Anaemia after birth: recognising and testing iron shortage

At a birth you lose blood, and with it iron. At a normal birth this is often a few hundred millilitres, with heavy blood loss more. Together with the high iron need of pregnancy, that makes anaemia after birth very common.

The tricky part is that the symptoms, such as tiredness and paleness, look exactly like what you already expect in the postpartum period. A blood value helps to see whether there really is an iron shortage. Below you will read how that works and what you can test.

Why do you get anaemia after birth?

Anaemia after birth arises mainly from the blood loss at delivery, on top of an iron store that was already drawn on during pregnancy. Your baby took up a lot of iron in the last trimester, so your own store is often already lower. The blood loss at birth then gives the final nudge.

With a caesarean or a birth with a lot of blood loss the chance of anaemia is greater. Also, if you already had a low ferritin just before birth, you start with a deficit.

Your body slowly tops the store up again afterwards, but that takes weeks to months.

Which symptoms fit anaemia?

Anaemia can cause fatigue, paleness, dizziness, palpitations and shortness of breath on exertion. In the postpartum period many of these are present without anaemia too, from sleep loss and recovery. That is why a blood value is more reliable than going by how you feel.

Mild anaemia sometimes gives no symptoms at all. According to Thuisarts.nl the symptoms usually go away again once an iron shortage is topped up.

If you stay very tired despite rest, that is a good reason to have your iron look along. We discuss the overlap with postpartum fatigue in fatigue after birth.

Which blood values: Hb and ferritin

The two most important values are haemoglobin (Hb) and ferritin. Your Hb shows how much oxygen your blood can carry and drops with anaemia. Your ferritin shows how large your iron store is and can be low before your Hb drops. Together they give a fuller picture.

These values are guidelines, not hard limits. Laboratories may use slightly different cut-off values, and a result just under or over a threshold says little on its own. How to read ferritin, you read in ferritin level.

Iron through food and testing yourself

You can support your iron intake through your food and, if needed, through supplements. The Voedingscentrum names meat, wholegrain products, pulses and green leafy vegetables as good iron sources. Vitamin C helps your body absorb plant-based iron better. Coffee and tea with a meal can slow absorption down.

If you want to map your iron status after birth yourself, you can do so at Lunara without a referral. The Iron Status test looks at Hb, ferritin and iron. For a broader picture there is also the Anaemia test.

Do not take iron tablets on your own initiative, because too much iron is not without risk. Whether a supplement is useful depends on your Hb and ferritin, and you decide that with your GP. This article belongs to our overview of recovery after birth, and follows on from anaemia in pregnancy.

Frequently asked questions

How long does it take for my iron to recover after birth?

That varies per person and depends on how low your store was. With food and, if needed, a supplement it often takes several weeks to months before your ferritin is back up. A check of your blood value shows whether it is going the right way.

Can I prevent anaemia with food?

An iron-rich diet can help, but gives no guarantee, certainly after heavy blood loss. The Voedingscentrum advises eating varied with iron-rich products. Whether a supplement is needed depends on your blood values.

Does anaemia affect breastfeeding?

A considerable iron shortage can affect your energy and recovery, which can make feeding harder. The milk production itself need not suffer. Discuss ongoing symptoms with your midwife or GP.

If I could give you one thing to take away: do not underestimate the effect of blood loss at birth. If you stay tired or pale, the combination of Hb and ferritin tells you more than how you feel. Discuss a low result calmly with your GP, so you know whether topping up is needed.

References

1. World Health Organization (WHO). Haemoglobin concentrations for the diagnosis of anaemia. WHO, 2011.
2. NHG and Thuisarts.nl. Anaemia (bloedarmoede). Dutch College of General Practitioners.
3. Voedingscentrum. Iron in the diet. Voedingscentrum.
4. RIVM. Pregnancy, birth and the postpartum period. National Institute for Public Health and the Environment.

Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. Blood testing through Lunara does not replace the regular postpartum check-ups. For treatment decisions, discuss your results with your GP or midwife.