Woman with fever and thermometer wrapped in blanketSafeguarding against postnatal sepsis (infection)

 

What is postpartum sepsis (infection)?

While you were pregnant your body’s natural immunity (which fights off infections) was suppressed, so that your body didn’t treat your developing baby as a foreign body/infection that needed to be attacked. This process is called immunosuppression which can mean that after giving birth, you remain more vulnerable to developing an infection and mild infections can become more serious (severe sepsis) a lot quicker.

Postnatal infection (also called postpartum infection) isn’t that common; however, as a new mum you need to be mindful that there are wounds following your baby’s birth, where infection could enter your body. These include the site where your placenta (afterbirth) was attached to the wall of your uterus (womb) as well as, wounds caused by possible vaginal and/or perineal lacerations, tears or from an episiotomy. If your baby was born by Caesarean section, you will also have an abdominal wound. However, postpartum infections can also develop in the breast and also in the bladder or kidneys; particularly if you had a urinary catheter inserted around the time of the birth, or within the initial hours following their birth.

It is estimated that as many as one to eight per cent of births result in infection. Postpartum infections can be serious, especially if symptoms are ignored, not detected quickly, or are not treated and the infection passes into the bloodstream. This can lead to sepsis.

Sepsis is rare however, and for the majority of new mums, postnatal infection only impacts on their postnatal recovery from their baby’s birth, and can potentially delay bonding and attachment with their new baby. For this reason, it is important that health and wellbeing in the postnatal period is monitored and any potential infections are detected early and treated promptly.

This article has been written to explain the signs and symptoms of postnatal infection to look out for. If you feel unwell or are concerned that your body is not recovering as it should be, you should always seek advice from your midwife or GP as soon as possible.

What factors increase the risk of developing infection?

If you had an assisted birth using forceps or ventouse, or your baby was born by Caesarean section, you can be more prone to infection because these types of birth are more often associated with longer and more difficult labours, more labour care interventions, and the need for sutures (stitches). If the amniotic fluid (also called ‘liquor’ and the ‘waters’) surrounding your baby break – called spontaneous rupture of the membranes – early on in your pregnancy (ie prematurely) or more than 24 hours before your baby is born, this can also increase your risk of developing an infection.

Very occasionally a small fragment of the placenta can be left inside the uterus and becomes infected. This can cause blood clots to form and in some cases, heavy bleeding can occur. Infections are also more likely to occur if you have needed stitches; these can be perineal if you had a vaginal birth or abdominal if your baby was born by Caesarean section.

 

Pregnant woman with the fluWhat are the signs of possible infection?

The signs and symptoms that you experience will depend on where the infection is; however, in the majority of cases individuals will have a raised temperature (fever), chills, feel fatigued (extreme tiredness), and generally unwell (often experiencing flu-like symptoms like a headache and muscle aches). You may also experience pain or tenderness in the area that is affected; this might be lower abdominal pain or perineal pain. You may also have localised inflammation (redness), warmth and swelling in the affected area.

 

Urinary infections

If you have developed an infection in your bladder or kidneys (called a urinary tract infection (UTI), or kidney infection), you are likely to have feelings of ‘urgency’ (the sudden need to pass urine) and ‘frequency’ (needing to pass urine often), and may struggle to pass urine only to find that little if anything comes out. You may also have discomfort or a burning sensation when passing urine. Some women also notice that their urine looks ‘cloudy’, rather being ‘clear’ and that it has a very strong or unpleasant odour. More rarely, a severe urinary tract infection can cause a small amount of blood to be seen in the urine; this condition is called haematuria.

 

Wound and uterine infections

If you have developed a wound infection, then you are likely to feel unwell, have a raised temperature and have pain or tenderness, and possibly also inflammation (redness) in the affected area. There can sometimes also be a small amount of ooze/discharge from the wound site. However, where the infection has developed inside your uterus, then it is likely that you will have an offensive discharge (blood loss with a nasty odour). Where the colour of your vaginal bleeding (lochia) changes and becomes a red colour again and/or is heavier than it was, or you pass blood clots, this may be an indication of a uterine infection.

 

Breast infection

Mastitis is a relatively common infection of the breast, affecting around 1:20 postnatal mothers. It tends to develop when breasts become engorged and a milk duct becomes blocked; women are also at increased risk of developing mastitis if they have cracked nipples. Ensuring that you wear a well-fitted nursing bra and ensuring breastfeeding is baby-led, will reduce the risk of the breasts becoming engorged and/or milk ducts becoming blocked. Similarly, making sure that your baby is well positioned and attached at the breast, will help to prevent nipple trauma. See also our article on ‘Managing common breastfeeding problems’.

 

How can I prevent infection developing?

This article has explained the symptoms of infection that you need to look out for; this next section will look at the steps that you can take to minimise any risk of developing infection.

a). Personal hygiene is very important. Ensuring that you wash your hands properly, change your maternity sanitary pads at least four hourly, or sooner if need be and do NOT use tampons, are all important measures in helping to prevent infection. Similarly, when you use the toilet, you should always wipe from the front to the back, so that you don’t introduce germs from the bowel (bottom) into the vagina.

b). If you have dogs or puppies in the house or work with animals, it is important that you wash your hands before going to the toilet, as well as afterwards. This may seem strange, but some animals can carry harmful bacteria such as Streptoccocus A or B, which can then cause serious infections. If these bacteria are present on your hands following contact with animals and you touch yourself whilst wiping; bacteria can easily come into contact with a perineal wound and then enter the blood stream.

c). Eating a healthy balanced diet, drinking plenty of fluids and getting as much rest as possible (which can be difficult with a newborn!) will also help to promote healing and your recovery from the birth.

If you gave birth in hospital it is likely that you will have been discharged home within a couple of days; a short hospital stay can mean that infections aren’t detected until you are back home. If you feel unwell, including flu-like symptoms, develop a temperature, or experience any other possible signs of infection, it is important that you contact your midwife or GP without delay. Your GP may prescribe a course of oral antibiotics (tablets), which should be completed even if you begin to feel much better after a couple of days. However, if you find that you are not feeling any better, despite having taken antibiotics for 48 hours, go back to see your GP. There are different bacteria that can cause infections and sometimes you may need to be prescribed a different type of antibiotic. If you are breastfeeding your baby, it is important that you tell your GP so that they can prescribe antibiotics that are safe to take and will not affect your baby.

More rarely, a serious postpartum infection may warrant readmission to the postnatal ward for intravenous antibiotics and additional treatments. Intravenous antibiotics work more rapidly because the antibiotics are given directly into the bloodstream and will tackle the infection much quicker. Where this is necessary, it is possible for your baby to remain in hospital with you, especially while you are breastfeeding.

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