A body recovering
Several changes happen after childbirth. The uterus contracts, wounds and tissue heal, fluid balance shifts, and hormone levels fall. Women who breastfeed also produce milk. For some, this period follows a pregnancy involving nausea, reduced food intake or low iron stores. For others, childbirth has involved substantial blood loss.
All of this may affect how a woman feels in the weeks after delivery. Lack of sleep is an important explanation for fatigue, but physical conditions can also be investigated and treated.
Simply asking a woman how she is feeling can open a conversation about more than sleep.
The difference between iron deficiency and anaemia
Iron is part of haemoglobin, the substance in red blood cells that carries oxygen around the body. In anaemia, haemoglobin is too low. With iron deficiency, available iron or iron stores are depleted. Someone can have iron deficiency without having anaemia.
Iron deficiency may develop during pregnancy. Bleeding during childbirth can reduce haemoglobin and mean that the body needs iron to produce new red blood cells. The effects depend partly on iron status before childbirth, the amount of blood lost, and recovery.
Fatigue and reduced physical capacity can be symptoms of anaemia. Some women also experience dizziness, palpitations or breathlessness on exertion. As these symptoms may have other causes, assessment should consider both the woman's experiences and appropriate tests.
What did researchers find in Oslo?
A Norwegian study from STORK-Groruddalen assessed 573 women about 14 weeks after childbirth. Researchers found anaemia in 25%. Iron deficiency estimates ranged from 19% to 39%, depending on the laboratory tests and thresholds used.
The highest estimate came from ferritin measurements, which reflect iron stores. Other measures identified a smaller group showing more marked iron depletion. That is why a claim about how many women have iron deficiency needs to explain how the researchers defined the condition.
The study took place in Groruddalen, Oslo, with data collected in 2008 to 2010. It provides valuable information about its participants, but a current national estimate would require a more recent representative study.
Researchers also found associations between lower iron intake, iron deficiency or anaemia during pregnancy, blood loss at childbirth and poorer postpartum iron status. These are findings from an observational study and may be influenced by other factors.
Does treatment restore energy?
Women with diagnosed iron-deficiency anaemia may receive treatment, usually oral iron or, in certain circumstances, intravenous iron. Treatment depends on severity, symptoms and other medical considerations.
A 2024 Cochrane review brought together 33 randomised trials of treatments for postpartum iron-deficiency anaemia. It examined oral and intravenous iron and other interventions. The evidence suggests intravenous iron may modestly reduce fatigue early on compared with tablets. However, evidence for several outcomes important to women was uncertain, and only eight of the 33 trials reported fatigue.
This makes it important to investigate and treat an identified deficiency while also considering other causes of exhaustion.
Care should begin with the woman
The Norwegian Directorate of Health's postpartum care guideline recommends a check-up with a midwife or doctor four to eight weeks after childbirth, tailored to the woman's health and needs. Both physical and mental health should be addressed.
With persistent fatigue, dizziness or symptoms after heavy bleeding, assessment of haemoglobin and iron status may be relevant. Thyroid disorders, mental health difficulties and poor sleep may also need consideration. No single blood test describes how someone is feeling.
Chest pain, fainting, breathlessness at rest or severe bleeding require urgent medical assessment.
What else do we need to know?
Norway has studies of iron status and national registry information about bleeding during childbirth. Yet there is no continuous, representative overview here of how many women experience iron deficiency throughout the postpartum period, who receives testing and how symptoms develop.
Better knowledge could support more targeted follow-up. Women need advice about rest and careful attention to symptoms that may have treatable medical causes.
Both matter to someone who has just given birth.