Normal tired or something more? When exhaustion is a warning sign

Every new mum is tired. That is so universally true that it can be hard to notice when tiredness has crossed a line into something that needs attention. Exhaustion can hide anaemia, a thyroid problem, an infection or postnatal depression, and it can affect your safety. This guide will help you tell the difference between ordinary new-baby tiredness and the signs that mean it is time to talk to your doctor.

Ordinary new-baby tiredness usually

• improves, at least a little, after a good stretch of sleep or a nap
• follows broken nights and eases as the nights get easier
• still allows moments of energy, interest and joy
• leaves you able to look after yourself and your baby, especially with help

Tiredness that needs checking

Talk to your doctor, midwife or health visitor if you notice any of these:

• exhaustion that doesn't improve even when you get more sleep
• feeling breathless, dizzy, or having a racing heart with ordinary activity
• looking unusually pale, or feeling cold all the time
• having lost a lot of blood at birth and still feeling wiped out weeks later
• feeling unusually shaky, hot and jittery or losing weight quickly, or the opposite, feeling sluggish, cold and heavy (the thyroid can be affected after birth)
• a fever, increasing pain, or a wound or breast that looks infected
• being unable to sleep even when you have the chance
• low mood, numbness, constant worry or loss of interest lasting more than two weeks

These don't mean something is definitely wrong. They mean it is worth a conversation, and possibly a simple blood test. Many causes of exhaustion after birth are very treatable.

Tiredness that is a safety issue

• Drowsy driving. If you nod off at traffic lights or struggle to keep your eyes open while driving, stop driving until you have had more rest, and ask for lifts or use other transport.
• Dozing with the baby. If you keep finding yourself falling asleep while holding your baby, especially on a sofa or armchair, tell someone and get support. Put her down on her back in her cot as soon as you feel sleepy.
• Mistakes with feeds or medicines. If you are too tired to make up bottles safely or keep track of your own prescribed medicines, ask someone to help.

When exhaustion is urgent

Seek help the same day, or call emergency services, if tiredness comes with chest pain, severe breathlessness, fainting, very heavy bleeding, confusion, or thoughts of harming yourself or your baby. Seek urgent help too if you have almost stopped sleeping altogether and feel unusually high, restless or not yourself, as this can be a sign of a serious but treatable illness after birth.

Making the conversation easier

Doctors sometimes hear I'm tired and assume it's just the baby. Be specific: I'm getting four or five hours of sleep in total but I'm still exhausted after naps. I get breathless walking upstairs. I've felt low for three weeks. Then ask directly: Could this be anaemia, my thyroid or postnatal depression? Would a blood test help? If you can, bring someone who knows how you have been, as they may notice things you don't.

Mercies for this morning

It is of the LORD'S mercies that we are not consumed, because his compassions fail not. They are new every morning: great is thy faithfulness. (Lamentations 3:22-23, KJV)

These words were written in a season of deep weariness and grief. They don't pretend everything is fine. They simply point to the one thing that does not run out: God's compassion. Your strength may be running on empty, but his mercies arrive fresh each morning, including the mercy of doctors, tests, treatment and people who help.

A prayer when I'm running on empty

Faithful God, I am more tired than I know how to say. Give me wisdom to notice when I need help, and courage to ask for it. Renew my strength each morning with your mercies, and lead me to the care I need. Amen.