Maternal Warning Signs

Contents

1. The list and its origin
2. The numbers behind the campaign
3. The danger window lasts a year
4. Headache, vision changes and dizziness
5. Swelling beyond the usual
6. Breathing trouble, chest pain and a racing heart
7. Fever, belly pain and bleeding
8. Leg pain, low mood and the baby’s movements
9. Normal and urgent differ by degree

Candace Cooley, a board certified obstetrician and gynecologist, has cared for women whose pregnancies ran a straightforward course and women whose pregnancies carried high risk, and has delivered their babies, and the warning signs described here belong to the months before and after a delivery. A common belief holds that once a healthy baby has arrived, most aches, swelling and exhaustion are simply what recovery feels like. The belief is fair. Pregnancy and birth do leave the body sore, swollen and tired, and most of those feelings fade on their own. The difficulty is that a few dangerous conditions begin with the same sensations, and the warning signs list exists to mark where ordinary ends.

The list and its origin

The Urgent Maternal Warning Signs were developed by the Alliance for Innovation on Maternal Health and are promoted by the Centers for Disease Control and Prevention through its Hear Her campaign, which tells women to seek care right away for any of them and to mention a current or recent pregnancy when they do.¹ The agency offers the list as posters, handouts and magnets in English, Spanish and more than two dozen other languages.² State groups adapt it: the New Hampshire Perinatal Quality Collaborative points families to the poster and notes that versions exist in more than 80 languages,³ and the Arkansas Department of Health condenses it to fourteen symptoms under the heading not to ignore them.⁴

The numbers behind the campaign

The list answers a stubborn problem. ABC News reported in 2020 that about 700 women in the United States die each year from causes related to pregnancy, and that more than 50,000 experience its most severe complications.⁷ In 2023 CNN reported federal data showing the rate rose to 32.9 deaths per 100,000 live births in 2021, with sharp gaps by race and age; the count of women who died rose from 658 in 2018 to 1,205 in 2021.⁶ A training webinar from the Reproductive Health National Training Center puts the share of these deaths judged avoidable at more than four in five.⁵

Figure

Maternal deaths in the United States, 2021

deaths per 100,000 live births

32.9

the rate for Black women compared with White women

2.6 times

the rate for women 40 and older compared with those under 25

6.8 times

The danger window lasts a year

The webinar stresses that deaths related to pregnancy can occur up to a year after it ends, which is why it urges clinicians outside obstetrics to ask about recent pregnancy.⁵ NPR reported in 2017 on a survey of postpartum nurses that found few knew most maternal deaths occur in the days and weeks after delivery, and that many spent ten minutes or less teaching new mothers the warning signs. The timing matters because a mother typically does not see her own doctor for four to six weeks after leaving the hospital, and up to 40 percent never return for that visit. Researchers who tested a short checklist and a one page handout found that mothers soon came back to the hospital holding it and naming a symptom.⁸

Figure

What postpartum nurses knew

knew most maternal deaths occur in the days and weeks after delivery

12%

named heart problems as the leading cause

24%

believed maternal deaths had declined

19%

Headache, vision changes and dizziness

The CDC describes a worrying headache as one that may feel like the worst of a woman’s life, persists or worsens despite medicine and fluids, starts suddenly like a thunderclap, or comes with blurred vision or dizziness. Flashes of light, blind spots and double vision belong on the list too, as do fainting, ongoing lightheadedness and lost stretches of time that a woman cannot remember.¹ Several of these can signal preeclampsia.

Swelling beyond the usual

The agency separates the slight swelling most women notice late in pregnancy from swelling that stops fingers bending or eyes opening fully.¹ ABC News recounted a mother whose swollen ankles were brushed off as normal for the last stretch of pregnancy, and who then developed preeclampsia with kidney failure.⁷ The routine visits at which pressure, weight and swelling are checked during pregnancy are set out in the prenatal care schedule.

Breathing trouble, chest pain and a racing heart

Shortness of breath, needing pillows to breathe lying down, chest tightness, and a pounding or irregular heartbeat are all on the list.¹ ABC News told the story of a mother of twins whose swelling and breathlessness after birth turned out to be peripartum cardiomyopathy, a weakening of the heart muscle whose symptoms can mimic late pregnancy.¹⁰ NPR noted heart disease accounts for more than a quarter of maternal deaths.⁸

Fever, belly pain and bleeding

The list includes a temperature of 100.4 degrees Fahrenheit or higher, severe belly pain that does not go away, bleeding during pregnancy heavier than spotting, and, after birth, soaking a pad or more in an hour or passing large clots.¹ NBC News described a healthy new mother sent home despite fever and fatigue who died of infection six days after giving birth, and hospital training to spot early signs of hemorrhage.⁹

Leg pain, low mood and the baby’s movements

The CDC lists swelling, redness, tenderness or pain in a leg, usually the calf of one leg, at any time in pregnancy or up to six weeks after birth; the area may feel warm and may hurt when the foot flexes, and similar pain or swelling can affect one arm.¹ In the NPR report, a new mother given that handout recognized the signs of a clot in her lung a week after delivery.⁸ The list also includes thoughts of harming oneself or the baby, which the CDC links to feeling hopeless, out of control or constantly worried; tiredness so overwhelming that a woman cannot get up to care for her baby; and a baby who moves less than before, where a change matters more than any count.¹

Figure

Ordinary discomfort and an urgent sign

	Common in pregnancy	Urgent warning sign
Swelling	Slight swelling, especially in the last months	Hands too swollen to bend the fingers, or a face too puffy to open the eyes
Nausea	Queasiness and some vomiting early in pregnancy	Unable to keep fluids down, with dry mouth, confusion or dizziness
Bleeding during pregnancy	Spotting	Bleeding like a period, or fluid leaking
Tiredness	Fatigue that rest improves	Sudden exhaustion that sleep does not relieve

Normal and urgent differ by degree

Read closely, the list mostly describes ordinary experiences pushed past a line. Swelling, nausea, tiredness, headache and bleeding are common in pregnancy and after birth; what moves them onto the list is severity, persistence or a sudden start. The CDC adds that the list cannot cover every symptom, and that a feeling that something is not right is reason enough to raise it.¹ Whether a particular symptom needs care is a question each woman should put to her own clinician, and promptly.