“I Lost Over Two Litres”: Recovery, Anaemia and Milk Supply After a Postpartum Haemorrhage
In this article
After a big postpartum haemorrhage (PPH), many women go home exhausted, dizzy and struggling to feed, and are told it is just “normal newborn tiredness”. This article explains what recovery after severe blood loss usually looks like, the signs that something more is going on, what follow-up you should get, how the bleed can affect breastfeeding, and what to do when you are still not right months later.
Quick answer · updated November 2026
After a large haemorrhage, anaemia can leave you tired, dizzy, breathless and emotional for weeks. Iron tablets, an iron infusion or a transfusion may be needed. A PPH can also make breastfeeding harder. If you are not improving, feel breathless at rest, or have leg pain or swelling, see a doctor promptly.
Your recovery at a glance
- 1In hospitalBlood tests, transfusion or iron, clot risk checked.
- 2The first weeks homeExhaustion, dizziness, getting help, feeding.
- 3Milk supplyWhy a PPH can make feeding harder, and what helps.
- 4Six-week checkIron levels, mood, periods, questions to ask.
- 5Months laterStill not right? Work, PTSD and rarer causes.
At any stage: heavy bleeding, a fever, feeling dizzy or breathless at rest, or pain, redness or swelling in a leg needs care the same day. Call 000 in an emergency.
I’m a nurse. I knew what a haemoglobin of 68 meant. I’d hung blood for women with numbers like that and told them to take it easy. So when they discharged me on day three with a script for iron tablets and a pamphlet, I thought, fine, I know this.
On day five I tried to have a shower. I got the water running and the room went grey at the edges and I sat down on the tiles, and the water ran over my feet, and the baby was screaming in the bassinet and I couldn’t get up. My partner found me there.
When I rang the hospital, the midwife said, “You’re a nurse, you’ll know what’s normal.” I didn’t. That was the thing. I didn’t know if feeling like my heart was running up stairs while I sat on the couch was normal. I didn’t know if the milk that never really came was because of the bleed or because I was failing at it. Knowing the words didn’t help. I was the patient.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
If you are reading this in the weeks after a haemorrhage, you may be more tired than you ever thought possible, with a newborn to feed and people telling you that “all new mums are exhausted”. That may be partly true. But losing a litre or two of blood is a physical injury on top of birth, and it deserves its own recovery plan.
This article is for you, whether you are days out or a year on and still not yourself. It is also written for health workers who became patients, because knowing the medicine doesn’t protect you from being dismissed. It is part of a series that starts with “I thought I was going to die”: postpartum haemorrhage, what happened and what you can do.
Why I can write this
I have been a medical negligence lawyer since 2013 and have worked on many hundreds of claims, many involving birth. My doctorate studied patterns of failure in medical negligence. I am not medically qualified. The clinical information here is drawn from Queensland Clinical Guidelines’ parent information, Haemorrhage after birth, the NSW Health postpartum haemorrhage guideline, and an Australian study of breastfeeding after PPH, all listed below.
Start with your question
- “Is it normal to still feel this bad?” The first weeks home
- “Should I have had an iron infusion?” Iron, infusions and transfusion
- “My milk didn’t come in. Was it the bleeding?” Milk supply after a PPH
- “My leg is sore and swollen. Is that related?” Warning signs
- “I’m a nurse (or midwife, or doctor) and no one took me seriously.” When you work in health
- “It’s been months and I’m still not right.” Months later
In hospital: what should happen before you go home
How you recover depends partly on how much blood you lost, what your haemoglobin (the oxygen-carrying part of your blood) was before the birth, and what was done to replace it. After a severe haemorrhage you may have had a transfusion, a night in recovery or intensive care, a catheter and two drips. Mater’s patient information notes that women are often quite anaemic afterwards and that managing everything can be very tiring at first. What happened in the emergency itself is explained in what happens during a postpartum haemorrhage.
The NSW Health guideline sets out some things that should happen after a significant PPH:
- Because a severe PPH increases the risk of blood clots in the legs or lungs, every woman who had a severe or massive PPH must have a clot-risk assessment after birth, with a decision about blood-thinning injections or stockings.
- Women who had a PPH with signs of severe shock, or needed the massive haemorrhage protocol, must have a clearly documented discharge plan and follow-up arranged before they go home, and be screened for an inherited bleeding disorder if that might have been the cause.
