When should I call 112 and when should I go to hospital after birth?
Most discomfort in the postnatal period is part of normal healing, but some symptoms can mean haemorrhage, infection, thrombosis or pre-eclampsia. The table will help you judge how quickly to seek help. If you are not sure which group your symptom belongs to, choose the more urgent one.
| What to do | Example symptoms |
|---|---|
| Call 112 | Very heavy bleeding, when blood soaks through your pad and clothes, especially with dizziness, weakness or a racing heart. Breathlessness, chest pain, coughing up blood. Fits, loss of consciousness, confusion, very fast breathing. Thoughts of harming yourself or your baby, hallucinations. |
| Go straight to the SOR (hospital emergency department) or the admissions room of a hospital with a maternity ward | Bleeding that gets heavier instead of lighter, or bright red blood coming back. Large clots. Fever with chills, tummy pain or foul-smelling lochia (postnatal discharge). A severe headache that does not go away with medication, spots or flashes in front of your eyes, pain under the ribs, vomiting, sudden swelling of the face, hands or feet. Pain and swelling in one calf. |
| Call your midwife or doctor the same day | Fever without other alarming symptoms. A painful, red and hot breast. A perineal or caesarean wound that is getting redder, more swollen and more painful, or is oozing pus. Pain or burning when you pass urine. Sadness, anxiety or a feeling that you are not coping that lasts longer than about 2 weeks or gets worse. |
| Ask your midwife at the next visit | Lochia that is gradually getting lighter in colour and less heavy. Perineal or wound pain that eases day by day. Questions about feeding, constipation, leaking urine, tiredness, contraception or scar care. |
Do not drive yourself to hospital; ask someone close to you for a lift or call for help. If possible, go to the hospital where you gave birth, as it has your records, but in an emergency choose the nearest one. We describe what a normal postnatal period looks like week by week in a separate article on how long the postnatal period lasts.
What bleeding after birth is dangerous?
Lochia (postnatal bleeding) is bloody and heavy at first, then gradually gets lighter in colour and less heavy. Bleeding that suddenly gets heavier instead of lighter, comes back as bright red blood after a few calm days or comes with large clots, for example bigger than a five-złoty coin, is a cause for concern. An unpleasant, foul smell from the lochia is also a warning sign.
According to the UK Royal College of Obstetricians and Gynaecologists (RCOG), abnormal or heavy bleeding can occur not only in the first 24 hours but up to 12 weeks after birth. This kind of late bleeding is often linked to an infection of the womb, and sometimes to a piece of placenta that has stayed in the womb. It needs to be assessed by a doctor, and heavy bleeding needs tests in hospital.
If the bleeding soaks through your pad and clothes, or you feel dizzy, weak or your heart is beating very fast, do not go on your own and do not wait. Lie down and call 112.
When does a fever after birth need urgent help?
A fever after birth can mean an infection of the womb, the perineal or caesarean wound, the urinary tract, or mastitis (breast inflammation). A fever-reducing medicine may bring relief but does not replace an assessment, so contact your midwife or doctor the same day. If the fever comes with chills, tummy pain or foul-smelling lochia, go to hospital.
- Womb: pain in the lower tummy that gets worse instead of better, and lochia with an unpleasant smell.
- Perineal or caesarean wound: increasing redness, swelling and pain, pus or foul-smelling fluid oozing out, the edges of the wound coming apart.
- Breasts: a hard, red, hot and painful area, usually in one breast, often with chills and flu-like symptoms.
- Urinary tract: pain or burning when passing urine, frequent urge to go.
A severe infection can develop quickly. Call 112 if you are breathing very fast, are confused, your speech is slurred, your skin is pale, bluish or blotchy, you have severe chills or you feel more unwell than ever before.
What symptoms can mean thrombosis or pre-eclampsia after birth?
The risk of deep vein thrombosis is higher for 6 weeks after birth. The typical symptom is pain, swelling and redness or bluish discolouration of one leg, most often the calf. With these symptoms go to hospital straight away, and if you also have breathlessness or chest pain, call 112, as the clot may have reached your lungs.
