Pregnancy & Childbirth

Although pregnancy is the same for people worldwide, their safety varies greatly depending on where they live and the type of medical care they receive, if any.

According to the World Health Organization, maternal sepsis refers to sepsis that results “from infection during pregnancy, childbirth, post-abortion, or the postpartum period.” Sepsis, which was often called blood poisoning, is the body’s overwhelming and life-threatening response to infection. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. Sepsis kills and disables millions, more than breast cancer, lung cancer, and stroke combined.

Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly), and/or amputations.

Maternal and postpartum sepsis are more common in the developing countries, but they also do strike people in wealthier countries, including in the United States. According to the Centers for Disease Control and Prevention, sepsis is the second leading cause of pregnancy-related deaths. Between 2014 and 2017 infection or sepsis caused 12.7% of pregnancy-related deaths in the United States. Pregnancy-associated sepsis requires early detection, accurate diagnosis, and aggressive treatment. In the United Kingdom, a 2019 study found that sepsis accounted for as many as 25% of all maternal deaths in that country.

 

How does sepsis occur in pregnancy and after childbirth?

Sepsis can occur because of an infection related to the pregnancy or one that is totally unrelated, such as pneumonia or a urinary tract infection (UTI). A recent analysis of delivery hospitalizations and postpartum readmissions in the U.S. found that 23% of in-hospital deaths were related to sepsis. The most common infections that triggered maternal sepsis were caused by bacteria such as E. coli, but those who are pregnant are also at higher risk of complications from COVID-19.

Sepsis can develop as the result of many complications. Here are just a few:

  • Miscarriages (spontaneous abortions) or induced abortions:Infections are a risk after any miscarriage or abortion. Non-sterile abortions, those that may be done outside of a healthcare facility, are a particular risk. Anyone who has had one should watch for signs and symptoms of an infection (lasting or increasing pain, discolored or odorous (smelly) discharge, abdominal tenderness, high temperature, fatigue, feeling unwell).
  • Cesarean sections: Sepsis can develop after any type of surgery. Cesarean sections are major abdominal surgeries with all the associated risks. See Sepsis and Surgery for more information.
  • Prolonged or obstructed labor: An unusually long time of labor or labor that stops progressing.
  • Ruptured membranes: The longer the period between the “water breaking” and the baby’s birth, the higher the chance of an infection.
  • Infection following vaginal delivery: Although not common in the developed world among those who give birth in healthcare facilities, infections are very common in the developing world.
  • Mastitis: Infection in the breasts can trigger sepsis.
  • Viral or bacterial illnesses: Any illness that raises the risk of sepsis in the general population will do so during pregnancy as well.

Who is at risk?

Anyone who is pregnant, has miscarried or aborted, or who has delivered a child is at risk of developing maternal or postpartum sepsis. However, some do have a higher risk others. Risk factors associated with developing maternal sepsis include not having given birth before (medically called nulliparity), and having public or no health insurance. Other childbirth-related risk factors include having a C-section, using assisted reproductive technologies in order to become pregnant, and having multiple births (twins, triplets, or more).

Those who may be more prone to getting an infection, which can lead to sepsis, are people:

  • With diabetes
  • Who undergo invasive procedures to help them get pregnant
  • Who undergo invasive tests during pregnancy

Being Black (due to racial disparities in US healthcare) also increases the risk of sepsis during pregnancy.

Are vaccines during pregnancy a good idea?

The CDC recommends that people be up-to-date on their vaccines before becoming pregnant, if possible. Speak with your doctor about your immunity to the so-called childhood diseases and if you need booster shots. People are also encouraged to get the seasonal flu vaccine even when pregnant. If you travel, you may need vaccines specific to your destination. Learn more about vaccines at Prevention: Vaccines.

Is sepsis hard to detect during pregnancy or the postpartum period?

Diagnosing sepsis during pregnancy or after recently given birth can be challenging. Pregnancy and delivery cause many changes in the body, including a faster heart beat, changes in blood pressure, and faster breathing. Usually, these are signs that may alert a healthcare provider that there may be something wrong, such as an infection. Also, many people get chills and sweat heavily after giving birth. They may also have pain, or feel dizzy or light headed.

