Hb and homebirth?

[Levanna]

At my earlier blood tests my Hb was 13.9, now at 32 weeks it's 10.3. I've declined iron tablets for now, but have been told that it should ideally be above 10.5 for a homebirth, and definitely above 10. I'm hoping to improve it through diet, but could anyone tell me where I stand regarding a homebirth if I can't raise it, or it drops further? Also what risks could be associated with a low Hb at birth?
TIA!

Sorry! Another question. I've also been told I have to be free of thrush for a homebirth, it's been coming and going due to several courses of anti biotics, where do I stand if I do have it at birth? Also, what are the risks associated with vaginal thrush at birth?!
Again, TIA!

I think you are being told a lot of rubbish... why don't you ring AIMS,... you will get the straight forward answers. It is IDEAL (i.e. medically proven - yet loads of health practitioners seem to ignore this!) to have a hb of less than 10 for a birth... home or not!
It will be worth you while to talk to them : www.aims.org.uk/

D6 have a ref, 4 that, pupuce

What ????????

Check everything the doctors tell you as unfortunately many GP actively discourage it and will use any excuse. I once overheard my local GP telling the midwife to tell a pregnant woman "anything you like but I have not got the resources to fund homebirths and she is not having one". Charming!

Pupuce - why is it better to have an hb of less than 10 for a birth - just curious as to why they bother putting us on iron tabs then?

!!! 100g/l is the same as 10.0 g/dl
so here is the study....

BMJ 1995 Feb 25;310(6978):489-91

Relation between maternal haemoglobin concentration and birth weight in different ethnic groups.

Steer P, Alam MA, Wadsworth J, Welch A.

Academic Department of Obstetrics and Gynaecology, Charing Cross and Westminster Medical School, Chelsea and Westminster Hospital, London.

OBJECTIVETo assess the relation of the lowest haemoglobin concentration in pregnancy with birth weight and the rates of low birth weight and preterm delivery in different ethnic groups. DESIGNRetrospective analysis of 153,602 pregnancies with ethnic group and birth weight recorded on a regional pregnancy database during 1988-91. The haemoglobin measurement used was the lowest recorded during pregnancy. SETTINGNorth West Thames region. SUBJECTS115,262 white women, 22,206 Indo-Pakistanis, 4570 Afro-Caribbeans, 2642 mediterraneans, 3905 black Africans, 2351 orientals, and 2666 others. MAIN OUTCOME MEASURESBirth weight and rates of low birth weight (< 2500 g) and preterm delivery (< 37 completed weeks). RESULTSMaximum mean birth weight in white women was achieved with a lowest haemoglobin concentration in pregnancy of 85-95 g/l; the lowest incidence of low birth weight and preterm labour occurred with a lowest haemoglobin of 95-105 g/l. A similar pattern occurred in all ethnic groups. CONCLUSIONS--The magnitude of the fall in haemoglobin concentration in pregnancy is related to birth weight; failure of the haemoglobin concentration to fall below 105 g/l indicates an increased risk of low birth weight and preterm delivery. This phenomenon is seen in all ethnic groups. Some ethnic groups have higher rates of low birth weight and preterm delivery than white women, and they also have higher rates of low haemoglobin concentrations. This increased rate of "anaemia," however, does not account for their higher rates of low birth weight, which occurs at all haemoglobin concentrations.

The issue of haemoglobins is one that infuriates me. There is a lot of evidence out there that a haemoglobin of 9.5 - 10.0 is actually a sign of a well working placenta and not actual anaemia. However, iron pills are still given out in abundance. Unless a woman is symptomatic of anaemia, ie. tired, breathless, fast pulse - there is no need for iron tablets. The risk however, is that a large blood loss can result in profound anaemia which may require blood transfusion. It is probably sensible for a woman with a haemoglobin of less than 10 to have a managed third stage rather than dissuaded from homebirth.

As far as homebirth is concerned, a woman has the right to give birth at home whatever her haemoglobin is. However, if she has a large blood loss, her haemoglobin will drop which may result in profound anaemia. She needs to be informed of this fact, but at the end of the day, the choice is hers.

