Would it be irresponsible to refuse an iron test (I think it probably is)

[Sufi]

I am 35ks. I am booked for a HB & am low-risk and under community MW care. I may well go into hospital to the MLU unit on the day if they have room for me - it's lovely and staffed by the community midwives.

However, last wk it turned out they'd forgotten to check my iron levels when they took bloods at 28wks. I have been feeling exhausted & this is why it came up. Have been self-treating for anaemia and taking pregnacare, Spatone, eating better & cut out tea & coffee. Feeling better so think I probably was anaemic.

They want to check my blood next wk. If iron levels below 10, they will refuse me a HB AND not allow me to use the MLU. This means I have to go into a really nasty, horrible hospital with MWs I don't know & who have a reputation as being dreadful. The hospital also has several legal cases pending due to its shocking post-natal care.

Now, if something went wrong & baby came early (as happened with my 1st DC) I would go into hospital, no quibbles. BUT if all goes well but my iron levels are low, I really don't want to miss out on community MW-led care.

I've researched it and low iron levels do not mean higher risk of PPH. I am happy to be in hospital at the MLU in case of PPH but it's unlikely given that I have no history of it and am probably not that low on iron anymore.

So do I just refuse the iron test next week? If I'm borderline it's 'policy' to refuse me - and I don't think I can cope (emotionally) with that. Or is that completely irresponsible and I should just suck it up, as there's no such thing as the ideal birth?

Thing is, I was content to go with the flow until last week, when a) I read a terrible post about this particular hospital and b) I thought they'd bloody well checked my iron when they were supposed to & it seems so arbitrary to refuse me access to the MLU that's literally on the same corridor as the main maternity ward.

Sorry, long & rambling post. Not really coping with this very well.

Hi Sufi, not a rambling post, I understand your concerns. I think you are better off having the test for a number of reasons - best to know for sure rather than worry about the outcome, if iron levels are still low (and 10 is pretty low i think) despite all the extra things you are doing, then there is something that needs attention and it may be that the sooner you sort it, the sooner it can go up and you might get your HB or MLB after all. If you are borderline then you should talk to the MW's you know and explain all of your concerns and ask them if the policy can be flexible on this occasion. Of course the best outcome is that all the work you are doing means the results come back and you iron counts are up!

I was told yesterday i'm dangerously anaemic and that this means risks of premature birth (sorry not sure what PPH stands for if its the same thing!), low birth weight for the LO and me needed blood transfusions. I'm loathe to get more medical intervention than i need for other reasons, but i am telling myself that it is not just me that i am potentially putting at risk here and I'm sure not for the first time(!), i have to start putting someone elses needs before my own.

I know this must be upsetting, esp if you had a strong idea in your head of how things would work out but remember you are still in control of this and can work with the MWs to identify any issues and help resolve them.

One final comment - one negative post doesn't mean the whole ward is a bad thing - i am sure each and every ward, including the MLU could name ladies who have good and bad things to say about each.

xxx

I think as you have been looking after yourself, there is a chance that you won't be too anaemic. But for peace of mind and to limit risks to baby, have the test done and rule it out.

Oompa made some v good points.

PPH is post partum haemorrage I think.

If I was you I would keep up your Spatone with orange juice, bear in mind that no one can refuse you a HB, if you refuse to go to hospital they must send someone out to you, and I would have the iron test because I like to know numbers.

A random thought - I don't know if it's possible just to get an iron test done privately somewhere so you can vet the results before you allow your MW to do it? Or is that nuts?!

Good luck though. If you are feeling well I don't expect you have too much to worry about.

sh77 makes a good point - if you have been treating yourself for an iron deficiency through diet etc then you are likely to have improved your levels.

Mine was 10.6 which was borderline and I was prescribed tablets after the 28 week test. I took them up to 38 weeks (last week) after replenishing my supply via subscription but when I asked the midwife last week whether I should continue as I had run out again she said there's probably no need, they wouldn't bother testing me again for iron as my result was only borderline anyway and the tablets were just to be on the safe side.

I was about to suggest the same as spilttheteaagain - could you have the test separately? My health authority runs a blood drop in where you just give them a form saying what the test is for (you get these at your GP reception), then they send the results back to your GP surgery and you phone up for the results. You don't need to speak to the GP, the receptionist tells you. I don't think the result is passed on to the GP/midwife unless specifically requested, ie, directed by the doctor or midwife themselves prior to the test.

I would personally have the test at the midwife's request. Chances are you're run down and tired due to pregnancy itself anyway at this stage, it probably has nothing to do with your iron levels if you have been taking care of yourself. I hope it all turns out ok for you!

Thanks everyone, I know you are right and thanks for the sensible advice. It's just such bad timing - if I'd known at 28wks then I'd not have a problem now, but as it is I've been given 2 wks to get my iron levels up.

I don't want to put baby at risk, or myself (PPH is post partum heamorrage). I'm just fretting about the ward after reading such a terrible post about it. And the thought of being denied access to the lovely community midwives, literally just across the corridor in the MLU, is frustrating to say the least.

I'll get tested and then see what the results are. You're right. Argh, I just wish I didn't have to think about all this.

Will look into private testing as well, as MWs will only test next wk, when I'm 36wks, but if I go term I may well have higher levels by then.

Oompa sorry to hear you've got to have a transfusion. If it's any consolation, my mum had one after major surgery last year (she was given option of transfusion or another week on the ward) & she felt better within hours of it.

If you have been taking iron and spatone etc then your iron levels should be fine, and so its probably worth taking the test.

Low iron levels also wont necessarily cause a PPH but if you have one the clinical effects will be much greater with a low hb (haemoglobin), thats why the midwives want a decent starting hb, just in case of a bleed. 10 is just a number that is used as a general rule by most hospitals in deciding what is considered too low to be within the normal range, so it is a bit of a magic number.

Dont know if its an option at the hospital you are booked at, but in the hospital where I work as a midwife, we sometimes use a product called 'venofer' which is an IV iron supplement which will rapidly increase your haemoglobin levels. Its usually given as a course of 3-5 IV infusions, each 2 days apart and is very effective. Obviously it has side effects and so shouldnt be used without due consideration but in your case where it would make the difference between a home birth and a hospital birth, I would say you have a good case for using this medication.

Good luck whatever you decide.

Thanks mintpurple I'll take the test and mention that to the MWs. I know I'm not being enirely rational but am scared!