Homebirth and low iron levels.

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Background: I am 27, 3 DCs, 37 weeks pg. Healthy(ish) pg, spd and chronic thrush though 2 previous easy uncomp homebirths.

So, last week I had a letter from the drs saying that they needed to 'discuss' the results of my last blood test. I knew that it would state that my iron is too low!

I ring, and after much cajoling get them to tell me what it is. 8.6, lower than I thought, but considering my diet is crap and I've not been taking any iron, only to be expected. I promised faithfully to take my iron supplement, sytrol, and to get my levels up!

My midwife has just rang up and basically said that if it doesn't go up to 10.5 then I am not 'allowed' (grr) a hb! I, politely, tell her that according to all the information I have looked at, that there is no reason why I should be in hospital. She said I am at more risk of pph. I argued back that there doesn't seem to be any evidence supporting this, just that if I do lose lots of blood, then I will be less able to cope with it IYSWIM?

Also, I asked what would happen if I were to go into labour now. She said I would have to go into hospital and have a blood test and if it were still too low then I would have to stay in hospital and have a canula etc..! Not bloody likely. I did 'joke' that they would have to catch me first!

She is a fab MW, really good on all matters, but what do I do? (aside from the obvious of upping my iron, which I am doing) I don't want to fall out with her, but do know my rights on hb. She did say at the end that of course we can't force you to come in, but that I would have to speak to a supervisor and discuss options, whatever that means?

Any ideas/help welcome, please

Thanks if you got to the end!!

Did they give you any of the other blood work values? You might find this and this useful as background reading if you haven't seen them before.

I know there are a lot of women on the homebirthUK mailgroup who have dealt with this and similar issues - some have found a letter is a good way forward at this point, as many HCPs are far less prepared to put in writing what they'd say either over the phone or to your face. AIMS can also be a very good resource.

Is sytrol a tablet? Some women find either SpaTone or Floradix (both natural liquids rich in iron) do a much more effective job of boosting iron levels without nearly as many side effects.

Fingers crossed you get things sorted without them getting too fraught

Just wanted to add another vote for SpaTone. You can buy it in health food shops like Holland and Barret, and Boots. It is a clear liquid iron supplement that you take with orange juice to boost absorption, and is great if you need extra iron. You can have 2 sachets a day if pregnant.
And I hope you get your home birth

take the spatone / floradix stuff and contact supervisor of midwives for further advice. All the best

Oh, thanks. Sorry I didn't come back to this, had a hectic day!!

Tangle, sorry I got it wrong, it's Sytron, which is liquid iron. I had a hard time with spatone, as I couldn't eat certain things while taking it iirc? I was (and still am) struggling to eat enough anyway!

Never heard of Floradix, will give it a try.

Funnily enough, I have read homebirthuk site before, it's great, but have never seen that page before, thank you.

They only gave me the 8.6, no other values. Have no idea what my MCV is, so I will find out.

I think I will just ring the supervisor anyway, rather than wait for her to ring me, and explain that I am doing all I can to bring my iron up, and I will be safer at home etc.. and see what she says. MW says I may have to compromise on my physiological 3rd stage, ie have the Syntometrine. Not sure about that either, but will wait and see.

Thanks all.

Haven't come across Sytron before - sounds a lot better than ferrous sulphate tablets .

Can you clarify what you meant re. spatone - I've never come across people being told there were foods they should avoid while taking it (which is how I read it the first time), but then realised you could mean that you personally found problems with foods while taking it.

I'd be taking issue with the MW telling you what you "have" to do, but then I've become more beligerent recently! At the end of the day, though, they can make a recommendation but they can't force you to follow it. If the supervisor starts taking the same tone, can you ask her what research she's using to justify that recommendation? I'd be interested to know, and its a question that often causes rapid back pedalling

Good luck

Hi Strech
Don't want to tread on anyones toes here but i've been lurking and read your thread and thought I should post some important info.
If it is your Hb (Haemoglobin) level that is 8.6 then that is quite low.
to get a decent increase then you need to be taking therapeutic levels of elemental iron. Unfortunately the reason spatone has few side effects and is therefore so popular is becuase there is actually very little elemental iron in each sachet so it wont bring up your level by any decent amount. Sytron is excellent as it is a different type of iron to ferrous sulphate but does contain therapeutic levels of elemental iron. therefore it is non constipating but will still do the trick. my advice would be to stick with it for the next couple of weeks and take it with orange juice which helps the iron get absorbed. hopefully homebirth will go ahead fine. hope this helps.

