Breathlessness After Birth

When to call 999

Call 999 or go to A&E if you have severe difficulty breathing, pain in your chest or upper back, your heart is beating very fast, or someone has passed out. The NHS says these "could be signs of a pulmonary embolism or another serious condition," and adds: "Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance."

Ask for an urgent GP appointment or get help from NHS 111 if you have difficulty breathing which comes on suddenly, or you are coughing up blood.

NICE NG194 tells midwives to warn every woman at her first postnatal contact to seek medical advice without delay for "leg swelling and tenderness, or shortness of breath, which could indicate venous thromboembolism," and for "chest pain, which could indicate venous thromboembolism or cardiac problems." Breathlessness after birth is on the official red-flag list. It is not a symptom you are supposed to sit on.

Cause one: a clot on the lung

The NHS lists the symptoms of a pulmonary embolism as difficulty breathing that comes on suddenly, chest pain that is worse when you breathe in, and coughing up blood. It adds that you may also have pain, redness and swelling in one of your legs — usually the calf — because a pulmonary embolism "often happens when part of the blood clot dislodges itself from your leg and travels up to your lungs."

This matters after birth specifically because the NHS names having had a baby in the previous six weeks as one of the times your chance of a clot is higher. Sudden breathlessness plus a sore calf is the combination to act on immediately.

The NHS is clear on the outlook when it is caught early: "You should make a full recovery from a pulmonary embolism if it's spotted and treated early."

Cause two: a heart muscle problem

This is rare, and almost nobody is told about it. The NHS cardiomyopathy page lists, among the causes of dilated cardiomyopathy: "pregnancy — peripartum cardiomyopathy is rare and sometimes develops during pregnancy, or within 3 months of the baby's birth."

The reason it gets missed is that its symptoms read like normal new motherhood. The NHS describes heart failure as typically causing "shortness of breath, extreme tiredness and ankle swelling." Every one of those is also an unremarkable feature of the fourth trimester.

The features that should push you to be seen rather than to wait are breathlessness that is getting worse rather than better; breathlessness lying flat, or waking you at night needing to sit up; a cough that will not settle; new swelling that is worsening; and a heart that races or pounds when you are not doing anything. NICE's postnatal red flag — chest pain that "could indicate venous thromboembolism or cardiac problems" — covers this too.

Cause three: anaemia

This is by far the most common explanation, and the least frightening. The NHS lists the symptoms of iron deficiency anaemia as tiredness and lack of energy, shortness of breath, noticeable heartbeats (palpitations), paler than usual skin, and headaches.

Blood loss at birth, on top of pregnancy, is a straightforward route into it. NICE NG194 asks midwives to assess for "symptoms and signs of anaemia" at every postnatal contact, so it is a recognised part of routine postnatal checking rather than something you have to argue for.

It is diagnosed with a full blood count — the NHS notes "You do not need to do anything to prepare for this test" — and treated with iron replacement, which the NHS says is usually taken for about six months. Ask your GP for the test rather than self-treating; the NHS warns to keep iron tablets out of reach of children because an overdose in a young child can be fatal.

Cause four: deconditioning, and a body that has been through a lot

If you are breathless walking up the stairs you used to run up, and it is steadily improving week by week, and you have no chest pain, no one-sided leg pain, no swelling that is getting worse and no palpitations at rest, this is the likely answer. Pregnancy, surgery, blood loss, broken sleep and weeks of very little movement all reduce fitness quickly.

Two honest caveats. First, "it's just deconditioning" is a diagnosis of exclusion, and it is not one to make for yourself while you are inside the six-week window for clots or the three-month window for peripartum cardiomyopathy. Second, there is no published timetable for how fast fitness comes back, and anyone who gives you one is making it up.

Also worth ruling out

The HSE lists severe muscle and joint pain as a possible sign of sepsis, and NICE puts anyone who gave birth in the last six weeks in a high-risk group for it. A chest infection presenting as breathlessness, fever and a cough belongs in the same-day category, not the wait-and-see one.

Panic and anxiety can also cause genuine, frightening breathlessness. That is a real diagnosis and a treatable one, but it is not the one to reach for first while there is an unexcluded physical cause.

How to be taken seriously

Lead with the timing: "I gave birth [x] weeks ago and I am short of breath." Then say whether it came on suddenly or crept up, whether one calf hurts, whether you have chest pain, and whether you can lie flat. Those four details map directly onto the three causes above, and they are what the person on the other end of the phone is trying to establish.