Pre-eclampsia is associated with pregnancy, but it can also appear or continue in the days and weeks after birth. The symptoms are a severe headache that does not go away with ordinary painkillers, vision problems such as spots or flashes, pain under the ribs, vomiting and sudden swelling of the face, hands or feet. With these symptoms go to hospital straight away, and if you have fits or lose consciousness, call 112.
If you had high blood pressure or pre-eclampsia during pregnancy, ask on discharge whether and how often to measure your blood pressure at home. Write down the readings and show them to your midwife at her visit.
Baby blues, postnatal depression or postpartum psychosis: when to get help straight away?
Baby blues usually start around day 3 after birth: tearfulness, irritability and trouble sleeping most often pass after about 10 days. If sadness, anxiety, a lack of joy or the feeling that you are a bad mother lasts longer or gets worse, it may be postnatal depression. Tell your midwife or POZ doctor (primary care GP), and you can see a psychiatrist without a referral.
Postpartum psychosis is rare, affecting about 1 in 1000 women after birth, and usually starts suddenly in the first weeks. The symptoms are hallucinations, hearing voices, delusions, confusion, extreme agitation or thoughts of death. It is an emergency that needs hospital treatment, so call 112 or go to a psychiatric hospital, where you will be admitted without a referral in an emergency.
If you have thoughts of harming yourself or your baby, call 112. If you need to talk, you can call the free, 24-hour number of the Support Centre for Adults in Mental Crisis on 800 70 2222 or the Crisis Helpline on 116 123. People close to you who notice a sudden change in your behaviour can also call for help.
What can a POZ midwife help with, and when do I need a doctor?
After the birth, a POZ midwife (a primary care midwife funded by the NFZ, Poland's public health insurer) makes at least 4 wizyty patronażowe (postnatal home visits) and assesses your health throughout the postnatal period. Under the perinatal care standard, she checks, among other things, how your womb is contracting, the amount and appearance of your lochia, how your perineum or caesarean wound is healing, your breasts and lactation, passing urine and stools and how you are feeling, and in week 4 the risk of postnatal depression.
- With your midwife you can discuss: healing of the perineum and wound, removal of stitches, breastfeeding and sore nipples, the pelvic floor and leaking urine, mood and tiredness, the return of fertility.
- You need a doctor when symptoms point to a complication: haemorrhage, infection, thrombosis, pre-eclampsia, mastitis that does not clear up, or depression or psychosis.
When a problem goes beyond what a midwife can handle, the standard requires her to tell you that you need a medical or psychological consultation. A POZ midwife works on working days between 8:00 and 18:00, so in the evening, at night and at weekends do not wait for her to call back; instead, get help from the out-of-hours service (nocna i świąteczna opieka zdrowotna), a hospital or by calling 112.
Where can I get help at night, at weekends and on public holidays?
The out-of-hours service (nocna i świąteczna opieka zdrowotna) operates Monday to Friday from 18:00 to 8:00 and around the clock on public holidays. You do not need a referral or an appointment, and you are not limited to your local area. A doctor gives advice at the clinic, by phone and, when medically justified, also at home.
It is a good place to go, for example, with a fever and a painful breast or burning when passing urine that cannot wait until morning. It is not the place for life-threatening conditions: with heavy bleeding, breathlessness or chest pain, call 112, and you can go to the SOR or a hospital admissions room without a referral, wherever you live.
The address of the nearest out-of-hours clinic, hospital with an SOR or pharmacy on duty can be given to you by the advisers on the free, 24-hour NFZ Patient Information Line on 800 190 590. It is an information line, not medical advice, so if you have worrying symptoms it does not replace contacting a doctor.
This article is about the mother's health. If you are worried about your baby's condition, for example a fever, listlessness, weak sucking or worsening jaundice, contact a doctor, and in an emergency call 112.