- A debrief should be offered at the earliest suitable time, and again later if needed.
Definition
Anaemia: a low level of haemoglobin in your blood, so your body carries less oxygen. After a PPH it is usually caused by blood loss, sometimes on top of low iron stores from pregnancy. Ferritin is a blood test that shows how much iron you have stored.
In plain terms: after losing a lot of blood, your body is running on less oxygen. Your heart works harder, your muscles tire faster, and your brain feels foggy. It isn’t weakness. It is physics.
Questions to ask before discharge
- How much blood did I lose, and how much blood or iron did I receive?
- What is my haemoglobin today, and what is the plan to bring it up?
- Have I been assessed for blood clot risk? Do I need injections at home?
- Who is my follow-up with, and when?
- Who do I ring if I feel worse, and what symptoms should make me come straight back?
Iron, infusions and transfusion
Queensland Clinical Guidelines’ parent information explains that treatment for anaemia after a haemorrhage can include more iron in your diet, iron tablets, an iron infusion or a blood transfusion, and that blood tests are usually done to check. The national Patient Blood Management Guidelines for obstetrics and maternity, published by the National Blood Authority in 2015 and currently under review, cover anaemia and transfusion in pregnancy and after birth.
Which treatment is right depends on your numbers, your symptoms, and whether you can tolerate tablets. Women in online forums often describe being sent home on tablets with a very low haemoglobin, then struggling for weeks. If you were, it is reasonable to ask your GP or the hospital whether an infusion would be appropriate. You can ask to have your haemoglobin and ferritin rechecked.
If you had a transfusion, you may want to know what you received and how much. That is all in your records. My guide to getting and reading your birth records explains how to get them.
The first weeks home
The Queensland parent information says plainly that anaemia can make you feel tired, dizzy and emotional, and that you should tell your provider if you are more tired than expected. That is the key phrase: more tired than expected. Every new parent is tired. Not every new parent sits down on the shower floor because the room has gone grey.
In practice, recovering from a major haemorrhage at home often means:
- Needing to sit to shower, feed and change nappies.
- A racing heart or breathlessness with small efforts, like stairs.
- Headaches, poor concentration and feeling cold.
- Feeling emotionally raw, tearful or numb.
- Being frightened of every gush of normal postnatal bleeding.
You will need more practical help than you planned. Partners who return to work after two weeks often leave women alone at the lowest point of their haemoglobin, and partners may be struggling too; “He was left holding our baby in the corner” is written for them. If you can, line up family, friends or paid help. Keeping a simple note of who helped and for how long is also worth doing; it matters if questions about your care come up later, as I explain in “Is it too late?”.
Warning signs: not just tiredness
See a doctor the same day if you have
- Heavy bleeding: soaking a pad every hour or two, or passing large clots
- A fever or chills
- Dizziness or breathlessness while resting
- Pain, redness or swelling in one leg
- Chest pain, or sudden shortness of breath
- Bleeding that had settled and comes back bright red
Why: these can signal a secondary haemorrhage, an infection, worsening anaemia, or a blood clot, which is more likely after a severe PPH. Chest pain or severe breathlessness: call 000.
From Queensland Clinical Guidelines parent information “Haemorrhage after birth” (2024) and the NSW Health PPH guideline. The Queensland leaflet uses a fever threshold of 37.5°C.
Bleeding that comes back weeks later is covered in “I passed a clot the size of a golf ball”.
Milk supply after a PPH
This is one of the most painful parts of recovery for many women, and one of the least explained. The Queensland parent information says that sometimes a PPH can affect your milk supply and make breastfeeding more difficult, and that you should ask for help.
An Australian study, Women’s breastfeeding experiences following a significant primary postpartum haemorrhage (Thompson and colleagues, 2010), followed women in NSW hospitals who had a significant PPH. It found:
- 85% of the women had hoped to fully breastfeed, but only 63% did so from birth.
- Greater blood loss was linked to longer delays before the baby first had contact with the mother, and longer delays were linked to a lower chance of starting full breastfeeding.
- In the first week, 70% of women who lost less than 2,000 mL were fully breastfeeding, compared with fewer than half of those who lost 3,000 mL or more.
