What do you think the hospital will do? Anaemia and C Section

[flowertea]

Apologies if this is a bit rambling, I’m getting anxious as the time approaches.

I’m 38 and 38+2 weeks pregnant, 2 previous C Sections.

I’m booked for C Section on Friday 24th at 39+0. Pre op should be on Thursday.
However last week after a growth scan I was told go to day care because even though growth scan was fine, they’ve realised I’m still anaemic from 37 week bloods being Haemoglobin level 8.6. (have been taking iron since 28 weeks but only managed to keep it 8.6 cause can only tolerate the iron every couple of days and I’ve tried everything! but it hurts my stomach and causes bad constipation even liquid and even with laxatives)

They’ve booked me for an iron infusion on Wed 22nd but said it won’t make any difference to the surgery cause won’t have enough time to get levels up, it’s for me postnatal. They said it’s up to the Anaesthetist if they’ll go ahead with the C Section with HB at 8.6. 😵‍💫

There are two separate issues - I don’t want the infusion, had one with my daughter and it made me so ill, and since it won’t make a difference to the surgery anyway, but if I don’t agree will they postpone C Section?

Also what do they mean by up to the Anaesthetist? I mean what will they do, postpone it and if so to do what?

I really don’t want the date postponed I’ve had some episodes of frantic movements which from my previous pregnancies don’t feel normal, and really anxious just want baby out.

If anyone has any advice I’d be grateful. Going to try get through to someone tomorrow to discuss but doubt I’ll get to speak to anyone who’d know until Thursday xxx

Take the infusion. It's the lesser of the two evils. Not all medicine makes you feel good at the time.

If youre already anaemic they wont operate unless they have taken pre-op measures to improve your levels.
The iron infusions won't have an immediate effect but will help longer term so personally I would take it if offered and follow their guidance.
You dont want major abdominal surgery when youre anaemic as this will make your recovery prolonged.

@JungleRun21 How can they not operate though? The baby has to come out in week 39 regardless, and they strongly advised against VBAC due to 2 previous sections. They could postpone it? that's what I'm worried about, the uncertainty is making me anxious. I don't even have a confirmed time for the pre op yet.

I understand that it is bad to be anaemic before surgery, but I don't think they are taking into account the full picture as to why I am very wary of the infusion. The last time I had a (non life threatening) reaction in my arm, I felt absolutely awful for days after, and got a flare up of an infection I hadn't had for years, which I don't think is coincidence since iron increases infection. I'd rather feel exhausted than that.

I would definitely have the infusion. Discuss the reactions and ask if you can have a different preparation but don't not have it.

Anaemia can cause problems with now and in the future, and it can impact the baby's long term health. I would ask for the infusions sooner if possible. I would also ask to be booked in for a second infusion post delivery and ensure your bloods are taken and any anaemia corrected going forward.

Your hb and ferritin will increase pretty quickly.

@FlamingoBiscuits I can't get the infusion any sooner, they only picked up that I was still 8.6 for haemoglobin last week, and my C Section date is Friday. I'm supposed to be getting the infusion on Wednesday!

Do you really understand how bad it is to have a c section when anaemic? It’s not just “bad”, it’s far worse than a reaction in your arm, it can be life threatening.

Increased risk of large blood loss, increased risk of cardiac strain leading to cardiovascular complications, poor oxygen delivery which can impact organ function- believe me, you’d rather not risk that.

Most likely I’d say is getting the transfusion done ASAP and pushing section date back slightly to give it time.

Have the infusion. It's going to be pants looking after a baby when you are anaemic and oral iron isn't working.

As you say the baby is definitely coming out so if the anaesthetist isn't happy, they will advise a blood transfusion as well.

However blood transfusions don't top up your iron so you still need the iron infusion.

I was booked for an elective section for my 2nd baby a few weeks ago. This was booked because I had a bad haemorrhage during my first birth and also because baby 2 had already been diagnosed with a heart condition.
I found out 2 weeks before the section date that I was very anaemic despite being on iron tablets.
I was advised if my levels didn't improve when doubling the dose of the tablets, I would need an infusion before surgery.

