You after the birth

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Postnatal symptoms you should never ignore

After you’ve given birth, it’s normal to have some bleeding, and to feel a little discomfort and tiredness. Time, rest and self-help are usually all that is needed to make you feel better.

Nevertheless, real medical emergencies do occasionally happen in the days and weeks following birth. It’s important to seek help as soon as possible to make sure you don’t become severely ill, or to help you to get better more quickly.

After you've had your baby, ask your midwife or GP how you can get hold of urgent maternity care, if you need it. You may be given a contact number for the maternity unit triage or the postnatal ward rather than the ambulance service (NICE 2013). Put these details, and your maternity notes, in a safe place, and tell your family where you keep them. This will help if the maternity ward arranges an ambulance to be sent out to you, as the crew will be able to check your notes and start treatment straight away.

Which postnatal symptoms need emergency treatment?

Get immediate medical help if you have any of the following:

Sudden and heavy blood loss, or increasing blood loss, including clots (postpartum haemorrhage) (NICE 2006, NICE 2013)

This may be accompanied by signs of shock, such as a racing heartbeat, dizziness, sweating and feeling faint. If the bleeding becomes heavier, and soaks more than one pad an hour, or if you’re passing fresh clots larger than a 50p piece, call the number you have been given for urgent maternity care. If you think you are going in to shock, dial 999.

Severe or persistent headache

This may be a side-effect of an epidural or spinal anaesthesia, and may feel like a bad migraine that’s worse when you sit or stand (OAA 2011).

You should call your GP the same day, so she can assess you over the phone and then face-to-face, if needed.

However, in the first 72 hours after your baby is born, a bad headache can also be a sign of pre-eclampsia, along with blurred vision, nausea and vomiting (NICE 2006, NICE 2013). If you have these symptoms in addition to a bad headache, call the number you have been given for urgent maternity care.

Raised blood pressure

Your blood pressure should be taken within the first six hours after you have given birth. If the bottom figure (diastolic) is greater than 90, you may have pre-eclampsia, and be at risk of eclampsia. You should have your blood pressure taken again within four hours if you have no other symptoms (NICE 2006).

In the meantime, if you develop other signs of pre-eclampsia, such as headache, blurred vision or sickness, you should call the number you have been given for urgent maternity care (NICE 2013).

Upper abdominal pain

You may have a rare condition called HELLP syndrome if you gave birth within about the past 48 hours and have the following symptoms:
  • are feeling extremely worn out
  • have vomited, and feel nauseous
  • feel tenderness or pain in your upper abdomen (Lloyd 2009, NICE 2006)

HELLP affects your liver function and how your blood clots. You may also feel as though you’re getting flu. These symptoms need checking urgently, so you should call the number you have been given for urgent maternity care or go to your nearest accident and emergency department (A&E).

Shortness of breath

Being short of breath is usually the result of doing something active, such as walking up a hill. However, if you become very breathless, and it doesn’t stop when you rest, you need immediate help. It may be a sign of a clot stuck in a blood vessel of your lung (pulmonary embolism) (NICE 2006). Call the number you have been given for urgent maternity care or go to your nearest A&E.

Chest pain

Having a pain in your chest may be a sign of a chest infection, or of strained muscles from exertion in labour. However, it could also be a sign of a pulmonary embolism, so you shouldn’t ignore it (NICE 2006). If you are also short of breath and/or coughing up blood, call the number you have been given for urgent maternity care.

Calf pain

Pain, swelling or tenderness, particularly in your calf, could be deep vein thrombosis (DVT) (NICE 2006, NICE 2013, RCM 2014). This is a blood clot in the deep veins of the muscle, and can be life-threatening. You may also have redness, particularly at the back of your leg, below where your knee bends, and a feeling of heaviness or warmth in the area of the clot (NHS Choices 2014). If this is the case, call the number you have been given for urgent maternity care or your GP surgery the same day.

Manic behaviour, including insomnia and severe agitation

After having a baby, some mums experience dramatic changes in their emotional and mental health. Thought disorders, severe agitation, confusion, hallucinations and delusions can be the beginning of a rare condition called postpartum psychosis (MIND 2013, SIGN 2012). Mild symptoms can develop into serious mental illness within a matter of hours, so it’s important that you get treatment (SIGN 2012). Call the number you have been given for urgent maternity care or your GP surgery the same day.

Very high fever (38 degrees C or over)

High fever can be accompanied by shivering and abdominal pain, and is a sign of infection that needs urgent attention (NICE 2013). If you have an infection that is not treated straight after having your baby, you may become very ill, very quickly.