- The authors concluded that women with greater blood loss may need extra breastfeeding support and earlier chances for the baby to suckle.
So if your milk was slow or never really came, it wasn’t because you didn’t try hard enough. Separation from your baby, exhaustion, anaemia and the stress of the emergency can all play a part. NSW Health’s guideline now recommends skin-to-skin contact and early feeding wherever possible after birth, partly because they help prevent PPH and support feeding.
The Australian Breastfeeding Association runs a 24-hour helpline on 1800 686 268. A lactation consultant can help you build supply, combine feeding, or stop with less guilt. Formula feeding a healthy baby while you recover is a legitimate choice.
A rare cause to know about
Very rarely, severe blood loss in childbirth damages the pituitary gland in the brain, which controls several hormones. This is called Sheehan’s syndrome. According to the Pituitary Foundation, early signs can include difficulty breastfeeding or no milk supply, and periods that don’t return or are irregular; later signs can include fatigue, dizziness, weight changes and loss of body hair. It is diagnosed with blood tests and imaging and treated with hormone replacement. It is uncommon where maternity care is good, but if your milk never came in after a big bleed and you are still exhausted and your periods haven’t returned months later, it is reasonable to ask your GP about it.
Iron and haemoglobin
Ask for your haemoglobin and ferritin to be rechecked, and what the plan is if they are still low.
In plain terms: find out if the tank is still empty.
Bleeding, legs, breathing
Mention any ongoing bleeding, leg pain or swelling, or breathlessness, even if it seems small.
In plain terms: rule out the things that can turn serious.
Mood and memories
Say if you are having flashbacks, nightmares, panic, numbness or low mood. Ask about a mental health plan.
In plain terms: the emergency can hurt your mind as well as your body.
Milk and periods
If your milk never came in and your periods haven’t returned, or you feel profoundly unwell, ask whether hormone tests are needed.
In plain terms: check for the rare causes, not only the common ones.
A checklist to take to your GP or six-week check. Write your answers down before you go.
The six-week check
The Queensland parent information recommends seeing your GP for a check-up about six weeks after birth. After a haemorrhage, it is worth booking a longer appointment and taking your discharge summary with you. Many GPs won’t have the full hospital records, and the discharge summary may understate what happened. I have seen “PPH 900 mL” on a summary when the theatre notes said 2,500 mL.
This is also a good moment to ask the hospital for a debrief if you haven’t had one. Knowing why you bled helps with recovery and planning; see “Nobody ever told me why”.
When you work in health
Nurses, midwives, doctors and paramedics who haemorrhage often describe two opposite problems. Some are given less explanation, because staff assume they already know. Others are given less care, because they look like they are coping, or because they are told, as in the story above, “you’ll know what’s normal”. Neither is fair. When you are the patient, you are entitled to the same explanations, checks and follow-up as anyone else.
Working in health can also make recovery harder in specific ways. Going back to a ward or birth suite where haemorrhages happen can trigger memories. Night shifts and twelve-hour days are hard on a body that is still anaemic. If you are struggling, talk to your GP about a graduated return to work, and consider your employer’s employee assistance program. My article on birth trauma when you work in health explores this further.
Seven months later I was back on nights. Second week. A buzzer went in the bay and a woman said, “I feel funny,” and she was grey, and I was moving before I knew it.
She was fine. It was a faint. But afterwards, in the tea room, I realised my own heart was going like it had on the couch that first week, and I couldn’t get my hands to stop shaking around the cup. I’d been telling everyone I was fine. I’d been telling myself I was fine. I was still breathless on the stairs to the car park every morning.
I went to my GP the next day and said it all, properly, in order, like a handover. She rechecked my bloods. My iron stores were still nearly empty. Seven months. She arranged an infusion and a referral to a psychologist who works with health workers.
What changed wasn’t really the iron. It was that I stopped treating myself like a colleague and started treating myself like a patient. I wrote down the numbers from my discharge summary and the numbers from that week and put them side by side. For the first time it looked like what it was.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
Months later: still not right
Most women gradually recover their energy as their blood and iron stores rebuild. If you are still exhausted, breathless or foggy months later, it is worth asking whether your iron stores have actually recovered, whether you have postnatal depression, anxiety or post-traumatic stress, and, rarely, whether something like a hormonal problem is involved.
