Debra Bingham

conceptual illustration of a mother with child and signs of danger in the background

The Centers for Disease Control and Prevention indicates that an estimated 700-900 women in the United States die each year from pregnancy- and childbirth-related causes; another 65,000 women nearly die.

"If [nurses] aren't aware that there's been a rise in maternal mortality, then it makes it less urgent to explain to women what the warning signs are," Bingham told NPR's Morning Edition.

Post-Birth Warning Signs to Help You Save a Mother's Life

Our Researcher: Debra Bingham, DrPH, RN, FAAN

By Libby Zay
(from the spring 2018 issue of Nursing For/um magazine)

Despite a global decline, maternal mortality has increased in the United States in recent years, and more American women are dying of pregnancy-related complications than in any other developed country, according to a 2015 study published in The Lancet journal.

Debra Bingham, DrPH, RN, FAAN, associate professor, has more than 30 years of clinical experience as a high-risk perinatal nurse, and for the past decade, much of her work has focused on reducing maternal morbidity and mortality. Bingham is the founder and executive director of the Institute for Perinatal Quality Improvement, an independent organization, and co-author of a study published in MCN: The American Journal of Maternal/Child Nursing in August that found many nurses are ill informed about the dangers mothers face after giving birth.

Nearly half of the nurses who responded to a survey that was part of that study were unaware that maternal mortality had risen nationally in recent years, and only 12 percent knew that the majority of maternal deaths occur in the days and weeks after delivery. Only 24 percent correctly identified heart-related problems as the leading cause of maternal death in the United States.

There is good news: The study also found that nurses and new mothers could be quickly educated on the signs and symptoms that require urgent care. Under Bingham’s direction as vice president for research, education, and practice from 2010-16, the Association of Women’s Health, Obstetric, and Neonatal Nurses developed and implemented a checklist indicating potentially life-threatening complications for new mothers in four hospitals in New Jersey and Georgia, and nurses reported that mothers were returning with the handout, explaining that they had certain symptoms.

To help make the information easier to remember, the leading causes of maternal morbidity and mortality spell POST-BIRTH. 

If a new mother has any of these POST symptoms, she should call 911:

  • Pain in chest could mean the mother has a pulmonary embolism or cardiac disease.
  • Obstructed breathing or shortness of breath are additional signs of lung and heart problems.
  • Seizuresmay indicate the mother has a condition called eclampsia, a severe complication characterized by high blood pressure.
  • Thoughts of hurting themselves or the baby may mean the mother has postpartum depression.

If a new mother has any of these BIRTH symptoms, she should call her health care provider; if she does not hear back from her provider she should seek emergency care:

  • Bleeding (heavy), such as soaking more than one pad in an hour or passing a chicken egg-sized clot or bigger, may mean the mother has an obstetric hemorrhage.
  • Incision that is not healingor increased redness or discharge from the episiotomy or C-section site can be signs of infection.
  • Red or swollen legsthat are painful or warm to the touch may mean the mother has a blood clot.
  • Temperature of 100.4 degrees or higher,as well asbad-smelling blood or discharge from the vagina, may mean the mother has an infection.
  • Headache that is very painful and does not get better — even after taking medicine — or pain in the upper, right area of the belly may mean the mother has high blood pressure or postpartum preeclampsia.

To download a patient handout with this information in English and Spanish, visit www.awhonn.org/POSTBIRTH.

For more information on post-birth warning signs, visit www.perinatalqi.org/PPDischargeEdu.