A number of reports, 1 , 2 , 3 including the ‘Confidential enquiry into maternal deaths’, 4 , 5 have noted the need for earlier identification of women who are becoming unwell and for seamless care to support their recovery. While there has been considerable improvement in dealing with obstetric emergencies, 6 other complications can occur, even in the context of what appears to be an uncomplicated birth. There remains a need for midwives to recognise signs of deteriorating illness and refer appropriately.