The psychological impact of a haemorrhage is real and common. If you are having flashbacks, avoiding reminders, struggling to sleep even when the baby sleeps, or feeling detached from your baby, read “I still wake up back in that room”. If people keep saying “at least your baby is healthy”, this article may help.
What to look for in the records
Your records show how serious the haemorrhage was and whether recovery was properly planned.
| Record | Why it matters for recovery |
|---|---|
| Blood results before and after the birth | Your haemoglobin and ferritin in pregnancy and after the bleed, which show how depleted you were. |
| Transfusion and iron infusion records | What you received, how much and when. |
| Clot risk (VTE) assessment | Whether a blood clot risk assessment was done after a severe PPH, and what was decided. |
| Discharge summary | How the blood loss was described, your haemoglobin on discharge, and the follow-up plan. |
| Postnatal notes | Whether dizziness, breathlessness or feeding problems were recorded, and what was done. |
| Lactation and midwifery notes | Separation from your baby, delays in first feeding, and any feeding support given. |
| Debrief or follow-up notes | Whether a debrief was offered, held, and recorded. |
| GP and follow-up records | Repeat blood tests, mood screening, and any referrals in the months after. |
How the law looks at it
Recovery is not usually where a claim starts, but it is where its consequences show. And sometimes care after the bleed is itself the problem.
Standard of care
Under section 5O of the Civil Liability Act 2002 (NSW), a health professional isn’t negligent if they acted in a way widely accepted in Australia by peer professional opinion as competent practice, unless that opinion is irrational. Guidelines are evidence of that practice, not the law. Questions might include whether a clot risk assessment was done after a severe PPH, whether a woman was sent home with a very low haemoglobin and no adequate plan, or whether worsening symptoms reported after discharge were properly assessed.
Causation
You must show, more likely than not, that proper care would have made a real difference. The High Court in Tabet v Gett [2010] HCA 12 confirmed that losing only a chance of a better outcome isn’t enough.
Consent and information
Under Rogers v Whitaker [1992] HCA 58, you are entitled to information about material risks and your treatment options, including, for example, the options for treating anaemia.
What recovery means for a claim
If a haemorrhage was caused or worsened by negligence, the effects described in this article (prolonged anaemia, time off work, help you needed at home, feeding difficulties, psychological injury) are part of what a claim considers. The categories and thresholds are explained in “Is it too late?”. Claims in NSW generally must be started within three years of when you knew, or ought to have known, enough to claim, and within twelve years of the birth; if your baby was also injured, don’t assume their claim can wait until they are 18. See medical negligence time limits in NSW.
In my practice
In recovery, the chain of small failures I see most often runs like this. The haemorrhage is managed, the woman stabilises, and the focus moves to the baby. Her haemoglobin on discharge is low, but the summary records a smaller blood loss than the theatre notes. Iron tablets are prescribed without a recheck date. The partner goes back to work. When she rings with dizziness, someone reassures her over the phone (I write about that pattern in being dismissed by doctors). When she sees her GP, the GP is working from the understated summary. Months later she is still breathless, and nobody has joined the dots. None of these steps feels dramatic. Together they can turn a recoverable injury into a year of illness. It is exactly the kind of pattern my doctoral research examined.
Holding two truths
Your body has done something extraordinary: it survived. And it may still be struggling, and that struggle is not weakness or ingratitude. You can be glad to be alive and grieve the early weeks you didn’t get to enjoy. You can also be a capable professional and need someone else to take care of you for a while.
The bigger picture
NSW Health’s 2025 PPH guideline strengthened requirements on antenatal anaemia, follow-up plans after severe haemorrhage, clot prevention and debriefing. Queensland has published plain-language parent information on haemorrhage after birth. The national blood management guidance for maternity is under review. And the NSW Birth Trauma inquiry heard from many women about the gap between hospital discharge and real recovery. RANZCOG’s statement on PPH focuses on the emergency, and Safer Care Victoria’s PPH collaborative on prevention; far less has been written about the months after. Postnatal care after a serious complication is still uneven, and it is often women themselves who have to push for the next test.
Support
- Australian Breastfeeding Association: 1800 686 268, 24 hours.
- Pregnancy, Birth and Baby: 1800 882 436. Maternal child health nurses, 7am to midnight.
- PANDA National Helpline: 1300 726 306. Support for parents, including partners.
