Anaemia: Why severe fatigue after childbirth is dangerous for mother and newborn —experts

When people say the woman has the baby, and so she’s fine, it’s time to go home. The women, too, assume the same and say, smiling, “Oh, because I feel better now I’ve had the baby, I want to go home.”

Even when she feels tired and weak, she is told, “Once you get home, you’ll be fine.” The older women tell her the same: “It’s just a common symptom. Every woman has this. And as you go on, you’ll get better.”

The response from the nurse to her before leaving the hospital sometimes is, “Don’t worry; you’ll get over it. You just delivered.”

These are common conversations women have after delivery. Weakness, tiredness, and feeling faint after childbirth are often seen as a transient condition, with no reason for alarm. It is not considered important even though these symptoms are sometimes suggestive of a low blood volume, which is termed ‘anaemia’.

Ms Chisom Chieme from the Centre for Clinical Trials, Research, and Implementation Science, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, speaking at the 8th international and scientific conference of the Association of Fetomaternal Medicine Specialists of Nigeria (AFEMSON) with the theme “Contemporary Research in Fetomaternal Medicine”, recounted many misconceptions about fatigue in women after childbirth.

“Many people do not consider anaemia as probably the reason for this; they don’t look out for it at this time in this woman’s life. Even at the postnatal clinic, common questions asked are “Is your baby sucking well?” and “Are you eating and sleeping well?” and so on. Other complaints, like tiredness, may be overlooked, she said.

Anaemia after childbirth is a significant contributor to maternal morbidity in low-income countries, which is still under-addressed. Studies show that untreated anaemia in pregnancy can push a woman into having anaemia even after childbirth, which will also affect her care for the newborn.

Professor Hadijat Raji, a consultant obstetrician and gynaecologist at the University of Ilorin Teaching Hospital, declared that anaemia after childbirth has far-reaching consequences.

Such women stand a greater risk of postpartum depression, poor wound healing, and cognitive impairments in newborns.

“When you have anaemia and you have an infection setting in, wound healing is compromised,” she added.

However, the fatigue experienced by women with anaemia goes beyond just tiredness. They’re so exhausted that they may not be able to take care of themselves, their newborn, the other children at home and their husbands. They are misunderstood as being lazy.

Professor Raji stated, “This makes it more difficult for the woman to get help. So, she is just silently suffering in the background from anaemia after delivery. She is not able to sit down long enough to breastfeed her child long enough to allow the milk to get down completely.

“So she’s not able to breastfeed effectively, so she has compromised milk production. And so the infant is not getting a sufficient quantity of breast milk. The quality of the breast milk is also affected when you have anaemia because you have less iron in the body.”

When the woman is tired, she’s not able to bond with her child at all. So, all these things affect the quality of life of the woman, her newborn, and the entire family. Therefore, it is a significant issue that requires attention.

Dr. Monsurat Aderolu, also a consultant obstetrician and gynaecologist, stated that addressing anaemia after childbirth fits into the larger strategy of reducing morbidity and mortality in Nigeria, bearing in mind the nation’s high fertility rate and poor maternal care.

She added, “So, when a woman is managed effectively for anaemia after childbirth, it prevents the present health issue and also takes care of the future health issue.

“It can be an entry point to increase the postnatal health coverage, and we can counsel these women on other reproductive services. These women are seen in the postnatal clinic and counselled on child-spacing, family planning, and even on the prevention of malaria and others.”

Dr. Olawunmi Adamiloye, a consultant obstetrician and gynaecologist, declared that from the IVON-PP study, which involved women across four states in Nigeria, the use of intravenous iron therapy, particularly ferric carboxymaltose, is a far more effective treatment for moderate to severe anaemia compared to oral iron supplements.

She stated that, unlike oral iron supplements that are taken daily for a long period to build blood levels, only a single intravenous dose of the intravenous iron therapy will effectively correct the anaemia within 15 to 20 minutes.

The intravenous iron therapy offers a one-time solution that works faster and reduces the likelihood of requiring a blood transfusion, reinforcing its practicality in real-world settings.

“Black stools, headache and constipation were reported in the oral iron supplements group, with only one test participant reporting constipation for the intravenous drug. It has resulted in no adverse event.”

People assume that by the time an intravenous medication is given, it means that the person is very sick. But a single intravenous dose of the intravenous iron therapy is far more effective than the other alternatives, including herbal remedies.

Regardless, “We did find a greater effectiveness with ferric latoxymotose, an intravenous iron therapy, at six weeks and six months after delivery in correcting not just iron deficiency but also anaemia,” said Professor Bosede Afolabi, the director for the Centre for Clinical Trials, Research and Implementation Science at the College of Medicine at the University of Lagos.

Everybody with anaemia can be easily picked up with a blood test and treated. Having a safe delivery is not the end of it. We need to ensure that women are also healthy after childbirth to ensure their newborns and families are healthy as well.

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