Once the baby arrives, everyone in the room starts talking about the baby. Feeds, weight gain, sleep, the vaccination chart. You get sent home in a day or two with an appointment somewhere around six weeks, and almost nobody sits you down to explain what should be happening in between. That in-between stretch is where the risk sits.

India's maternal mortality ratio is 88 per 100,000 live births for 2021-23, roughly 22,500 deaths a year, and a large share of those women were discharged looking perfectly well. Government guidance says you should stay at least 48 hours after a normal delivery. A study of more than 17,000 women in rural Uttar Pradesh found that most went home within 24.

Why The First Six Weeks Matter

WHO counts the postnatal period as six weeks and asks for four check-ups inside it. One within 24 hours. One at 48 to 72 hours. One between day seven and day 14. The last in week six. Most Indian women get the six-week one, if that.

The other problem is that nobody tells you what to look for. When researchers asked women in the slums of Raipur to name a danger sign, roughly half could name one for pregnancy and half for labour. For the period after birth, 7.4 per cent could. Antenatal counselling in this country is thorough right up to the delivery and then it stops. So here is what to look for.

1. Excessive bleeding

Some bleeding is normal and it has a name, lochia. It runs two to six weeks and changes colour as it goes, bright red at first, then brownish-pink, then a pale yellowish white.

What is not normal: soaking a full pad in an hour, clots bigger than a golf ball or bleeding that had almost stopped and suddenly turns bright red again. Any of that, call the same day. If it comes with dizziness, breathlessness or a heart that will not slow down, go in.

The timing is what catches people out. Bleeding can start up again weeks after you are home, usually because a small piece of placenta stayed behind. Doctors call this secondary postpartum haemorrhage and it can happen any time up to 12 weeks. Bleeding remains the biggest single killer of mothers in India, behind roughly a quarter of maternal deaths.

2. Anaemia

Tired all the time. Out of breath on the stairs. Heart thumping when you stand up too fast. One small infection after another. Every one of those is also what everybody tells you to expect after a baby, which is exactly why anaemia goes unnoticed for months. And it is common here in a way it is not elsewhere. NFHS-5 found 57% of Indian women aged 15 to 49 anaemic, and 52% of pregnant women.

There is a second reason it matters. Anaemia decides how much blood you can afford to lose. A bleed another woman would get through without much trouble can put you in real difficulty. Ask for a haemoglobin test at your first visit after delivery, not at six weeks.

3. High blood pressure

Most people file preeclampsia away as a pregnancy problem. It can start after you deliver, including in women whose pregnancy was completely uneventful. In one large study of women readmitted with high blood pressure after birth, 63% had carried no such diagnosis anywhere in their pregnancy.

Most cases show up in the first 48 hours. Some turn up weeks later. Watch for a headache that painkillers will not touch, blurred vision or flashing lights, puffiness in your face and hands or breathlessness that comes on suddenly. Any of those, get seen the same day. A fit is an ambulance call.

4. Infection

Infection can set in any time up to day 42. Usually the lining of the uterus, the urinary tract or a wound from a caesarean or an episiotomy. Fever of 38 degrees Celsius or more. Pain low down. Discharge that smells genuinely bad, not merely unfamiliar. A wound going red, hot and hard. It takes hold easily because the uterus is left with a raw patch where the placenta came away, and the cervix stays open for several days after birth.

Antibiotics deal with this well, provided they are started early, so the real danger is the wait rather than the infection. Sepsis linked to pregnancy still causes around 11% of maternal deaths worldwide.

5. Blood clots

Your blood clots more easily during pregnancy. That does not switch off the day you deliver. For six weeks afterwards your risk of a clot runs nine to 22 times higher than normal, highest in the first fortnight, and it can stay up for as long as 12 weeks.

Three things stack up. The clotting changes your body made on purpose so you would not bleed too much at delivery. The pressure the uterus has been putting on the veins in your pelvis. And the fact that you are barely moving. A caesarean adds to all three. That pressure falls on the left side in most women, which is why these clots turn up in the left leg far more often than the right.

Pain, swelling, warmth or redness in one calf or thigh needs a scan that day. Chest pain or breathlessness that starts suddenly is an emergency, because a clot that reaches the lungs can kill. Six weeks of resting indoors, in this one respect, works against you.

6. Postpartum depression

Crying easily and swinging between moods in the first fortnight is common and usually passes on its own. Depression is different. It carries on past two weeks, it gets worse rather than better, and it starts getting in the way of looking after yourself or the baby.

About 22% of Indian mothers go through it. What makes it more likely is worth naming plainly: money trouble, violence at home, a difficult marriage, a husband who is not around and having had a girl. That last one tells you something. This is not only hormones settling down. It has a great deal to do with how a woman is treated after she gives birth, and by whom.

Only about half of Indian mothers know enough about the condition to spot it in themselves. If any of this sounds like you, say it out loud to somebody. If you are having thoughts of hurting yourself or the baby, that is the same day and not next week, from a doctor or a mental health professional.

When To Go To The Hospital Straight Away?

  • Bleeding that soaks a pad within an hour or clots the size of an egg or bigger
  • A headache medicines will not touch or one that comes with vision changes
  • Fever of 38 degrees Celsius or higher
  • One leg red, swollen, warm or painful
  • Chest pain or breathlessness that starts suddenly
  • A wound that is not healing or is leaking
  • Any thought of harming yourself or the baby
  • Do not wait for the six-week visit

Nearly everything on this list warns you before it turns into an emergency, and nearly all of it is treatable if somebody catches it early. The trouble is that a woman three weeks into a hard recovery is the worst possible judge of her own symptoms, and everyone around her is looking at the baby. Book the earlier check-ups instead of waiting for the six-week one. And tell one person at home what is on this list, so that somebody besides you is watching.

(By Dr Preeti Rastogi, Senior Director and Head of Department, Obstetrics and Gynaecology, Medanta)

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