It also may be more difficult to diagnose infections during pregnancy and the postpartum period. For example, urinary tract infections usually cause a frequent need to urinate, but this can happen because of pregnancy alone. So if someone is going to the bathroom a lot, they may just chalk it up to being pregnant and not realize there may be an infection.

If you suspect sepsis, call 9-1-1 or go to a hospital and tell your medical professional, “I AM CONCERNED ABOUT SEPSIS.” 

The information here is also available as a Sepsis Information Guide, which is a downloadable format for easier printing.

Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.

Suggested Citation: Sepsis Alliance. Sepsis and Pregnancy & Childbirth. 2023. https://www.sepsis.org/sepsisand/pregnancy-childbirth/

Updated March 3, 2023.

Maternal Sepsis Week

Join Sepsis Alliance for Maternal Sepsis Week, the week of Mother’s Day, to raise awareness of maternal sepsis, honor survivors, and remember those who have passed.

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Resources

SEPSIS “Pregnancy and Childbirth” – Español PSA (0:55)
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SEPSIS “Pregnancy and Childbirth” – Español PSA (0:55)

SEPSIS “Pregnancy and Childbirth” – PSA (0:23)
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SEPSIS “Pregnancy and Childbirth” – PSA (0:23)

Amanda’s Story – Maternal Sepsis
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Maile’s Story – Maternal Sepsis
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Kayleigh’s Story – Maternal Sepsis
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Sepsis: Pregnancy and Childbirth
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Maternal Sepsis Fact Sheet
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Faces of Maternal Sepsis

Courtney H.

Last year I had an induction to go into labour for my first pregnancy, I gave birth and then got sent to the ward. I had to stay at the ward myself as my partner went home. It was about 11pm at night where I started feeling like I had the flu. I felt so unwell and dehydrated, during this time my newborn baby was crying all night and I didn’t get any sleep until 8am. When I woke up about 10am I told the nurse I had a temperature, I remember dripping of sweat uncontrollably and shaking. (Sepsis and ... Read Full Story

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Paula Jacobs

After working on development of one of the country’s first electronic sepsis alerts, followed by 18 years of leading teams in early detection and treatment of sepsis, I thought I knew everything there was to know about sepsis. But I did not know how it makes you feel. That all changed in 2016 when I developed severe sepsis after just a couple of days of fever from undiagnosed pneumonia. (Sepsis and Pneumonia) There was no preceding upper respiratory illness, no cough, just fever and extreme fatigue. It was about the sickest I had ever felt, with that vague yet horrible ... Read Full Story

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Kelsi Godfrey

Thursday, March 23rd 2023 I gave birth to my fourth son. Everything went well and it was a normal delivery. Friday, March 24 I started experiencing shortness of breath, but all of my vitals were fine. Then on Saturday, March 25 2023 everything went downhill FAST so luckily I was still at the hospital. My heart rate started going up and blood pressure dropping. I was then intubated. By late afternoon/early evening, my doctors found my uterus was infected and determined I had streptococcal toxic shock syndrome that caused severe septic shock. (Sepsis and Pregnancy & Childbirth, Sepsis and Toxic ... Read Full Story

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Kimberley Sidhu

I had my second daughter in May 2024. The day before I gave birth, I complained to my midwife I was unwell, and the following four days after her birth. I was dismissed. I went to the ER as I felt something was wrong and was placed into the ICU for sepsis. I can contracted group a strep in my uterus and it was in my blood and spreading to my other organs. (Sepsis and Pregnancy & Childbirth, Sepsis and Group A Streptococcus) I needed to have an emergency hysterectomy and two blood transfusions while – learning later, I was ... Read Full Story

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Krystal Anderson

Krystal Anderson: A Life Cut Short from Maternal Sepsis, A Legacy of Strength and Resilience Krystal Anderson’s life was marked by vibrant dedication to her passions and profound love for her family. A mother, wife, daughter, sister, and friend, Krystal was a beacon of joy and inspiration to all who knew her. Her sudden passing at the age of 40 from maternal sepsis, mere days after the tragic stillbirth of her daughter Charlotte Willow, left a community in mourning and a family without its cornerstone. Krystal was a dynamic and impactful person to everyone she encountered. She thrived in dual ... Read Full Story

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