The common places for infection are in the area between your vagina and rectum (perineum), a caesarean wound, your urinary system or your womb (uterus). If you have a perineal or caesarean wound that is slow to heal, it could be because it is infected. If you have a urine infection, you may have pain when you wee or find it difficult to wee. If you have an infection in your uterus, you may also have pain in your tummy and/or smelly discharge from your vagina (NICE 2013). Call the number you have been given for urgent maternity care or your GP surgery the same day.

Unable to wee within six hours of your baby’s birth

If you have not been able to wee a good amount within this time, you may have urine retention (NICE 2006). If you've had your baby in hospital, your midwives will automatically keep an eye on how much wee you pass. If you are at home, having a warm bath or shower may help (NICE 2006). If you still can't wee, you should call the number you have been given for urgent maternity care or your GP surgery the same day.

Suicidal or intrusive thoughts

If you are having morbid or intrusive thoughts, such as a desire to harm yourself or others, including thinking about suicide, seek help (NICE 2013).

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 2013). Contact your GP or midwife, 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.

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

Speak to your midwife, health visitor or GP as soon as possible if you have any of the following symptoms:

Unpleasant, smelly vaginal discharge

This can indicate an infection in your womb or vagina (NICE 2006, NICE 2013).

A tender tummy

This can be a sign of an infection (NICE 2006, NICE 2013), and may be on the outside of your tummy around your stitches, if you've had a caesarean. Or it may be inside your womb, as the place where the placenta comes away is a wound that needs to heal. If an infection in your womb is left untreated, it can increase your risk of heavy bleeding (postpartum haemorrhage), so it’s important to seek help. You should also seek help if your caesarean wound starts to bleed (RCM 2014).

Widespread rash

This can be a sign of an infection and needs to be checked out (NICE 2013, RCM 2014).

Severe, swollen prolapsed piles

Though piles are common, they can become very swollen and painful after your baby’s birth. 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, seek help (NICE 2006).

Baby blues that don’t go away within a few days

It's common to feel moody, weepy, tired or anxious within three days to five days of giving birth. These baby blues usually pass within a few hours or days. But if you continue to feel very low, and aren’t enjoying being a mum, you could be suffering from postnatal depression (MIND 201, NHS Choices 2013). If you are 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 2013).

Severe perineal pain, perhaps with swelling, stinging or smelly urine

This could be an infection in your stitches or a urine infection (NICE 2006). A midwife or GP should examine you to check that your perineum is healing properly. It could also be a blood-filled swelling (haematoma), or a large bruise, inside the tissues of your vagina (RCM 2014).

Leaking from your bottom

Needing to rush to the loo is common after having a baby. But if you are leaking from your bottom before you get to the loo, and can’t control your bowel movements (faecal incontinence)(NICE 2006), call your GP or midwife as soon as possible.


It may be a couple of days after giving birth before you feel the urge to have a poo. If you haven't had a poo within three days, and are feeling constipated and uncomfortable, tell your doctor or midwife, so you can prevent it from getting worse (NICE 2006).


Lloyd C. 2009. Hypertensive disorders of pregnancy. In: Fraser DM, Cooper MA. eds. Myles Textbook for Midwives. 15th ed. Edinburgh: Churchill Livingstone, 397-413

Marchant S. 2009. Physical problems and complications in the puerperium. In: Fraser DM, Cooper MA. eds. Myles Textbook for Midwives. 15th ed. Edinburgh: Churchill Livingstone, 665-78

MIND. 2013. Understanding postnatal depression. National Association for Mental Health. [pdf file, accessed April 2014]

NHS Choices. 2013. Feeling depressed after childbirth. NHS Choices, Health A-Z. [Accessed April 2014]

NHS Choices. 2014. Deep vein thrombosis. NHS Choices, Health A-Z. [Accessed April 2014]


NICE. 2013. Postnatal care. National Institute for Health and Care Excellence, Quality standard 37. [Accessed April 2014]

OAA. 2011. Headache after an epidural or spinal injection: what you need to know. Obstetric Anaesthetist's Association. [pdf file, accessed April 2014]

RCM. 2014. 24 hour signs & symptoms: advising on the potentially life-threatening signs in postnatal care. The Royal College of Midwives. [pdf file, accessed April 2014]

SIGN. 2012. Management of perinatal mood disorders: a national clinical guideline. Scottish Intercollegiate Guidelines Network. [pdf file, accessed April 2014]

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I had womb infection at the second week of giving birth. I had fever, abdominal pain, headache & was shivering too. Luckily it's cured, however I'm concerned if this will cause infertility or affect my next baby's development in my womb? Thanks.
Gave birth to my baby boy his 13 days old today his weight was 4195g and I have a horrible pain in my left leg I'm even limping please help
I have such bad back pain wat shud i do????
My baby is 7 months now, it would have been helpful back then :)
Snugent, I totally agree!

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