told I can't have a homebirth while anemic, or while having a haemaglobin level under 12, is this true??

[himynameisfred]

surely if I bleed lots I can go to hospital for a transfusion afterwards.

I've had 3 perfectly normal deliveries with no complications.

Anyone have any knowledge on this rule?

Well, i am surprised, i was told yesterday my count was very good at 11.4 and all is ready for my home birth now. I thought the cutoff was lower, about 10, but i could easily be wrong. Have you checked out the home birth website?

I thought the cut off point was 10 as well. But I do understand why they want you to have a good hb - I bled a lot after my third birth (home birth)- and my hb went down from 13.5 to 8. If it had been any lower to begin with, this would have been a lot more serious.

Seems a bit extreme, i'm planning a homebirth for DC, have had 3 previous vaginal births.

At 28 weeks my hb was 10.3 so am taking double dose of spatone but midwives still happy with me having baby at home.

TBH I would question this with supervisor of midwives.

Good luck

Mine was 10 when my bloods were done at 28 weeks, and I was told it would have to rise if I wanted a home birth so was prescribed iron tablets which I couldn't take, so been taking spatone which wasn't improving so got Floradix.

How many weeks are you? I went to see my midwife for my 32 week check and was told I would be tested again at 35 weeks so I would still have time to get levels up if still below recommended levels.

Personally, having also had three straightforward deliveries the last being a home water birth, I still would not want to put myself at risk.

What is your HB level? I am feeling tons better so I am hoping that's a sign they have increased.

Effectively, no, you can't be told you CANNOT have a homebirth. The decision is yours.

There is information here under the 'But what if...' section and whilst it may be the policy of your local NHS trust to advise you to go to hospital for a low Hb level, if you choose to have a homebirth then they should support you.

Write to the Supervisor of Midwives, state your intention and that you expect to be supported in your plans :)

I have refused most of the 'routine' blood tests in this pregnancy, and that includes my iron levels. If they didn't know your iron levels, what exactly would they be able to say to you?!

why would you do that, flisspaps? they're only trying to help. much better to take spatone or similar than to look for a fight! many mws are very supportive of homebirths, they just want to make sure it's going to be safe for both.
I was in this position and spatone got my levels up enough to be able to have homebirth.

I'm sure I read somewhere that your levels drop in late pregnancy anyway and that's normal?? Mine was 10. Something at the 28 week bloods and I had a homebirth.

The midwife told me to take iron tablets but they don't agree with me so I did a bit of research got comfy and didn't take them and she never even checked my levels again..

I'll get screamed at as "irresponsible" for suggesting this, but this is part of why I refused blood tests in later pregnancies, beyond the fact that the blood tests made me feel quite dreadful. I also didn't want them to faff about questioning my HB levels. I felt confident by then that I would know in myself If I was anemic, a little or a lot, and I knew by then what worked for me, too, wrt keeping my iron levels up.

GreatEXPATations Because the tests are not compulsory and as having a low Hb level won't make any difference to my plans it's useless for me to know. I already take an iron supplement (as I say in my other post). Why would I want to have a test unless I was going to do something with the information?

I'm not looking for a fight, and the MWs have been accepting of the fact that I decline the tests when they offer although one or two have been a bit when looking through my notes and have assumed that test results have been lost or forgotten until I explained. It's also something I've chatted to the Supervisor of Midwives about, and she didn't raise any concerns with me. In fact, the two that I've spoken to in this pregnancy have been very supportive of my plans and one told me that ultimately, attending a homebirth is the pinnacle of what she does. :)

Much along the same lines as ragged really.

I was dog tired and breathless, my eyebrows and eyelashes thinned and it still didn't occur to me that I was anemic! I just put it down to being busy with three other children etc!

Having never been anemic before, I was very grateful for the blood tests at 28 weeks as I now feel tons better, and would have just ploughed on putting it down to normal third tri joys!

I would be very reluctant to give up on my home birth, but will always be guided by advice,I know where I would prefer to be if I haemorrhaged.

It's likely to be true yes as where I live anyway anaemia takes you out of the 'low risk' criteria. Where I live I was told if I had anaemia I wouldn't even be able to use the mw lead birthing centre!

I also refused blood tests with DS2 - had both DSs at home and was a touch anaemic with both.
Take floradix daily and eat plenty of iron rich food and you should be able to boost your iron level.

Although, some very interesting reading here on midwife.org,

www.midwifery.org.uk/index.php?option=com_content&view=article&id=233:anaemia-in-pregnancy&catid=91:hidden-archives&Itemid=110

It is interesting about not being able to a home birth with a low Hb. I intend to go to hospital for no2 so not really a problem. But I have to say for DS1 I went into hospital with a Hb of 13.2 I was there for 4 weeks in all due to issues with Pre-eclampsia and came out with a Hb of 7 just goes to show hospital food is not good for you! Not once all the time I was in hospital was my hb checked my own docs checked it when I got home due to my extreme fatigue that they said could not just have been the new baby.

thank you, some very interesting reading indeed.

My hb is 9.3, up from 8.9, I've been like this for two years, and take spatone (just managed to get it on prescription, saves a lot of money!)

I thought 12 was a bit high! As I'm sure I was only at 11 with my homebirth last time (in a different region).

I'm not sure what the worst that could happen is. I could faint and be very pale if for the first time ever I bled extensively at the birth (I really havent bled much in the past).
If I pass out and am taken in by ambulance after the birth, even this is more preferable to me than a hospital birth.

Maybe I'm missing something?

