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's 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 get better more quickly.

After you've had your baby and been discharged from hospital, if you need urgent maternity care you should call 000 or go to your nearest hospital emergency department. If you gave birth in a private hospital, your midwife may give you a number to phone if you’re worried about any symptoms. Put this number, if you’re given one, and your maternity notes in a safe place, and tell your family where you keep them.

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)
This may be accompanied by signs of shock, such as a racing heartbeat, dizziness, sweating and feeling faint (NCCPC 2006, NICE 2013).

Bleeding and passing a small clot of blood in the days after giving birth is normal. But if the bleeding becomes heavier or soaks more than one pad an hour, or if you’re passing fresh clots larger than a 20-cent coin, go to your nearest hospital emergency department. If you think you’re going in to shock, dial 000 and ask for an ambulance.

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 2016).

In the first 72 hours after your baby is born, though, a bad headache can also be a sign of pre-eclampsia, along with problems with your vision and pain in the upper part of your abdomen (NCCPC 2006, NICE 2013).

If you have a severe headache, or one that won't go away, see your doctor straight away or go to your nearest hospital emergency department.

Raised blood pressure
Your blood pressure should be taken within the first six hours after you give 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 (NCCPC 2006).

If you develop other signs of pre-eclampsia, such as headache, problems with your vision, or upper abdominal pain, you should see your doctor straight away, or go to your nearest hospital emergency department (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, NCCPC 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 see your doctor straight away or go to your nearest hospital emergency department.

Shortness of breath
Being short of breath is usually the result of doing something active, such as walking up a hill. But 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) (NCCPC 2006). Go to your nearest hospital emergency department.

Chest pain
Having a pain in your chest may be a sign of a chest infection, or of strained muscles from exertion in labour. But it could also be a sign of a pulmonary embolism, so you shouldn’t ignore it (NCCPC 2006). If you’re also short of breath or coughing up blood, go to your nearest hospital emergency department.

Calf pain
Pain, swelling or tenderness, particularly in your calf, could be deep vein thrombosis (DVT) (NCCPC 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 the knee bends, and a feeling of heaviness or warmth in the area of the clot (NHS 2016). If this is the case, see your doctor on the same day you notice your symptoms. If you can't get in to see your doctor, go to your nearest hospital emergency department.

Manic behaviour, including insomnia and severe agitation
After having a baby, some mums experience dramatic changes in their emotional and mental health. Rapid mood changes, severe agitation, confusion or disorientation, hallucinations and delusions can be the beginning of a rare condition called postpartum psychosis (MIND 2016, 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). See your GP the same day, or go to your nearest hospital emergency department.

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 soon after having your baby and it’s not treated swiftly, 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’s slow to heal, it could be because it’s infected. If you have a urinary tract 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).

See your doctor straight away, or go to your nearest hospital emergency department.

Unable to wee within six hours of your baby’s birth
If you haven’t been able to wee a good amount within this time, you may have urine retention (NCCPC 2006). If you've had your baby in hospital, your midwives will automatically keep an eye on how much wee you pass.

If you’re at home, having a warm bath or shower may help (NCCPC 2006). If you still can't wee, you should see your doctor the same day.

Suicidal or intrusive thoughts
If you’re 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’re a bad mum, or that your baby will be taken away from you if you tell someone (MIND 2016). Contact your GP or midwife, or talk to a friend or family member, so they can get help for you. You'll be given the support you need to look after yourself and your baby.

Unpleasant, smelly vaginal discharge
This can indicate an infection in your womb (uterus) or vagina (NCCPC 2006, NICE 2013).

A tender tummy
This can be a sign of an infection (NCCPC 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 from 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).

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

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

Severe, swollen prolapsed haemorrhoids
Although haemorrhoids (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 bottom, seek help (NCCPC 2006).

Baby blues that don't go away within a few days
It's common to feel moody, weepy, tired or anxious within three 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 2016, NHS 2015).

If you’re feeling panicky, or very anxious and worried all the time, obsessing about things, or can't concentrate because you're feeling so down, speak to your child health nurse or GP. She can give you the help and support you need (NICE 2013).

Severe perineal pain, possibly with stinging or smelly urine
This could be an infection in your stitches or a urinary tract infection (NCCPC 2006). A doctor should examine you to check that your perineum is healing properly. It could also be a blood-filled swelling (haematoma), or 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’re leaking from your bottom before you get to the loo, and can’t control your bowel movements (faecal incontinence), call your GP or midwife as soon as possible.

Constipation
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 (NCCPC 2006).

Discover what to expect at your six-week postnatal check.