Postnatal symptoms you should never ignore

After you’ve given birth, it’s normal to have some bleeding, discomfort and tiredness. Time, rest and self-help are usually all that's needed. Most new mothers make a full and uncomplicated recovery after their new baby is born. But occasionally, post-birth complications and post-pregnancy health problems happen that do need emergency help like sudden blood loss, high fever, headaches and leg and stomach pain.

Here’s what to do if you’re worried about any signs of complications after a c-section or vaginal birth.

Share this information too with your partner or a family member so they can look out for symptoms for you, like signs of infection after birth. A loved one may also recognise the symptoms of mental health problems, such as postnatal depression, before you do.

Which postnatal health problems are an emergency?

You should get immediate medical help if you have any of these symptoms as it could be a sign of a serious health condition. That means calling an ambulance or going to accident and emergency (A&E).

Sudden and heavy blood loss (postpartum haemorrhage)

If you have sudden and heavy blood loss, or increasing blood loss that may include clots, this is known as postpartum haemorrhage. You can lose 500ml or more of blood very quickly and will need urgent treatment (RCOG 2016).

If you bleed heavily in the 24 hours after your baby is born, you’re likely to be in hospital, in which case you’ll be treated quickly by the staff there (Begley 2014).

If you’re at home and you start to bleed heavily, call an ambulance if:

• the bleeding suddenly increases, and soaks more than one pad an hour
• you pass lots of large blood clots that are bigger than a 50p piece
• you start to feel faint or dizzy
• your heart starts to race, or your heartbeat becomes irregular (NICE 2015)
  
  

Severe or persistent postpartum headache

A severe headache after birth could be a symptom of pre-eclampsia. Call an ambulance if you get a severe headache, and have one or more of the other main symptoms of pre-eclampsia:

• vision problems such as blurring and flashing lights
• nausea or vomiting (NICE 2015)
  

Symptoms of pre-eclampsia usually come on within 72 hours of giving birth (NHS 2018a, NICE 2015).

Stomach pain after giving birth

There is a rare condition called HELLP syndrome that can develop while you’re pregnant and up until about a week after your baby is born (BMJ 2020). It’s a bit like pre-eclampsia (BMJ 2020). Symptoms include:

• feeling sick and being sick
• pain in the top part of your tummy, or on the upper right side of your tummy
• feeling weary and worn out
• a headache
• swollen feet and ankles (BMJ 2020)
  

HELLP affects how well your liver works and how your blood clots. It can be very serious and potentially life-threatening. If you have all the symptoms of HELLP you should call the number you have been given for urgent maternity care or go to your nearest A&E.

Shortness of breath and/or chest pain

If you have chest pain and feel short of breath then it could be a symptom of a pulmonary embolism (Knott 2015, NICE 2015). Other symptoms include coughing up blood and feeling faint (Knott 2015). If you have any of these symptoms, don’t ignore them. Call an ambulance.

A pulmonary embolism happens when a blood vessel in your lungs gets blocked, usually by a blood clot. If blood isn’t reaching your lungs properly, it can be life-threatening, so getting treatment quickly is vital.

High fever, especially fever and chills a after c-section

High fever (38 degrees C or over) can be a sign of sepsis, which is an infection that’s spread from just one part of your body to the whole of your body (NHS 2019b).

As well as having a high temperature, you’ll probably feel shivery and have a fast heart rate and breathing (NHS 2019b). Depending on where the infection started, you may have other symptoms such as:

• severe abdominal (tummy) or groin pain, which doesn’t get better after you take painkillers
• smelly discharge from your vagina
• sore and tender breasts
• a red and painful caesarean-section wound with smelly fluid coming from it
• pain when you wee, needing to wee quickly or more often than usual and smelly wee (RCOG 2012)
  

If you develop sepsis you can become very ill, very quickly (RCOG 2012). If you have these symptoms, you should call for an ambulance.

Leg pain after pregnancy

If you develop pain in your lower leg, usually just in one leg, then it could be a sign of deep vein thrombosis (DVT) (NICE 2015). Your leg may also look red and swollen and feel warm to the touch (NHS 2019a).

DVT is a blood clot in the deep veins of your leg. It can be life-threatening if the clot moves and travels through your body to your lung (a pulmonary embolism).

Many women get sore and tired legs after pregnancy (Knott 2015), and DVT can also develop without any symptoms at all (NHS 2019a). But, if you develop the symptoms of DVT you should always get it checked.