I asked if they would cancel the section and was advised they wouldn't, but would ensure the iron infusion was done a few days before to increase my levels ahead of the surgery.
I was advised that they wouldn't be keen to operate if I didnt have an infusion and because I was elective (despite the complications) they could push things back.
Being anaemic means you have fewer red blood cells circulating. If you then suffer a bleed, you will face emergency interventions which will prolonged your recovery and could have a longer hospital stay.
Either way I didnt get my section as baby came earlier then planned at home which was a bigger risk than being anaemic and having a section.

The Anaesthetist does get a say in whether the procedure goes ahead or not.
I have a long standing back issue which could cause difficulty with a spinal or epidural block. I had an Anaesthetist appointment to discuss it and was advised that it would be down to the duty Anaesthetist on the day as to whether they felt comfortable placing the needle in my back given my condition. It may then result in a push back on the op and someone more comfortable performing it instead when they were available.

At the end of the day, they are making a recommendation for your safety and to ensure guidelines for patient care are followed.
If you choose not to have an iron infusion thats your decision. But you need to ensure you are fully aware of any potential complications ahead of time. God forbid anything happened which could have been minimised with having pre-operative treatment.
I think you need to have a discussion with a consultant about it all first so you can make a plan now. Maybe try and give them or your midwife a call to explain your worries.

@Jellybunny56 Yes I understand all this. However it wasn’t just a reaction in my arm, it’s a flare up of a chronic UTI infection (one of the listed side effects is increased risk of infection) which has previously caused me years of awful pain, and also I felt ill for days after the infusion. It wasn’t so late on last time that I had the infusion.
I’m also really anxious to get this baby out asap. I’ve had some episodes of frantic movements and just really anxious about coming this far for something to happen. After the infusion whilst waiting days for the section I’ll be a nervous wreck that it’s caused some harm to the baby. I’m really not happy about pushing section date back.

@JungleRun21 Sorry for your recent experiences but congratulations on your baby 🙂, and thank you for letting me know what happened with you. I’m guessing I might have to get the infusion then, despite my real reservations. If they then still postpone the section anyway I’ll really not be happy.
How did you manage to speak to the anaesthetist or consultant please? My iron infusion was booked by a midwife but I think signed off by a consultant not my own. I have no number for my consultant I’ve only seen them once and no idea who the anaesthetist is or how I’d speak to them.

Did you read the actual risks I listed? You know, the ones that can be life threatening for both you and your baby? I’m sure your reaction was unpleasant last time, but you survived it.

My midwife arranged an appointment with an Anaesthetist at my booking appointment when I first saw her based on my history of my back problem.
In that appointment they just went over my history, googled my back problem, said it may cause an issue for a spinal but would depend on the Anaesthetist. Made a note on my file and that was it!

I couldn't contact my consultant easily but if you call and speak to your midwife office they should be able to provide you with contact details?
Failing that the best way I got hold of mine was just to call the main switchboard of the hospital and ask for the antenatal clinic and they can doverylt your call. Antenatal were super helpful when I called them.
I hope you can get it sorted soon.
I know how stressful it can all be!

@Jellybunny56 Yes I read it and I know the risks, I knew about them. I did not know it could be a risk to the baby because presumably they would be already out or nearly out after I'm cut open. If there would be a risk to the baby then I'll consider infusion. I'm really wary though because they've already said it won't make any difference to my HB levels during the C Section - it's literally days before it so not enough time to make any difference. So how could it make the C Section itself any safer?

It wasn't just unpleasant reaction, it was 2 years of chronic UTI pain it was the worst 2 years of my life and I'm not happy to repeat that, I'd honestly rather take the life threatening risks to me, risk to the baby would be different.

Delaying the c section would give it more time to work.

Again, 2 years of pain or… the end of your life? A no brainer.

@Jellybunny56 They can't delay the C Section by much more than a few days though. There's also the risk I'll go into labour myself and then end up with an emergency C Section anyway which is worse than an elective I think.

The iron infusion is the 22nd, and the C Section has to be done between 24th - 30th.

I've managed to leave a message for my named consultant to phone me back, so hopefully I'll be able to discuss it and get some clarity.