Postpartum Anemia Explained: Symptoms, Recovery, and Treatment

Most women are anaemic after delivery, which means you’re liable to feel extra-tired and weak (as if you need that with all this other stuff!). This is because you lose blood, whether you have an uncomplicated vaginal delivery or a c-section.

So what exactly does anaemia mean?

Anaemia is a condition in which there is too little haemoglobin, which is carried by red blood cells, thereby decreasing the capacity of the blood to carry sufficient oxygen to meet physiological needs. There are a number of causes of anaemia, including blood loss, iron deficiency and other micronutrient deficiencies. Iron deficiency often occurs before anaemia and is one of the most common forms of nutritional anaemia. 

In comparison with pregnancy, maternal iron requirements usually decline during the postpartum period, defined as the period beginning just after childbirth throughout the subsequent 6 weeks. However, this period may serve as a time to restore iron lost during pregnancy and delivery. Maternal iron stores are not really utilised for breast milk production, as there is very little iron in breast milk.  

Iron deficiency and anaemia during the postpartum period may have long-term health implications for the mother and her infant. Mothers with low iron stores at the time of delivery and following childbirth may experience fatigue, altered cognition and depressive symptoms. These alterations in the mother’s emotional and cognitive functioning may, in turn, affect her interactions with the infant and may negatively impact infant behaviour and development. If iron stores are not restored soon after childbirth, the negative consequences of postpartum iron deficiency and anaemia may continue through other stages of the reproductive cycle, particularly in areas where there is a high prevalence of anaemia and among women consuming diets that are low in bioavailable iron and who have short inter-pregnancy intervals (less than 18 months); this can lead to continued adverse maternal and infant outcomes.  

Learn more: Ferritin and iron deficiency in a nutshell.

So, even if you develop an iron deficiency during pregnancy, the good news is that your stats will likely return to normal after you give birth. The general consensus seems to be that by two months postpartum most women’s iron levels will be back to normal. But if you suffered from iron depletion during pregnancy it might be a good idea to help your body rebuild those stores so you’ll have the energy you need to keep up with baby. 

How do you know if you are low in iron after having a baby? 

Feeling tired and low is the new normal for many new mums after childbirth. You’ve been through a lot. In the first few days it’s the baby blues that can affect your mood, caring for your newborn may be challenging especially if baby is fussy and you’re a first timer in parenting.  

But feeling tired and low is sometimes also the sign of low iron levels. After pregnancy, your iron levels are low – they’ve been depleted during pregnancy, and you may be shocked by how much you are bleeding in the first six weeks (lochia). All blood loss equals decreasing iron levels. And frankly, if you had a c-section, or trauma during birth (e.g., haemorrhaging) you may have already lost a lot of blood.

One of the strongest predictors of postpartum anaemia is anaemia during pregnancy, as iron stores tend to remain low for several months after childbirth, especially if there is significant blood loss during the delivery and additional iron is not consumed in sufficient quantities. Worldwide, there are limited data on the prevalence of postpartum anaemia. Studies conducted in high-income countries have reported that 10–30% of postpartum women were anaemic. Data suggest that anaemia is a common problem throughout the world and the prevalence of anaemia in postpartum women may be higher in low- and middle-income countries, as compared to published figures for postpartum women in high-income countries. 

Learn more: How to treat iron deficiency and anaemia during pregnancy.

If you are anaemic, many factors about your life can be affected: 

1. How you feel

Because anaemia can make you fatigued, lightheaded, or even dizzy, caring for your baby can be extra challenging. Try to accept all the help you can get at home!

2. You risk anaemia in future pregnancies

Having anaemia puts you at a higher risk for developing anaemia again in a future pregnancy. It’s important to treat anaemia as soon as it is diagnosed, preferably even before it can become a problem. 

Your body knows how to heal itself. It’s important you talk about the concern with your doctor or midwife so they can refer you to a blood test. They are the correct people to guide you through to the right supplements for you if you need some, but there’s a lot you can do to help your body out, and we’ll talk about those a bit further down. 

What can I do to help my body recover from iron deficiency? 

Iron deficiency can make you feel short-tempered and irritable, and become more vulnerable to postnatal depression. Tiredness can also make breastfeeding and bonding with baby more difficult. But there are ways to manage it. 

Eating plenty of iron-rich foods will help you to rebuild your body's stores of iron. There are two sorts of iron-rich foods: 

- Red meat, fish and poultry contain haem iron, which is easily used by your body. 

- Pulses, dried fruit, bran flakes and dark green vegetables, such as kale, chard, watercress and broccoli, contain non-haem iron. Non-haem iron is harder for your body to absorb. 

Vitamin C helps your body to absorb the non-haem iron in meals. Drinking orange juice or eating vitamin C-rich fruit and veggies, such as peppers or kiwi fruit at mealtimes, will help. 