Thrush is neither here nor there IMO

thanks for the info pupuce. fascinating. is it the case that a big baby leeches the iron out of you more, so that if you had low iron and took supplements to put it up this would not affect the baby's weight, or would taking iron supps make it more likely you would have a low weight baby?

BTW I was symptomatic with HB of 10.2 at 30 weeks - tired, some dizziness etc and iron tabs did help me. Tho of course everyone is different.

Levanna - I had low Hb in both my pg's, as low as 9.4 in second and was told the same as you. Wish I had known about that study pupuce mentioned but at the time I followed my own instincts.........I felt pretty healthy and had two wonderful homebirths.

If you are worried there is a natural source of iron you can use to supplement as well as diet, it is called "spa iron" and comes in orange box, I get mine in boots, it does not have the same side effects as the man made stuff.

There does seem to be lots of evidence to point to the fact that slightly low Hb means a placenta doing its job though, and I think pupuce is right, you should call aims, actually there is an interesting article on Iron and homebirth on their website.

Take it easy levanna and have a lovely home birth !!

Thanks pupuce for the address of the aims website, it has an interesting page on this, and also a link to a page from the UK Midwifery archives about 'anaemia' in pregnancy aswell.
It has all made very reassuring reading, and I feel much better placed to stand my ground if need be!
Thanks for the other replies too, I'm not quite sure what is going on, as when I first spoke with my local community midwives about a homebirth I met nothing but enthusiasm, but I now feel that it may be in jeapordy, as one 'problem' abates, another is invented!

ooh, Levanna, how well timed is your post

Despite a normal Hb (had another test last week), my OB (yes, a docotor!) has put me under pressure to start taking iron supplements - I've never understood why, when I'm feeling tip-top.

I've got an appt this week so now I have ammunition - thank you!

I've just returned from the OB and my Hb is 11.3, with an MCV of 85 - seems normal, right? (29wks)

She's got me under real pressure to take iron and I refused, saying I'm not anaemic as the MCV is fine. I also said that iron supplementation in the past has caused horrible, painful constipation and I'm not going through that. Her reply was that I can have 'stool' softners. I said surely I can avoid constipation in the first place by not taking unecessary iron

She then played her trump card by saying as I'm having a section I'll lose 2 pints of blood and if my Hb is only 10 then I'll be badly anaemic. Shite, methinks. Anyway, I agreed (with no intention of doing this) of taking iron every 2 days.

AND THEN, she said I just scraped through the GTT at 6.8(it's routine in Canada, they don't wait for you to spill glucose, which I've never been doing). The way they do it here you only have to starve for 3 hours and there's always a risk you get a false positive. Anyway, she then said I need to cut back on cake - bitch, I've been avoiding junk except for 1 Tunnocks wafer a day

I've never in my whole life felt soooo bloody inadequate. Jeez, it's like I'm a bad person already and I've not given birth.

I was told if U lose 2 pints (I did) that they expect the Hb 2 fall by 2 points, so that would be from 11.3 to 9.3 for U. Is that really a typical C-Sect. blood loss? When I lost a bit over 2 pints (vag. birth) my Hb went to 10.2... doc said it was obviously an error, but even allowing for margin of error, still high enuf they sent me home with only iron supplements.

Not sure about GTT, but U must know that there's a lot of controversy about the validity of gestational diabetes as a pregnancy "disease", anyway.

From what I cam remember I had an Hb of about 9.4 at 36 weeks but it was not considered to be a problem at the time and I was not told I had to have extra iron. The mid-wife did mention though that a low iron count might be a problem if I wanted an epidural (not sure why) but I didn't have one of those in the end either! Having given birth and nobody mentioning high blood loss, I did almost collapse when I tried to get up off the bed - iron was hurridly measured and was down to 8.4. I was given iron and it was measured again the next day - down to 7.2!! Was feeling pretty badf at this point and was recomended a blood tranfusion - but again not forced - it was my choice. However the thought of spending my first few weeks coping with a new baby and being anaemic (one of the midwifes also pointed out that it might affect my milk production) decided to to go with the blood transfusion - 2 units. In hindsight I'm glad I did. I wonder sometimes whether the fact that I had low hb at 36 weeks should have ben taken more seriously - and if I had od had iron earlier, it may have prevented the transfusion. However, it all worked out well in the end.