Which postnatal symptoms mean I need to get medical advice the same day?

Call the number your midwife has given you for urgent maternity care, or your GP surgery to speak to a doctor or midwife, if you have any of the following:

Sudden changes to mental health

In the month after having a baby, some mums experience a dramatic change in their emotional and mental health (SIGN 2012), including being agitated, depressed, confused or having manic behaviour. If you have hallucinations and delusions, or become confused or depressed, it could be the beginning of a rare condition called postpartum psychosis (SIGN 2012).

Postpartum psychosis can happen to any woman, whether they’ve had mental illness before or not. Mild symptoms can develop into serious mental illness within a matter of hours, so it’s important that you get treatment as soon as you can (SIGN 2012).

Postpartum psychosis can be a frightening experience for everyone involved, but women usually make a full recovery (RCP nda).

Suicidal thoughts

If you’re having thoughts about harming yourself, including thinking about suicide, get help as soon as you can (RCP ndb). You may have severe postnatal depression, which can be serious for you and your baby if it’s not treated.

Having thoughts like this doesn’t mean that you are a bad mum, or that your baby will be taken away from you if you tell someone (MIND 2020).

Contact your GP, midwife, or health visitor, or talk to a friend or member of your family, so they can get help for you. You'll be given the support you need to look after yourself and your baby.

Unable to wee

If you haven’t been able to wee within six hours after giving birth, you may have urinary retention (NICE 2015). This is when your bladder doesn’t empty and you can’t wee (Tidy 2015). It can be extremely uncomfortable and if it’s not treated it can cause severe pain, infection and damage to your kidneys (Tidy 2015).

If you've had your baby in hospital, your midwife will keep an eye on how much wee you pass. If you’re at home, having a warm bath or shower may help (NICE 2015). If you still can't wee, seek advice the same day from your midwife or doctor.

Severe headache after an anaesthetic

Having an epidural or spinal during labour and birth can sometimes cause a severe headache within the week after birth.

The headache is caused by the needle containing the anaesthetic accidentally puncturing the membrane around your spinal cord (OAA 2018).

The headache can feel like a bad migraine that’s worse when you sit up or stand, and you may also have neck pain, feel sick and dislike bright lights (OAA 2018).

Which postnatal conditions are urgent, but can wait until morning?

Give your midwife, health visitor or GP a call if you have any of the following:

Signs of infection after pregnancy

Even if you don't have a fever, you may have an infection if you notice:

• Unpleasant, smelly vaginal discharge. This could be an infection in your womb (uterus) or vagina.
• A painful and red caesarean section wound. You may have smelly liquid coming from the wound too.
• A tender tummy, which could be a symptom of an infection in your womb.
• Pain in your side and problems weeing, such as needing to go urgently and pain when you wee. This could be a urine infection.
• Swollen and tender breasts, which could be mastitis (breast infection).
• Pain, swelling and discharge in the area between your vagina and anus (your perineum). This could be an infected tear or episiotomy wound.
  (Wong 2017)

Leaking from your bottom

When you have a vaginal birth, sometimes the ring of muscles that controls your bowels can get damaged (NHS 2018b). If this happens, it can cause faecal incontinence (NHS 2018b). This is when you can’t control your bowel movements so you’re leaking poo before you get to the loo (NHS 2018b).

Severe, swollen or prolapsed piles

Many women develop piles when they’re pregnant, but these can become more painful after your baby is born (Payne 2016).

Piles are varicose veins just inside the anus, but they can pass outside (prolapsed piles). If you have severe, swollen or prolapsed piles, or any bleeding from your rectum, talk to your midwife or GP (NICE 2015).

Baby blues that don’t go away

It's common to feel moody, weepy, tired or anxious two days to three days after giving birth. These baby blues usually pass within a couple of weeks (PHA 2020). But if you continue to feel low for weeks, and aren’t enjoying being a mum, then it’s possible you could be suffering from postnatal depression (SIGN 2012, NICE 2015).

If you’re feeling very anxious and worried all the time, feeling panicky, obsessing about things, or you can't concentrate because you're feeling so down, speak to your health visitor or GP. They can give you the help and support that you need (NICE 2015).

More on postnatal health

• Discover what to expect at your six-week postnatal check.
• Visit our community to talk about any postnatal symptoms you’re worried about: Always speak to your GP or health visitor if you have any concerns about your emotional or physical symptoms. In the meantime, you may find it helpful to talk over your worries in the friendly BabyCentre community