That's interesting mumofthreetobe - do you have any information on how absorbable iron is in its different forms? When spatone was suggested to me after a PPH with DD, I was given to understand that whilst the absolute levels of iron might be lower than in other forms such as ferrous sulphate tablets, it was in a much more accesible form and therefore still provided a good mechanism to get Hb levels back up. I'd be interested to know (as would my MW) if that is incorrect. Thanks

Hi Tangle
Basically it's a case of looking at the amount of elemental iron in each sachet/or tablet of ferrous sulphate or 5ml of Sytron liquid. It gets a bit mathematical but the amount of elemental iron in one 200mg Ferrous sulphate tablet is 60mg and the dose for anaemia is one tablet of 200mg three times a day. This is a total of 180mg of elemental iron. If you look at spatones website there is a table which compares them. yes it (spatone) has higher bioavailability but because of the amount of absorbable iron in each sachet you would still need to take NINE sachets each day to get the same amount of absorbable iron as from Three tablets of Ferrous sulphate.
Sytron has 27.5mg elemental iron in 5ml and the standard dose for anaemia is 10ml three times a day, therefore you get 165mg of iron which again would equate to 8 or 9 sachets. If the recommended dose of spatone is just 2 sachets each day then this wouldn't be enough to increase Hb on its own. Hope that makes sense.

I didn't realise that mumofthreetobe.

Tangle, when I read the instructions for spatone, It said I couldn't eat/drink dairy for 2 hours either side, to aid absorbtion. At the time (with ds and now as well) I have to eat every 2 hours or so, little and often. I am mainly only eating cereal and cheese on toast so would be difficult to avoid dairy!

Thank you both. The Sytron is very good, it brought my levels up quite quickly with ds, but I still had 5 weeks to go and my hg was not as low as it is now, hence the worry. Tastes ok too.

Good for you to not be bullied!

I took Floradix after I had my baby. It seems very effective and is supposedly very well absorbed by the body. Good luck with your homebirth!

Thanks for that mumofthreetobe. I see where you're coming from (and I found the table, which does actually make sense). The bit I think they need to do more research on is their footnote one, which states "iron bioavailability decreases considerably when the amount taken increases above 100mg" - so whilst your Dr may prescribe you 1 x 200mg of ferrous sulphate 3 x per day, can you actually absorb any more iron than if you were taking one tablet a day, or smaller tablets? But I suspect we're now getting into a discussion that isn't really helpful to SFTMD

SFTMD - in the process of looking for that table, I found a page on spatone's website giving advice on how to maximise iron absorbtion, and they do advise avoiding dairy for an hour either side of taking it. Digging around about further, though, this isn't something specific to spatone - there seem to be a few studies that have found that a diet very rich in calcium can result in iron defiency and I'm guessing this is why spatone put the advice they do on their packaging. That said, it doesn't seem to be clear cut as there is conflicting research (ie that a calcium rich diet doesn't cause a problem). Some of what I found got very heavy but this page seemed quite accessible and well referenced - I was suprised to find that grains can be an iron inhibitor (they're rich in phytic acid, whatever that may be, which can apparently reduce iron absorption by upto 80%), but the effect can be lowered/negated by adding vitamin c.

At the end of the day you have to find the best compromise that you can, just be aware of the (possible) issues. Try and time your iron supplements as far away from known and suspected iron inhibitors as you can. If you don't get ill effects from the Sytron and its worked in the past then I certainly wouldn't change away from it, but you might want to ask whether there are any risks or benefits to taking spatone and/or floradix in addition.

Good luck

I also had a liquid iron supplement from the Dr. Have you read the info leaflet? Mine also advised avoiding similar foods to Spatone. So to optimise the iron you're getting from Sytron, you may have to avoid tea etc when you take it.

The spatone website used to say you can take 3 sachets a day during the third trimester which is what I did. Sorry can't find this page at the moment.

Just out of interest, how do you feel? Your iron is quite low, are you experiencing any symptoms? I was never sure if I was short of breath from carrying an enormous baby around or as a result of low iron levels.

Good Luck.

Hi, just thought that I'd come back to this instead of starting it again. I am now due in 9 days.
Well, I have been taking my iron, had another blood test and it's not come up really, 8.8, was 8.6.

I've got an appointment with the Haemotology dep on wed, I think they'll offer me a drip or something, and I HAVE to go into hospital if I go into labour before then

What are my options now? I REALLY don't want to go into hospital for birth, LRI is shit. I have no idea why my body is not asborbing iron either. Apparently, my ferritin levels are 3 (should be between 10 and 400??) and my MCV is 70 (should be higher) so it's not just my hb.

What are the dangers of having a homebirth with low levels of hb? Am I anaemic?

Sorry, but sat here crying now as it all seems to be going wrong now. DD2s first morning at school is wednesday and I will miss it

Sorry you're so worried. You know you still can insist on the HB, I planned 2 homebirths, one after a CS, so I've looked at these things too, and you do sound very clued up.

However, with my nurse's hat on, if it was me I would be a bit concerned about the blood results and think investigation with the haematologist is a fab idea. Perhaps you have a medical problem, rather than just dilution etc? At this level, you are anaemic, they may offer a drip or injection to get your iron levels up, or do a few tests as your blood tests are a bit off.

How are you feeling in yourself? Well or knackered and breathless? Hard to tell when you are very very pregnant though