Fever after giving birth: possible causes and when to seek care
In brief
A fever after giving birth (postpartum fever), meaning a temperature of 38 °C or more in the weeks after the birth, should always lead to a medical review the same day. The most common causes are infection of the womb (endometritis), urinary infection, mastitis and wound infection. More rarely, it is a blood clot or a serious infection that needs urgent treatment.
Why should fever after giving birth be taken seriously?
After a birth, the womb is healing, the perineum or abdominal wall may have been stitched, and the breasts are starting to produce milk. Each of these areas can become infected. Most of these infections respond well when treated early. Some, however, can progress quickly to a body-wide infection (sepsis), which remains an important cause of serious maternal complications. For everything about recovery after birth, see the Childbirth in Paris page.
A temperature of 38 °C or more, measured with a thermometer, warrants medical advice the same day. Simply feeling warm or having slight shivers when your milk comes in is not enough to call it a fever, but take your temperature if in doubt.
What are the main causes of fever after giving birth?
| Cause | Associated signs |
|---|---|
| Endometritis (infection of the womb) | Lower abdominal pain, tender womb, heavy or foul-smelling lochia. More common after a caesarean. |
| Infected retained placenta | Prolonged or heavy bleeding, pain, fever. |
| Urinary infection | Burning, frequent urge to pass urine; back pain on one side in kidney infection (pyelonephritis). More likely after a urinary catheter. |
| Mastitis | Red, hot, painful area of the breast, aches. In women who are breastfeeding. |
| Wound infection | Episiotomy, tear or caesarean scar that is red, hot, swollen or leaking. |
| Venous thrombosis | Painful, swollen leg, or pelvic pain on one side; fever that persists despite antibiotics. |
| Widespread pelvic infection | Severe lower abdominal pain, feeling very unwell. An emergency. |
| Non-obstetric causes | Flu, gastroenteritis, COVID-19, appendicitis… |
A fever can also occur with no obvious cause just after an epidural or a long labour. It is then closely monitored in the maternity unit.
What increases the risk of infection after birth?
Any woman can develop a fever after giving birth, even after a straightforward pregnancy and birth. Some situations, however, make an infection more likely and call for extra vigilance in the first weeks:
- a caesarean section, especially an emergency one during labour;
- waters breaking long before the birth, or a fever during labour;
- a long labour with many internal examinations;
- a ventouse or forceps delivery, a significant tear or an episiotomy;
- manual removal of the placenta or a manual check of the womb, meaning a hand is inserted into the womb to remove the placenta or check that it is empty;
- heavy bleeding after the birth and anaemia, which weaken the body's defences;
- diabetes, obesity or a treatment that weakens immunity;
- carrying group B streptococcus during pregnancy.
These factors are noted in your discharge summary. If any apply to you, the team will remind you of the signs that should prompt a visit. Your maternity record or birth report is useful to show if you see another doctor or go to an emergency department.
What are the signs of sepsis after giving birth?
The Royal College of Obstetricians and Gynaecologists (RCOG) stresses the early recognition of postpartum sepsis. It can develop within hours. The following signs mean you should, in France, call 15 (SAMU) or 112 (or your local emergency number) straight away:
- high fever with severe shivering, or on the contrary a low temperature (below 36 °C);
- fast breathing, breathlessness;
- a racing heart, feeling faint, feeling very weak;
- confusion, unusual drowsiness;
- mottled, cold or very pale skin;
- very severe abdominal pain;
- diarrhoea and vomiting with fever;
- passing very little urine.
Group A streptococcus, a bacterium that can come from a sore throat in someone close to you, is a classic cause of serious infection after birth. Mention any sore throat in your family if you have a fever.
What tests are done for fever after birth?
The doctor first looks for the source of the fever with a full examination: breasts, scars, abdomen, womb, calves, throat and lungs. Further tests depend on what is found:
- blood test: blood count, inflammation markers and, if the fever is high, blood cultures;
- urine test (urine culture);
- vaginal or wound swab;
- pelvic ultrasound, looking for placental fragments or an abscess;
- Doppler ultrasound of the veins, or even a CT scan, if a thrombosis is suspected.
Say if you are breastfeeding and which medicines you take: treatments will be chosen accordingly.
How is fever after birth treated?
- For the fever: paracetamol is the first-line treatment and is compatible with breastfeeding. It brings relief but does not treat the cause: it must not delay seeing a doctor.
- Antibiotics: they are needed for most infections. A severe infection is treated in hospital with intravenous antibiotics.
- Additional procedures: removal of placental fragments, drainage of a wound or breast abscess.
- Anticoagulants for venous thrombosis.
In the vast majority of cases, breastfeeding can continue during treatment, including with mastitis. Uncomplicated cases are managed at home, with close follow-up arranged by the practice or by the maternity unit where you gave birth.
How can I reduce the risk of infection after giving birth?
- wash your hands before changing your pad and before feeds;
- change your sanitary pad regularly and avoid tampons while the lochia lasts;
- keep scars clean and dry;
- drink enough and pass urine regularly;
- make sure your baby latches well to avoid engorgement and mastitis;
- if someone close to you has a sore throat, they should wash their hands carefully and see a doctor.
In France, the midwife who follows you at home after you leave hospital also checks your temperature and scars.
When should I see a doctor for fever after giving birth?
Contact the maternity unit, your obstetrician-gynaecologist, your midwife or your GP the same day if you have a fever of 38 °C or more. Go straight to the maternity emergency department if the fever comes with:
- pain in the lower abdomen or back;
- heavy bleeding or foul-smelling discharge;
- a scar that is red, swollen or leaking;
- a painful or swollen leg;
- severe shivering or extreme tiredness.
In France, call 15 or 112 (or your local emergency number) if you have any of the serious signs described above, sudden breathlessness or chest pain.
Frequently asked questions
Can your milk coming in cause a fever?
It can come with a slight rise in temperature, but a clear fever of 38 °C or more means another cause should be looked for, particularly mastitis or infection of the womb.
Can I keep breastfeeding with a fever?
Yes, in the vast majority of cases. Paracetamol and most antibiotics prescribed after giving birth are compatible with breastfeeding.
How long after birth can a fever be linked to the delivery?
Most postpartum infections occur in the first few weeks. A fever within six weeks of the birth should raise the possibility of a cause linked to the delivery.
My fever went down with paracetamol: do I still need to see a doctor?
Yes. Paracetamol lowers the temperature but does not treat an infection. A medical review helps find the cause.
References
- Sénat MV, et al. Postpartum practice: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol, 2016. doi:10.1016/j.ejogrb.2016.04.032 — PMID 27155443
- Lissauer D, et al. Identification and Management of Maternal Sepsis during and following Pregnancy: Green-top Guideline No. 64. BJOG, 2024. doi:10.1111/1471-0528.18009 — PMID 39694496
- Mitchell KB, et al. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeed Med, 2022. doi:10.1089/bfm.2022.29207.kbm — PMID 35576513
Dr Olivier KadochObstetrician-gynaecologist and gynaecological surgeon in Paris (16th and 5th arrondissements). Former chef de clinique-assistant (senior registrar) at the Paris public hospitals (AP-HP); individually accredited by the French National Authority for Health (HAS). RPPS 10003957809. Background and practice locations
A question about your situation?Appointments at the practice or by video consultation, usually within one week to 10 days.
Book an appointmentGeneral information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.