Anaemia After Birth

The symptoms

The NHS lists the symptoms of iron deficiency anaemia as:

• tiredness and lack of energy;
• shortness of breath;
• noticeable heartbeats (heart palpitations);
• paler than usual skin;
• headaches.

It also names less common ones: ringing or buzzing in your ears, food tasting strange, feeling itchy, a sore tongue, hair loss, wanting to eat non-food items such as paper or ice, difficulty swallowing, ulcers in the corners of the mouth, spoon-shaped nails and restless legs syndrome.

Restless legs and hair loss are worth pulling out, because both get filed under "postpartum hormones" by default. If they are happening alongside breathlessness and a pounding heart, iron is worth checking.

Why this gets missed after a birth

Every symptom on that list is also a plausible feature of life with a newborn. Exhausted, breathless on the stairs, headachy, pale, heart thumping when you stand up — each one has an obvious alternative explanation involving broken sleep.

The pattern that suggests anaemia rather than sleep deprivation is that it does not track with how much sleep you got. A night where the baby slept and you still could not get off the sofa, dizziness on standing, or breathlessness carrying a laundry basket, all point somewhere other than tiredness.

NICE NG194 anticipates this. It instructs midwives to assess, at each postnatal contact and for all women, "symptoms and signs of anaemia" — listed in the same breath as infection, pain, bleeding, bladder and bowel function, and thromboembolism. It is a routine check, not a special favour.

Where the iron went

Two drains run at once. Pregnancy increases iron demand substantially over nine months, and blood loss at birth removes more in a few hours. A caesarean, an assisted birth, a large tear or a postpartum haemorrhage all add to it, but you do not need a dramatic birth to end up anaemic — entering labour with low stores is enough.

NICE NG194 also notes anaemia the other way round: it lists existing anaemia as a factor that "may worsen the consequences of secondary postpartum haemorrhage." In other words, being anaemic is not just uncomfortable; it makes a later bleed more dangerous. That is a good reason to treat it rather than wait it out.

The test

A full blood count from your GP. The NHS describes it as a blood test "to find out if the number of red blood cells you have is normal," and notes: "You do not need to do anything to prepare for this test."

The same test also checks for other types of anaemia, such as vitamin B12 or folate deficiency. Ferritin — your iron stores — is a separate request and worth asking about, because stores can be empty while the full blood count still looks acceptable.

The NHS notes that if the reason for the anaemia is not clear, a GP may do other tests to find out what is causing it. After a birth the cause is usually obvious, which tends to make this straightforward.

Treatment, without the numbers nobody gave you

The NHS says that if your red blood cell count is low, iron tablets "will be recommended to replace the iron that's missing from your body," and that "You'll need to take them for about 6 months." It suggests drinking orange juice after a tablet may help absorption, and to follow your GP's advice on how to take them. This page does not give doses; that is your prescriber's job, and it depends on the preparation.

Side effects the NHS lists are constipation or diarrhoea, tummy pain, heartburn, feeling sick and darker poo. Its advice is to take tablets with or soon after food to reduce them, and: "It's important to keep taking the tablets, even if you get side effects." If constipation is the problem — and after stitches or a caesarean it often is — say so, because the preparation can sometimes be changed.

The NHS also warns to keep iron tablets out of the reach of children, because "an overdose of iron in a young child can be fatal." With a newborn in the house that is easy to arrange and easy to forget.

If tablets are not tolerated or not working, intravenous iron exists and is used in maternity care. Ask about it rather than assuming tablets are the only option.

Food helps, but it will not fix a deficiency alone

The NHS lists dark-green leafy vegetables such as watercress and curly kale among iron-rich foods, and a GP will advise on diet if that is part of the cause. Diet is worth improving; it is not a treatment for an established deficiency, and treating yourself with supermarket supplements instead of getting tested means nobody ever finds out what your level actually was.

When dizziness is something else

The NHS says to call 999 if bleeding after birth is sudden and very heavy and you feel faint, dizzy or have a pounding heart — that combination can mean a postpartum haemorrhage. Do not attribute new dizziness with heavy bleeding to anaemia and go to bed.

Dizziness with breathlessness and chest pain, or with one painful swollen calf, belongs in the emergency category too. And NICE lists "persistent or severe headache" as a postnatal red flag that could indicate hypertension or pre-eclampsia, among other things — so a bad headache is a phone call, not a paracetamol.

Raise it at your check

The NHS says your 6-week postnatal check is offered 6 to 8 weeks after the birth, and that you can request an appointment yourself, "especially if you have any concerns." It also suggests making a list of questions to take with you. "Can I have my bloods checked, including ferritin?" is a good line to have written down.