- Gidget Foundation Australia: 1300 851 758. Free psychological sessions, including after birth trauma.
- Birth Trauma Australia: online peer support for mothers and partners.
- Lifeline: 13 11 14, 24 hours. In an emergency, call 000.
More options are in finding support after birth trauma in Australia.
The nurse on the shower floor is back at work now, and on her worst mornings she still takes the lift. But she rechecks her own bloods, she asks the questions out loud, and when a new mum on the ward says she feels “a bit funny”, she sits down beside her and listens.
With care, Rosemary
Frequently asked questions
How long does it take to recover from a postpartum haemorrhage?
It varies with how much blood you lost and your starting iron levels. Many women feel better over several weeks; some take months. If you lost your uterus, see emergency hysterectomy after birth. If you are not improving, ask for your blood to be rechecked.
Is it normal to feel dizzy after losing a lot of blood giving birth?
Dizziness and tiredness are common with anaemia. Dizziness or breathlessness at rest, chest pain, or a swollen painful leg need prompt medical review.
Should I have had an iron infusion after my PPH?
Treatment can include diet, tablets, an infusion or a transfusion, depending on your levels and symptoms. If you are still very anaemic on tablets, it is reasonable to ask about an infusion.
Can a postpartum haemorrhage affect milk supply?
Yes. An Australian study found women with greater blood loss were less likely to fully breastfeed early. Extra lactation support and early skin-to-skin contact help.
What is Sheehan’s syndrome?
A rare pituitary injury after severe blood loss in childbirth. Signs can include no milk supply, periods not returning and ongoing fatigue. It is diagnosed with blood tests and treated with hormones.
When can I go back to work after a PPH?
It depends on your recovery, your job and your iron levels. Talk to your GP about a graduated return, especially if your work is physical or involves night shifts.
Questions about your recovery?
When you’re ready, and not before, I can look at what happened with you, including the care you received after the bleed. A free case review means I listen, read your records, and tell you honestly what I see, with no obligation.
The series: After a postpartum haemorrhage
- “I Thought I Was Going to Die”: Postpartum Haemorrhage (PPH), What Happened and What You Can Do
- “Is It Too Late?” PPH: Time Limits and What a Claim Can Cover
- “Nobody Ever Told Me Why”: Why Did I Bleed So Much?
- “Their Arm Was Inside Me and No One Explained”: What Happens During a PPH
- “I Lost Over Two Litres”: Recovery, Anaemia and Milk Supply After a PPH (you are here)
- “I Passed a Clot the Size of a Golf Ball”: Secondary PPH and Retained Placenta
- “I Kept Telling Them Something Was Wrong”: When PPH Care Falls Short
- “He Was Left Holding Our Baby in the Corner”: When Your Family Saw the Haemorrhage
- “I Still Wake Up Back in That Room”: PTSD After a PPH
- “Can It Happen Again?” Pregnancy and Birth After a PPH
- “They Had to Take My Uterus”: Emergency Hysterectomy After Birth
This series is part of my work on birth trauma and obstetric negligence. If your injuries are making it hard to care for your baby, see “I can’t look after my own baby”.
References
- Queensland Clinical Guidelines. Haemorrhage after birth: parent information (C24.1-2-V3-R29). July 2024.
- NSW Health. Postpartum Haemorrhage, Guideline GL2025_013, section 7. August 2025.
- Thompson JF, Heal LJ, Roberts CL, Ellwood DA. Women’s breastfeeding experiences following a significant primary postpartum haemorrhage: a multicentre cohort study. International Breastfeeding Journal 2010;5:5.
- National Blood Authority. Patient Blood Management Guidelines: Module 5, Obstetrics and Maternity. 2015 (under review).
- The Pituitary Foundation (UK). Sheehan’s syndrome. Used because no Australian patient resource was found.
- Pregnancy, Birth and Baby. Australian Breastfeeding Association.
- Pregnancy, Birth and Baby. Postpartum haemorrhage.
- NSW Legislative Council Select Committee on Birth Trauma. Birth trauma, Report 1. May 2024.
- Civil Liability Act 2002 (NSW), s 5O.
- Tabet v Gett [2010] HCA 12.
- Rogers v Whitaker [1992] HCA 58; (1992) 175 CLR 479.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