I'll meet my new midwife soon (moved area) and I wonder if I should just tell her I plan to have a homebirth, rather than say 'well I'm hoping for if I'm allowed..'

I'm 24 weeks pregnant by the way.

Gave birth last time before the midwives even got to my house, and it was the best birth ever.

himynameisfred - bleeding after birth is very serious, I should know.

Do you really want to know what the worst thing is that can happen?

My hb dropped from 13.5 to 8. This was serious, but the midwives handled it very well, giving me drugs to stop the bleeding immediately (it all happened within seconds - gushes of blood - you can lose a lot of blood very fast). It was still a drop of 5.5, and it took me weeks, a lots of iron tablets, to get better.

If I had started off with a hb of 9, and lost that amount of blood, my hb would have been 3.5, a life threatening situation. Probably too life threatening to reach the hospital on time.

This is why maternal death rates are so high in many developing countries - anaemic woman giving birth bleeding causing death. This is very rare in developed countries such as ours because fewer women are anaemic, and when they are, it gets picked up on, and something is down about it.

Fainting and being pale isnt the worst that could happen, the worst that could happen is that you could die, exceedingly quickly before you get to hospital. Neither the community midwives or paramedics have the drugs that are used in hospital or blood to transfuse you with. Obviously that's worst case scenario and I do think saying you need a hb of 12 is a very high cut off. It's 10.5 where I am. But it's 10.5 for a reason. The lower your hb the more likely you are to bleed.

There are things that the midwife or paramedic can do before you get to hospital, they could cannulate you and put fluids up but it's ot as effective as drugs and blood if you have a massive pph.

But if iron levels are low due to a larger volume of blood, you can afford to lose more blood before you are ill (you don't need as much blood post birth as you do pre-birth). Much of the larger blood volume is fluid which you sweat/wee out after the birth anyway. So in a way you can lose a certain volume of blood but it isn't the same concentration of blood as in a non-pg person.

As an analogy - if you dilute 50ml of squash cordial with 200ml of water or with 500ml of water you still have 50ml of squash cordial in each glass regardless of what you diluted it with, if you spill 10mls of the 550ml glass you haven't lost as much squash cordial as if you spill 10mls of the 250ml glass (1ml vs 2.5mls). So spilling the more concentrated squash will result in less being in the glass overall even though the same amount was spilled, if the extra water in the 550ml glass is removed you will still have more cordial left (49mls vs 47.5ml).

If that made any sense. (Squash cordial in this analogy being the red blood cells).

Also, size of the mother has to be taken into account - if you are a tiny 5' and weigh 7st pre-pg and have only gone up to 9st at full term you probably can't afford to lose as much blood as a 5' 10" 14st pre-pg/17st pg woman. The larger the frame (skeleton) of the person the easier it will be to recover due to the larger bone mass being able to make blood faster than a small framed person.

Tell her you are planning one if that is what you want to do (don't ask, you don't seek permission as its no-one's place to give it), write to the Supervisor and ask for a copy of their guidance on Management of a PPH in a non-obstetric setting. Then you can see what they can do at home should you bleed excessively. Easier and safer to plan a HB and get a management plan in place with all of the community midwives aware of your circumstances than to announce you'll stay at home once you're actually in labour when you're higher risk.

Viva - Have you got a citation for the statement ' The lower your hb the more likely you are to bleed. '?

The link posted earlier stated that low HB wasn't part of the mechanism of post-partum hemorrhage -' The mechanisms of PPH are uterine atony, lacerations, and retained products. None of these should be affected by anaemia, though I guess a general aplasia of marrow could lead to thrombocytopenia as well as anaemia. '

I don't really think it works like that at all.

For every litre of blood you lose at delivery you can expect your iron to drop a whole point. This is regardless of what volume of blood you may or may not have in your system. Your hb should be a certain level whatever your blood volume is. Saying you have more blood because your bigger does not mean your iron level will be lower at all.

So if your iron level was 9 and you lost 2 litres you'd expect your iron level to then be 7. The lower your iron level gets the more chance you have of going into DIC as well where the blood fails to clot and you continue bleeding.

At 24 weeks you have a while to get your levels up. The super iron girder tablets are better for that than spatone IME.

Personally, I wouldn't have a HB with low levels. My first 2 dcs were born at home and I am due with dc3 whenever he decides to arrive. I have struggled with anaemia this pregnancy and during the time before I became pregnant. I was taking Spatone but it wasn't enough. Before I got pregnant I took the prescription tablets (those ones where each tablet is over 400% of your RDA and they make you take 3 a day) and got my levels up. During pregnancy I stopped those but took 2 sachets of Spatone a day yet they dropped right back down again so I am back on the tablets and have been told to stay on them until the end of the pregnancy even though the latest bloods showed a rise again. I've not had loads of extra blood tests, just a couple to check my levels which seems perfectly sensible to me.

I love HB and I am very, very glad that my levels are OK at the moment an I can go ahead with it but I also place trust in the MW team and would not hesitate to follow their advice.

Rcog pph guidelines state that there is evidence to show that iron deficiency can increase the risk of a pph due to depleted uterine myoglobin levels.

Last time I was in hospital with fainting, when Hh Levels were at their lowest the doctors told me that it was very unlikely they'd have the blood I needed on site, they'd need time to prepare to have it ordered in.
So they'd probably put fluids in me to keep my blood pressure up while they organised the bloods, even if I was in hospital- that would take time.
So I questioned whether being 10 minutes away from the hospital would make much difference.