Avoid drinking  tea and coffee  with meals, as they contain polyphenols, which make it harder for your body to absorb iron from food. Antacid drugs that relieve heartburn also prevent you from absorbing iron from the foods that you eat. 

If you are breastfeeding, you could take a vitamin supplement for mums that contains iron.  

You probably won’t have had a blood test after childbirth unless you had a Caesarean, lost a lot of blood during delivery, or had other issues such as dizziness or palpitations. Talk with your care team, and if you do get diagnosed with iron-deficiency anaemia, you can have a prescription for iron supplements or buy them over the counter.  

Some very good options if you have a sensitive stomach include liquid iron supplements such as Floradix, as it is easy to take, highly absorbable, and in concentrated form. 

Can you breastfeed if you have anaemia? 

Yes. Breastfeeding is good for you and baby even if your iron stores are low and you have been diagnosed with iron deficiency anaemia. That means your body doesn’t have enough iron to produce enough red blood cells and is the most common cause for anaemia in pregnancy and postpartum.  

It’s very common to suffer from an iron depletion after childbirth. A study of almost 1500 women found that around 30% were anaemic – this corroborates other studies which indicate that around 1 in 4 women are anaemic after baby arrives. It doesn’t help that the most common symptoms of anaemia – fatigue and weakness – aren’t uncommon in postpartum so many women don’t even realise they are anaemic.  

There is more evidence to suggest that choosing to breastfeed has much more benefits than feeding an iron-fortified breastmilk substitute. Baby’s own iron stores are used until they are about 6 months old, after which it’s a good idea to start to think about iron for them as well.  

Should you take iron supplements while breastfeeding? 

If you were anaemic during pregnancy or after delivery, as at least 1 in 4 women are likely to be, then yes. It’s important that you take an iron supplement while you breastfeed. Depending on the severity of your anaemia, you may be okay with a supplement or your doctor may tell you that a better option would be to get an iron infusion. If you lost a dramatic amount of blood during labour, a blood transfusion may be the way to go.  

Iron supplements are perfectly safe to take while you are breastfeeding. Very limited studies would even suggest that supplementary iron may make your breastfeeding journey easier. You may get a prescription for the iron supplement, or your doctor or midwife may recommend an over-the-counter supplement that may be better for you.   

The need for iron decreases after pregnancy. Partly because your body is no longer producing all that extra fluid, but also because your menstrual cycle hasn’t returned yet (especially likely if you are exclusively breastfeeding).  

The recommended dietary allowance varies depending on your location, so be sure to check with your health care team which recommended amounts apply to you. Keep in mind that ingesting too much iron may be actually worse for you, so definitely get your health care team onboard here.  

Most prenatal vitamins and many multivitamins have enough iron to supplement your diet. It is a good idea to continue taking your prenatal vitamins for about 6 to 8 weeks postpartum, especially if you are breastfeeding. During this time, your body has done a lot of balancing and your iron levels most likely have returned to pre-pregnancy levels.  

Advocate for yourself to receive a follow-up blood test to ensure that the iron supplements have done their job. If not, there is most likely an underlying issue which needs to be treated. These might include conditions such as coeliac disease where it’s difficult for your body to absorb iron. 

NOTE. Be sure to keep all iron supplements out of reach of all children, as they can be toxic in large doses. Some supplements may look like sweets, so children may overdose on them. 

Learn more: Breastfeeding diet and what to eat while breastfeeding.

Could iron deficiency be harming your milk supply? 

According to limited evidence, iron level may also affect lactation. The IBCLC accredited authors of ‘The Breastfeeding Mother’s Guide to Making More Milk’ believe it is important to treat iron deficiency whether or not you present with symptoms, but as of right now, the evidence is indeed most limited that there would be a direct causation between iron deficiency anaemia and low breastmilk production.  

Many women do swear by lactation herbs, foods and drinks, which often are iron rich – coincidentally or not, these may help your breastfeeding journey too.  

Herbs, such as alfalfa, nettle, dandelion root or leaf, burdock, and yellow dock may help in mild cases of anaemia. Be careful to start taking herbal supplements if you have other medications, as these may interact negatively.  

Last thoughts 

So, there you have it. A short series about the importance of iron and ferritin. We’ve walked through what ferritin is and if iron levels may affect your fertility. We’ve discussed the importance of iron during your pregnancy, and now in postpartum.  

In short, eat your vegetables (and meat if you’re so inclined), avoid tea, coffee, and dairy immediately with your iron-rich meals and instead opt for citrus fruits as these help with the absorption. If you aren’t offered lab tests, ask for the basic blood count and ferritin to be tested, and act accordingly to the results. Most women have their iron stores repleted in the first two months postpartum naturally – but you may need some help from a supplement.  

Keep on top of things. If you have any concerns about your own wellbeing, please speak out. You know your own body the best, and even though some level of fatigue and brain fog is to be expected, it’s a good idea to mention these to your midwife or doctor. They might even have ideas how to help you cope.  

And last of all, best of luck. You’ve got this.