Anaemic and hoping for home birth

[doingitagain14]

I have been sent a letter from my midwife telling me that bloods taken at booking appointment indicate that I am anaemic. I have been told to see my GP for a prescription for iron tabs. I'm not keen on this as have read some fairly negative stories about the side effects, but more worrying to me is that it might mean I am refused the home birth I am hoping for (no other issues and straightforward pregnancy and delivery last time). I feel ok at the moment - was really tired earlier in the pregnancy but this has been getting much better in recent weeks (now 14 weeks). I think my bloods were on the borderline during last pregnancy but managed to avoid any need for tablets.

If I can get my iron levels up to the acceptable level, would there be any good reason for refusing home birth?

[mayhew]

You have plenty of time to get your iron levels up to normal. In my area, an HB of 10 or more at 36 weeks is considered to give a safe margin. See how you get on with the iron tabs. Not everyone gets side effcts and if you do there are other versions to try. Vitamin c encourages iron absorption so make sure there is planty in your diet. The tannin in tea can reduce it so do not drink with meals.

The tabs can make you your poo go black!

[GingerJulep]

I'm trying this stuff: www.nelsonsnaturalworld.com/en-gb/uk/our-brands/spatone/ as my levels are over 10 but slightly lower than ideal.

Someone on here mentioned it being cheap on Amazon (which it was compared to other places - still a lot for water though!)

Not noticed any of the predictable iron side effects so far.

Also aiming for a home birth.

Green leafy veg/dark chocolate etc and vit C also good.

Good luck!

[Hawkmoth]

There are other forms of iron you can take if the tablets upset your stomach. Ferrous fumarate is gentler, and there are also liquid forms... Though they are foul. I've been through them all and none of them are at all pleasant, but they do work quickly.

Here the cut off is 10.5 and they measure at 28 weeks... So you've got lots of time to sort it out. Really it's an easy box to tick and not a risk I'd want to take. My baby is three weeks on Wednesday and I had a minor PPH after a home birth. It kind of took some of the enjoyment out of it, though everything turned out ok and I wasn't transferred... It was REALLY scary.

For reference, my HB was 11.2 at about thirty weeks.

[ohmeohmyforgotlogin]

Second spatone. Brilliant stuff. You can get it in Boots.

[doingitagain14]

Thanks for the replies, good to know there are other options that don't seem to have the same risk of side effects. Will maybe give the spatone a go.

[Pyrrah]

Really try and get the levels up.

I had an Hb of 8.5 when I went into hospital - they knew mine was low as it had been 7 at 38 weeks, I'd had HG and had only stopped throwing up at 32 weeks but was still nauseous - last thing I felt like taking was something that made me feel even more icky. I had no idea it could be dangerous - just thought it made you feel tired and made you crave crushed ice!

I ended up with a massive haemorrhage, 3 days in ICU and 5 transfusions. After the 2nd transfusion, my Hb was 5. One of the consultants had a massive go at me about my iron levels and how lucky I was and how PPH was the leading cause of maternal death - they had come very close to losing me in the operating theatre and he was quite badly scared I think.

No-one had explained to me that low Hb increases the risk of a PPH and also makes any PPH considerably worse than it otherwise would be.

[Janek]

That's really interesting pyrrah, i wasn't anaemic during pregnancy (although i do have a tendency towards it), but when the second lot of bloods were taken (28 weeks?) i got a prescription through the post from the mw, with the explanation that my fb? Was low so needed iron.

I must have had another blood test later, as i distinctly remember that the mw when i was in labour (hb) commented upon the level being low when looking at my notes, then being reassured that everything was okay when she saw my second, later level.

This was my second pg and i'd read a couple of pregnancy books two or three times by this point and i had no idea that pph is a side effect of anaemia. In fact i'm quite glad i didn't know...

[Pyrrah]

I'm a 'researcher' by nature - plus my father is a doctor and one of my best friends and also my uncle are both obstetricians - and I had no idea about the PPH/anaemia link.

I was high risk to start with so I was seeing midwives or consultants pretty much every week as well - although the birth itself was the only thing no-one was worried about - and no-one mentioned a thing.

Since some people can get unpleasant side-effects from iron tablets, I do think they ought to explain the issues as it would have made a huge difference to me and I'd have sucked up the feeling sick again had I known.

[reikizen]

www.midwifery.org.uk/?page_id=618 Low Hb does not predispose a woman to a pph, but it may make it harder to recover from afterwards. Spatone is very good, I recommend it to my women if they can afford it over iron tablets as it is very gentle and easily absorbed.
You can have a homebirth if you want one with a low HB, it simply means that you accept the associated (if any) risks. No-one can stop you, midwives must support your decision, and most will. It is the doctors who kick up a fuss...

[reikizen]

oh, and pyrahh, PPH is not the leading cause of maternal death in the UK, far from it! As I recall, it is sepsis, followed by suicide

[Pyrrah]

I didn't say it was the leading cause of maternal death 'in the UK' - I said that he told me it was the leading cause of maternal death fullstop (which IIRC is the case).

