Many women think that if they make it through birth without complications, like high blood pressure or preeclampsia, they’re in the clear. Unfortunately, that’s simply not the truth. According to the World Health Organization, most maternal deaths occur after childbirth, with hemorrhaging and postpartum preeclampsia being the most common conditions. And what’s even scarier is that the United States has a maternal mortality rate that’s much higher than other Western countries—nearly 700 women die each year during or after childbirth in the United States.

Further, because mom is consumed caring for her newborn, symptoms of one of the most common complications can go unnoticed. Here’s what you need to know about postpartum preeclampsia:

What is Postpartum Preeclampsia?

Postpartum Preeclampsia (PPE) is a rare but serious condition that occurs after childbirth. It causes high blood pressure and protein in the urine.

Postpartum preeclampsia typically occurs within 48 hours of giving birth, but can develop up to 6 weeks postpartum (called late postpartum preeclampsia).

Much like preeclampsia during pregnancy, PPE can cause complications beyond high blood pressure, including:

  • Postpartum eclampsia: Preeclampsia is the condition leading up to eclampsia. Eclampsia can cause seizures, which can have severe negative effects on the vital organs, including the brain, eyes, liver, and kidneys.
  • Pulmonary edema: This is a condition where excess liquid collects in the lungs. This is a serious and life-threatening condition.
  • Stroke: A stroke is another serious concern and is considered a medical emergency. A stroke can deprive the brain of vital oxygen and food, potentially causing life-long issues or death.
  • Thromboembolism: Another medical emergency, thromboembolism occurs when there is an obstruction of a blood vessel by a blood clot that has become dislodged from another part of the body.
  • HELLP syndrome: This condition is also a serious concern and can be life-threatening. It is a disorder of the liver and blood that can cause low red blood cell count and can lead to anemia.

Postpartum preeclampsia is clearly nothing to mess around with. If you’re at a higher risk for postpartum preeclampsia, it’s important to know what to look for and to check in with your doctor regularly.

What Causes Postpartum Preeclampsia?

Like preeclampsia during pregnancy, the causes of postpartum preeclampsia are not well understood and anyone can develop it.

However, doctors believe there are some common risk factors, including:

  • High blood pressure during pregnancy or chronic high blood pressure
  • Obesity
  • Multiples
  • Diabetes
  • Family history
  • Being younger than 20 or older than 40
  • Some research suggests impaired thyroid function is linked to preeclampsia
  • And finally, African American women

Black women are particularly at risk and have nearly a 1.5X higher risk of developing postpartum preeclampsia than non-Hispanic white women.

Postpartum Preeclampsia and Race

According to this study, women of color also have lower instances of remaining normotensive during pregnancy (adjusted odds ratio (AOR)=0.85, 95% CI 0.78–0.93). Black women have higher odds of mild preeclampsia, severe preeclampsia and superimposed preeclampsia.

So what’s a mama to do?

The most important thing you can do is ensure you get the care you deserve. You might even consider hiring a black postpartum doula to support you during your fourth trimester. Other steps you can take include:

  • Educating yourself and knowing the warning signs of postpartum preeclampsia
  • Practicing good self-care
  • Advocating for yourself and demanding care if you think something seems off

Shalon Irving, a Lieutenant Commander and CDC epidemiologist, died from complications of postpartum preeclampsia. She knew something was wrong, she knew the risk factors, and yet she still didn’t receive the care she needed. Now, her mother, advocates for all women of color to make the fourth trimester one filled with intentional care for all mamas. If you’re getting ready to enter the fourth trimester, create your own postpartum care plan.

Postpartum Preeclampsia Symptoms

The symptoms of postpartum preeclampsia are similar to symptoms of preeclampsia during pregnancy:

  • Headaches
  • Swelling, especially in feet and hands
  • Changes in vision
  • Upper abdominal pain
  • Chest tightness and pain
  • Excessive sweating
  • Decreased urination
  • Excess urine in protein
  • High blood pressure*

* Do not dismiss a slightly elevated blood pressure as postpartum preeclampsia can start out with readings like this and then escalate quickly.

