, to unplug the breastmilk duct. If you really feel you cannot nurse your baby with an infected breast, you should pump your breast milk, even if you don’t feed the milk to your baby but instead discard it. The point is to keep the milk ducts open.
There are other treatment options. Sometimes this infection can turn into an abscess. Although these abscesses can rupture and drain on their own, it’s probably easier to go visit your doctor and to get the abscess drained under local anesthesia. There are a number of antibiotics your doctor can give you to address the infection after the draining of the abscess.
3. Infected Episiotomy
Some women have an episiotomy. Episiotomy infections are rare, but often very painful. Most of my episiotomies were done, midline, that is, in the center of the perineum. A central incision can be made without interference from other tissue around the episiotomy and decreases the risk of damaging the vagina.
National Public Radio reported about a woman who told the story of episiotomy pain and being sent home by a practitioner who did not address her complaint. She later returned to the hospital with necrotizing fasciitis. Necrotizing means decaying and means the tissue around her muscle surface is infected. This condition is very hard to find and treat because there is so much other tissue around the site of the infection.
Fascia infection can occur with any surgery, but no one should die from an episiotomy. As I’ve emphasized before, track your temperature and call your doctor when it gets to be more than 100 degrees. You should see your doctor if you think you’re having trouble with your episiotomy. There are those who will tell you to stay out of the tub, but I think a clean plain old tub (not a hot tub or jacuzzi) is very good place for relief of episiotomy discomfort or pain.
4. Urinary Track Infection (UTI)
Bladder infections are mostly nuisances, with urgency, frequency, painful voiding, and voiding in small amounts. These symptoms are fairly common after delivery. There is currently a lot of controversy about treating UTIs with antibiotics, but the end result of an untreated postpartum UTI can be a kidney infection.
I had a patient with a postpartum kidney infection. She had a fever of 106.5. I sat with her in the hospital most of the night, something I did with my very sick patients. Like many very sick patients, she had a remarkable personality change, something I have found to be indicative of patients with sepsis, a serious blood infection which can end with death.
I knew this patient to be reserved and not particularly talkative. As I sat with her, about 2:00 a.m., she literally began talking non-stop and cracking jokes. The environment was surreal, listening to this very sick lady talking constantly, totally out of character. After several hours her fever dropped, she went to sleep, and I went home. We gave her the appropriate antibiotics and within five hours her temperature came down to normal. The first point is we treated her vigorously and she did well. The second point is beware of personality change associated with severe illness.
Don’t Let Infection Spoil Your First Week Home
With Your New Baby
I have tried to provide information here to help moms and dads safely negotiate their first week at home with their newborns. Years ago when a doctor could decide when patients were ready to go home, women and their families could stay in the hospital until the nurses and I knew they were well prepared to take their babies home. Unfortunately, today physicians are forced to push their patients out of the hospital when physicians recognize an extra day or two in the hospital might be of great benefit to the patient.