[doingitagain14]

Thanks reikizen. That's what I thought in terms of the risks associated with PPH. I will def try and get the levels up though - might see if they'll let me have a go with the spatone first to see if that works.

[Accidentallyquirky]

I've planned a home birth and at 34 weeks my iron levels where still to low so I had 2 weeks to get them up or I wasn't allowed my home birth.

To get them up I did the following - Fresh orange drank at same time as tablets been taken, no tea or coffee for an hour before and after tablets (I stopped totally)
Ready break has high iron levels too so I'd start my day with ready break then snack on broccoli etc. it worked and my levels where much higher two weeks later and I got the go ahead for my home birth

I had no side effects apart from lovely black constipated poos but once I started drinking lots of orange juice this stopped .

[4athomeand1cooking]

Yes very important about the tea and coffee as this makes it harder for the body to absorb iron.

[quickchat]

Please don't get hung up on home birth. I was anemic and my baby was born within 1 hour and i hemorrhaged 2 litres of blood because my womb didn't contract down quickly enough. I was told if I hadn't made it to hospital in time (I jumped out of my car and into an ambulance) I would most certainly have died.

Worry only about your anemia for now.. I have had 3 children and im perfectly fit and healthy but I have needed assistance twice. Birth can change very quickly.

[quickchat]

Pyrah please translate for me!! Hb ??

[reikizen]

Hb - haemoglobin level. anything under 110 (11) or 105 (10.5) after 28 weeks and we recommend iron supplements, anything under 10.5 and women are advised against a homebirth. Of course, as we don't routinely take bloods after 28 weeks we may not know what your Hb is. quickchat, that sounds very frightening but I am equally certain you would not have died! I have known women lose more than 2 litres of blood and be in vigorous health soon afterwards, pregnant women are usually young and healthy and recover very quickly from even very large blood loss.

[Minifingers]

"I'm equally certain you would not have died"

There was a thread on this board once - 'would you have died if you'd given birth in the past?:'. A brief survey of the responses suggested that about 10 times as many well-nourished mumsnetters believed they would have died in childbirth, as actually would have died going by historical maternal mortality rates from the 1800's. Odd!

[EagleRay]

Tread carefully around Spatone - gentle it may be but I took it when iron levels were low and my Hb levels subsequently divebombed causing my homebirth plans to nearly be jeopardised.

I quickly switched to the nasty old iron tablets from the chemists and was able to get my Hb levels back up to acceptable level fairly quickly. Didn't have a homebirth in the end for other reasons but am glad it wasn't due to this.

Spatone does seem to work for some people, but just make sure you aren't led into a false sense of security if you take it. I didn't have any major side effects with the iron tablets, apart from them making me poo more often!

[EagleRay]

By the way, if you Hb levels are giving cause for concern and it's impacting your birth plans it may be a good idea to get a second opinion. When my levels were low, I was told by community MW that they needed to be raised but it wasn't a huge deal. Later the same day I had an 'urgent' phone call from a hospital MW saying I could no longer have a HB and my GP was being contacted immediately to write me a prescription.

There also seemed to be confusion over what the Hb threshold was - got several different answers and so the guidelines seemed to be interpreted differently by everyone

[K8Middleton]

I was anaemic both times and had home births both times. In my first pregnancy I controlled it with diet, in my second with double dose of iron tablets because it wasn't improving.

Take the iron supplements. Severe anaemia is horrible. If you are worried about side effects you can do something about those - take your tablets with orange juice and drink plenty of water. You will probably be constipated any way just being pregnant. Sorry.

There are different types of iron - ask your GP for something least likely to cause constipation/upset stomach. If it is giving your diarrhoea you can start taking with food although you should start taking it on an empty stomach.

Honestly the shits, black poo and constipation are nothing compared with feeling so tired you could cry, not being able to catch your breath and worse.

Oh and I found Spatone a total waste of a lot of money so it's not brilliant for everyone and doesn't have anywhere near as much iron as the tablets. My GP was horrified it had been recommended by midwife when he checked the dosage and prescribed tablets 20 x stronger and told me to take 2 per day.

[K8Middleton]

X-posted with eagleray.

[EagleRay]

Ah, my experience exactly, K8Middleton. I felt like a complete fool when I realised how weak Spatone was.

Strangely enough, I had no problems with tiredness whatsoever, even when Hb levels were v low although I realise this was probably the exception to the rule!

[doingitagain14]

So I saw the lovely locum doctor who acknowledged my worries and suggested, as my levels were not drastically low, that I take the iron tabs but take fewer than the generally prescribed 3 a day and see how I go, while trying to eat as many iron rich foods as poss. Decided to give it a go (also thinking I get these for free rather than having to fork out for the spatone!) and see how I get on. She agreed that I would be best to get the levels up or else 'people will get a bit jittery about a home birth'.

Thankfully not feeling too tired (not like I was at about 8-10 weeks) just a standard amount of tiredness from looking after 3 year old who wants to get up crazy early!

[K8Middleton]

That's good news. Did she give you a list of iron rich foods? I found a good one online if you need it I could probably find it again?