Also, it’s important to note that not every woman who experiences this condition will have any—or all—of these symptoms. And when you’re already distracted by caring for your new baby and healing from childbirth (no small order!), you may not recognize these symptoms or you might brush them off as a normal part of postpartum recovery.

Because of this, it’s vital to be aware of the symptoms and have a great medical team that you trust. The bottom line is knowing what to look out for can help you be a better advocate for yourself. 

How is Postpartum Preeclampsia Diagnosed?

If you’re having any of the above symptoms, or think you might be, call your doctor right away. Your doctor will check a few things, including:

  • Blood pressure
  • Platelet count via a simple blood test
  • Urine for protein (Urinalysis)

In severe cases (like if you’ve had a seizure), your doctor may recommend a brain scan or other tests based on your individual needs.

Postpartum Preeclampsia Treatment

When postpartum preeclampsia is diagnosed it’s important to get treated right away. Left untreated, postpartum preeclampsia can cause seizures, stroke, and other serious complications.

All hospitals, birth centers, and home practitioners should have a postpartum preeclampsia toolkit that would look something like this toolkit created by California Maternal Quality Care Collaborative (CMQCC). This toolkit includes a number of medications (including intravenous magnesium) that are recommended for treating preeclampsia.

Your midwife may also pack some natural treatments like the ones listed below:

  • Magnesium (oral or topical)
  • Calcium
  • Vitamin B
  • Folic acid (methylated form)
  • Vitamin C
  • Lycopene
  • Vitamin E
  • Vitamin D
  • Coenzyme Q10
  • Low dose aspirin

Your practitioner may also recommend blood pressure medication, anti-seizure medication, or blood thinner, depending on the severity of your condition. Always check with your midwife or doctor before taking any supplements.

Does Postpartum Preeclampsia Go Away?

Postpartum preeclampsia is a very serious condition, but luckily, with proper (and timely!) treatment, postpartum preeclampsia recovery is likely. And just because you have preeclampsia once, doesn’t mean you will have it with subsequent pregnancies.

How to Prevent Postpartum Preeclampsia

There is some evidence that lifestyle and other self-care strategies can help prevent the onset of preeclampsia. According to the review, women who were more knowledgable about ways to care for their body through nutrition, lifestyle choices, stress reduction, exercise, etc. were less likely to have preeclampsia (or more likely to manage it well). Here are some more specific self-care strategies that may help you:

  • Exercise: With doctor’s approval, aim for at least 30 minutes of exercise a day—but don’t overdo it; even a short walk counts.
  • Sleep: Whether it’s during pregnancy or after birth, sleep is key for maintaining optimal health. If you’re not sleeping well, it may be a sign that something is off in the body. Interestingly, a 2016 study found that lower levels of melatonin were linked to preeclampsia. Try drinking tart cherry juice at night to support melatonin production. It contains the highest levels of naturally occurring melatonin. Getting natural morning light and avoiding too much artificial light at night can also help boost melatonin levels.
  • Relax: Stress is one of the biggest factors in derailing health. Among other harmful physiological effects, stress can cause elevated blood pressure—a risk factor for preeclampsia. Meditating, getting help with baby, journaling, or anything else that reduces your stress levels can help.
  • Diet: A healthy diet is important at all times, but is especially important during pregnancy and postpartum. Some research suggests that preeclampsia is a symptom of poor nutrition. Try the Brewer’s diet, which is focused on high protein and proper nutrition—it is meant to support healthy blood volume and prevent high blood pressure.

How a Postpartum Care Plan Can Help, Too

The statistics about maternal healthcare in the postpartum period are staggeringly grim—particularly n countries like the United States. Based on this information, it’s clear that most women aren’t getting the care they need during the crucial fourth trimester.

But a postpartum care plan can help you do everything possible to make sure your body and mind stay healthy following childbirth.