Iron levels required for homebirth

[Bozza]

My midwife is coming to see me on 18 April to discuss my request for a home birth. Apparently though my iron levels may cause an issue. She says that you need a blood count of 11.0 to be allowed a homebirth. At 28 weeks my levels were 10.2 but at booking-in they were only 11.3 (I think I have generally fairly low levels - have been rejected as a blood donor in the past).

I just wondered if anyone else had any experience of this. When the midwife comes she will do a blood test but what can I do if it comes back below 11.0? Can I ask for another or just insist on a homebirth or would this be dangerous?

I am on iron tablets which has been causing a whole other set of problems (constipation, piles etc) so have really started trying to improve my diet with iron, fibre and vit C (to help absorption). Lots of dried apricots!

Bozza, I am planning a homebirth (I'm 37 weeks). The last iron result recorded in my notes was 10.1, after which I started taking an iron supplement. I had a home visit from two midwives today, who said they would chase up the latest result, but they didn't say anything about it being an issue if still borderline. Wonder if your midwife is quoting local guidelines?
Sounds like you are working on getting your levels up anyway, so hopefully all will be ok.

Bozza, have you seen the page on this site entitled "You can't have a homebirth because..."? It mentions low haemaglobin counts.

...and says "these are not usually an obstacle to having a homebirth".

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Twiglett, do you mean Floradix? That's what I'm taking.

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Thanks for the link hd - very interesting. I have read some stuff from that site before. Also noted that the cut-off point mentioned there was 10.0 whereas my midwife said 11.0.

Twiglett I have been taking the iron supplement I got on prescription so would you still suggest I got the floradix? The "bad side effects" (as you phrase it) are improving very much since I really took a hold on my diet - had got a bit slack due to pressures of still working and being tired but I'm finishing work this week and am now concentrating on eating better. So the constipation is no longer a factor. To be realistic the piles are not going to completely clear up until after the birth (had similar problem with DS exacerbated by long second stage) but at least I can sit down again now. Last week got to the point where I wouldn't have a bath becase of the pain and DH persuaded me to use a rubber ring!

Am worried that if my iron is borderline it might make DH more anxious.

Hi there. Bozza - would suggest taking Florodix as well and also make sure you take your iron with some Vit C ie glass of orange juice to maximise absorption. Steak and Duck are also meant to be the best things to eat as they have the best Heomoglobin for quick absorbtion. Am currently doing this myself as am having the same problems with wanting a waterbirth at a birthing unit. Have just found out that their cut off rate is 10.4 and at 38 weeks don't have much time to raise it. I started out at 10.9 and then went down to 9.9. Its taken me since Jan to get up to 10. So have only days to get it up. Fingers crossed although midwife seems pretty relaxed that it will be ok. Another Blood test next week so see if its rising.

Bozza - the blood test is merely one of the services that your midwife can offer you. You can decline her kind offer She cannot refuse you a homebirth because of this!

As HD's linked-to site says, low iron levels are normal because you have the same amount of iron floating around in a couple of pints of blood more than usual. Its a design-feature not a problem...

The other supplement that works well is Spatone (Boots sell it, big orange box). Tastes nicer than Floradix! If you take 2 sachets a day it should raise your iron by 1 point a week, ish.

Am going to do my online shopping later today so will take all this into account. I have been taking the iron with my breakfast of porridge and orange juice so that should be OK. Have to watch the fibre side of things as well so thats why I've been eating the apricots - because they combine the two. Definitely going to increase my red meat intake as well though.

I thought that was the case zerub. That you could insist on a hb if you want one but not sure how to go about it and how stroppy to get. Because at the end of the day obviously don't want to put baby at risk. Although I think the biggest risk is for me to have to transfer to hospital after the birth. But as the link said and you pointed out there is no proven link with blood loss and low iron levels. DS was a big baby, so this one might be and the bigger the baby the further the blood has to go round.

My midwives suddenly started asking me 'have you been taking your iron' lateish in my last pg, I recall, and insisted the doc prescribe me iron supplements even though I wasn't that low. I think I was around 10 or 11 or suchlike. And I was going for a home birth, which I now realise may be why she got quite anxious about it. (Did have hb, and no further fuss about iron either.)

Bozza, you can email AIMS for advice on your rights to homebirth, safety of the iron thing, and how stroppy to get! (they will be pleased to hear from you). I guess how stroppy to get depends on how strongly you feel about homebirth / hospital birth.

Also, the problem with a low iron count is thought to be the mother's recovery if she haemorrhages - doesn't affect the baby's safety. And the experts don't agree that its a problem for the mother either. Here's a midwives' discusson on low iron counts.

Good luck!

I took pregnacare and my iron levels were v high during pregnancy. You need folic acid and b vits as well as iron in a supplement and most iron supps alone aren't as effective. Also steak and oranges. As Zerub says, you don't have to have any tests you don't want, inc blood, and you can't be told where to give birth. It's your body. And I would rather be tortured than have a home birth (or any birth except section tbch - sorry Pupuce - just read account of homebirth!) but do defend others rights to have a choice.

If you read the arguments on this long enough there are people who believe that low iron levels are the biological norm in human pregnancy, in fact they have various health benefits (so the argument goes). All I know is that nothing they say to you can make them deny you the right to a homebirth, Bozza; and 10.2 isn't that low. There was a detailed discussion on this on the homebirth-UK email list (including contributions from qualified midwives) and the verdict seemed to be that levels should be below 9, maybe below 8.5 in fact, before homebirth truly became too risky.

I had this worry to with my last pregnancy and labour, was told that I needed to raise my iron levels for a homebirth. I worried loads, swallowed nasty little pills and lived on iron rich food. When it came to the big crunch mw meeting about 4 weeks before, she asked me how I was feeling, I said loads better now I had taken lots of iron and she said that was ok and she needn?t do any tests if I felt great!! Couldn?t believe she was so casual about something I had got so worried about but didn?t dare question her as I didn?t want to tempt fate. Of course, other MWs might be more rigorous and after all, it is for our own safety and the babies?.
I took that awful orange and fibre drink you can buy from the chemist - fibregel? something like that - my midwife arranged it on prescription for me so cost nothing. It tasted yuck but worked a treat with the constipation and had no nasty stomach cramps or other side effects you can get with some constipation treatments. Watercress is a good source of iron, better than spinach, and as you have already said, make sure you have fibre and vit C. I found it easy to do my healthy bit with breakfast - All bran, glass of fresh orange and cranberry juice and a little pill..
Do be careful not to take too much iron in an effort to raise it further - it can throw your body out of balance and have knock on problems. Try boosting with extra iron through diet rather than more pills. If you like marmite, marmite on wholemeal toast is a good way to kick start the day.

grumpyzebra is right about 'allowing' you and all that bozza. Glad you're still thinking about homebirth! Mine did the same thing, told me they might be too low to 'Let' me have a homebirth and then didn't bloody well take any blood again! So how was she going to know? Baffling. Anyway, keep up the apricots etc.

Thanks everyone. Its nice to get a bit of validation for what I'm thinking/doing.

My prescription is for iron and folate - two tablets which I take with my breakfast of porridge and orange juice. Yesterday I actually went to Asda at lunchtime and bought steak, butter beans and brocolli for tea rather than routing through the freezer when I got home. Plus spent the afternoon at work eating apricots and drinking orange juice. My digestion seems to be back on track and I feel quite confident again. It just threw me a bit because I had other issues that I perceived might be considered a problem (previous large baby, episiotomy, syntocin (?) drip) but then she threw an unexpected one into the ring.

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