My friend is having the same argument with her health professionals.

Ideally, she would like a homebirth, if not at the local Midwife-Led unit. Her GP and local midwives have all stated that this not an option because of her border-line Hb (she's due in October).

I don't understand why they've changed their rules as I was anaemic with all 3 of mine - 1st and 3rd were born in the local unit without problems or mention of my low Hb.

I'm becoming very "militant" on her behalf about this and have been printing off stuff to give her "ammunition" for her next appointment.

Interestingly Levanna this situation has occurred in my own area. A woman has been classified as unsuitable for a homebirth because her HB is under 10, however, the midwives are now on call for her home birth. What that means is that she has been advised that a HB of less than 10 is unsuitable for homebirth but they will still attend her at home because she has made an informed choice. You have every right to make your own choice on the basis of unbiased information you receive from your midwife. You cannot be refused care.

Highlander - your HB sounds pretty fine to me. Our unit only recommends iron supplementation when Hb is less than 10, and as earlier posts have highlighted, even that is not evidence based! Spatone is fab by the way if you do want to try a supplement ( not essential though).

Slinky, I'm surprised your friend is already experiencing problems regarding her Hb when she isn't due for so long, particularly when I've recently read that it only takes between one and three weeks to raise Hb if it really is in need of raising! Then again, as I mentioned earlier, I'm starting to get the feeling that at least in my case 'problems' are being bandied about just in case for some reason a homebirth isn't viable for the local healthcare pro's, rather than anything to do with myself and my baby, so maybe not so surprised after all .

Having re-read that, I sound quite cynical! Sorry.

Don't worry Levanna

Round here, it's quite normal for them to fly into a panic at the hint of something out of the ordinary !

On discovering a low lying placenta with DS1 at 20 weeks, my midwife went into panic mode, talking about C-Sections etc etc - even though I pointed out that I read most placentas would move out of the way before 40 weeks

Unfortunately it seems that some mws will use any excuse to try to scare you out of a home birth (and often it's not their fault, it's to do with the rigid guidelines they are expected to follow).

If you want to increase iron in your diet I would suggest natural sources of iron in your diet (like dried apricots, dark green leafy veg, red meat etc.) taken along with sources of vit c to help you absorb the iron - OR a supplement from a natural source. as many people have pointed out, there are many probs with the standard iron supplements, basically because the iron isn't in a good form for you to absorb it. Sorry if you know all this already - have just re-read your first msg.

Regarding the thrush, the main risk is that the baby catches it as it passes through your vagina, then you and he/she keep giving it back to each other when breastfeeding. Your nipples and his/her mouth are ideal environments for thrush to thrive. Thrush in the nipples is horrible, plus you don't want your poor baby to have thrush in their mouth and/or bum.

Again, you might already know about the dietary measures to take - cutting out or cutting down on yeast and sugar (including fruit) and taking probiotics to change the balance of your gut flora (especially if all those antibiotics have wiped out the 'good' bacteria in your gut). I've personally found these two things really make a difference. If it's still around close to your due date you could also use a pessary to try to clear it out altogether.

hth

Sam

Levanna, my Hb was 10.3 at 28 weeks. Am worried as want a homebirth.

Midwife gave me some iron tablets but don't really want to take them unless essential.

Do any of you wonderful posters think I can raise them by diet in time for my 36-week bloods? I am 32.5 weeks at the moment (I don't eat meat, btw).

Levanna, I've had thrush this whole preg too. They are testing me for GBS now. Anyone any knowledge of this?

Sorry for sneaking these questions in on your thread, Levanna

just read the top message about gbs.i am a gbs carrier and when I was tested when pg with ds2 I had been feeling a bit thrushy.don't know if its connected. In my experience a home birth is out if you test positive for gbs as you will have to have anti-biotics in labour.
I have been + in both my pgs and both my boys were completely unaffected and healthy, so don't worry if you get a + result.But do have anti-biotics, its not worth the risk not to.Its a weird thing gbs , you carry it around without knowing and it doesn't do any harm,its only when giving birth that there is any prob.when you are in labour,btw,DON'T let them break your waters.The longer babs in that sac the better.
Sorry this is really garbled, but hope it is of some help.