When to call an ambulance

Call 999 or go to A&E if you have given birth recently and you are breathing very fast; are confused, have slurred speech or are not making sense; have blue, pale or blotchy skin, lips or tongue; have a very high or very low temperature, feel hot or cold to the touch, or are shivery; have a rash that does not fade when you press it; or you have symptoms you are worried might be sepsis. That list is the NHS's own, word for word, for an adult. The NHS adds a line that matters when you are the one being driven: "Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance."

Contact your GP, midwife or public health nurse immediately — the same day — if you have a fever, especially if your temperature is over 38 degrees Celsius. That threshold is published by the HSE in Ireland, in its guidance on when to get medical help after birth. The HSE lists it alongside tummy pain that is severe or not getting better, discharge or bleeding that smells bad or unusual for you, and any wound or stitches that are red, oozing pus or seem to be opening. The HSE also names severe muscle and joint pain as a possible sign of sepsis.

You will not be wasting anyone's time. The UK Sepsis Trust runs a nurse-led helpline on 0808 800 0029 if you want to talk to someone about sepsis, including after the event.

Why the first six weeks are different

This is the fact most postnatal information leaves out. NICE guideline NG255, on suspected sepsis in pregnant or recently pregnant people, instructs clinicians: "Take into account that people who are pregnant, have given birth or had a termination of pregnancy or miscarriage in the past 6 weeks are in a high risk group for sepsis."

The NHS sepsis page says the same thing from the other direction, listing "you're pregnant, have given birth, or had an abortion or a miscarriage in the past 6 weeks" among the situations that raise your chance of getting sepsis at all.

So the six-week window is not a soft caution. It is a formal risk category, and it applies whether your birth was straightforward or not. If you ring 111 or your GP, saying "I gave birth three weeks ago" changes how urgently you should be assessed. Say it early in the call.

What raises the risk further

NG255 singles out people in that six-week window who also:

have impaired immune systems because of illness or drugs;
have diabetes, gestational diabetes or other conditions alongside;
needed invasive procedures — NICE names caesarean section, forceps delivery, and removal of retained products of conception;
had prolonged rupture of membranes;
have, or have been in close contact with someone who has, group A streptococcal infection, for example scarlet fever;
have continued vaginal bleeding or an offensive vaginal discharge.

That last one is worth pausing on. Bleeding that is not settling, or discharge that smells wrong, is not a separate minor problem sitting next to a temperature. NICE treats it as part of the same picture.

Why a fever after birth is easy to dismiss

Two things work against you. The first is that you are expected to feel terrible. Night sweats, exhaustion, aching and shivering all happen in normal recovery, so a genuine fever hides in the noise. The second is that sepsis does not always announce itself with a high temperature at all. NG255 is explicit: "Take into account that people with sepsis may have non-specific, non-localised presentations, for example feeling very unwell, and may not have a high temperature."

NICE also tells clinicians to "pay particular attention to concerns expressed by the person and their family or carers, for example changes from usual behaviour." If your partner or your mother thinks you have changed — not just tired, but different — that is clinically relevant information, and it is worth saying out loud on the phone.

Where the infection usually comes from

The NHS notes that any type of infection can lead to sepsis, but bacterial ones are the most common cause, including chest infections, urinary tract infections, abdominal infections and skin infections such as cellulitis or infected wounds. After a birth, the realistic candidates are the womb lining, a caesarean wound, a perineal wound, the breast, the urinary tract, or a chest infection.

NICE NG194, the postnatal care guideline, tells midwives to check for symptoms and signs of infection at every postnatal contact, and to warn you at the first contact to seek medical advice without delay if you get "abdominal, pelvic or perineal pain, fever, shivering, or vaginal discharge with an unpleasant smell, which could indicate infection."

What happens when you are assessed

Expect observations: temperature, pulse, blood pressure, breathing rate, oxygen levels. NG255 says clinicians should "consider using an early warning score to assess people with suspected sepsis who are pregnant or have recently been pregnant, in any setting" — the score is designed to catch the person who does not look dramatically ill yet.

If sepsis is confirmed, the NHS describes treatment as antibiotics, oxygen to help with breathing, and fluids given into a vein, in hospital, with specialist care if you are very unwell.

Afterwards

The NHS is honest about recovery: "Sepsis is a serious condition, and it can take weeks or months to recover." Some people develop post-sepsis syndrome, which the NHS describes as causing extreme tiredness, nerve or organ problems, depression and anxiety, and difficulty concentrating — "It often lasts 6 to 18 months, but some people take much longer to recover."

If you have had sepsis, the NHS advises calling 111 if you develop symptoms of an infection, such as a very high temperature or feeling hot, cold or shivery, within 12 months of the episode.

The short version

A temperature over 38C after birth is a reason to be seen the same day, not tomorrow. Feeling inexplicably, frighteningly wrong is a reason to be seen even without a temperature. And the sentence that gets you taken seriously is the one people forget to say: "I had a baby three weeks ago."

Fever and Chills After Birth