Could I even have a home birth? (Anemia and low weight gain)

[CrazyCatLady]

I've had three babies. Each time I was under midwife care until the very last minute. And each time I've been dropped at the end (with no back up to go to) thanks to anemia and poor weight gain (that's it, but the anemia is very very severe). Nothing fixes the anemia, I've tried it all. So I've only had residents deliver my babies. The only other health issue I have is Hep B and mental issues.

I'm pregnant now and debating what to do. I don't really want to bother with a midwife if I'm just going to risk out again anyways. My guess is that I will be very anemic and not gain a lot of weight this time either.

-The first and third birth, I used no pain meds/epidural.

-All three births have used pitocin (for no good reason, other than I'm impatient in hospitals and want to hurry it along).

-The second and third birth were induced for going way over. I went even more over on my first, but I guess I was feeling more patient then.

-I've always been ready/prepared to do a UC, it's just never happened.

-I've never had any complications during laboring, pushing, or afterwards (other than fainting and blood sugar crashes immediately after the birth, which I think is normal?)

-Have never bled out or anything like that. My placentas come out pretty quickly on their own.

-All babies were born healthy and at good weights.

What do you guys think? Is there a midwife out there who will see me (and not drop me at 39 weeks for still being anemic)?

[MsBlack]

"Hep B and mental issues" perhaps played a part in all of this, not just your anemia. Most mws have a limit to the number of 'stressors' or problem areas that they are comfortable with....the more stressors or the more severe they are in pregnancy, the greater the likelihood for complications. Still, most women will give birth normally--but homebirth mws tend to work only with those they have assessed to be 'low risk'. Perhaps with everything together, the anemia made each of them feel that you were no longer 'low risk' enough to be a safe gamble for assisting to birth at home.

[mwherbs]

I agree with Ms Black- most likely a combo of things

1)severe anemia
2) low weight gain
3) mental health and meds that go with this?
4) Hep B
and 2 times you had 5) post dates
this is complex and I am sorry that you end up transferring we tend to think that everyone will have a successful and healthy birth and that despite the problems a mom may have we think maybe we can figure out a way to improve some of the conditions - so you may very well find another midwife to assist you but I doubt that you will find a midwife who will guarantee you a home birth - in addition the considerations for your baby is to give hepatitis B immune globulin (HBIG) shot to help keep the baby from aquiring the disease- and then around the same time a first dose of vaccine is recommended
if you still want a homebirth and a midwife but we also know there are no simple back up situations if you need to transfer out - how about some type of dual/parallel care so you have an established relationship with a hospital provider - actually a perinatologist may be the right type of expert you need to be sure your issues are addressed and a midwife that way you have no surprises - and this could be who would be able to provide the rx things you and your baby need
even in reading your story I had some ideas like one of the symptoms of gluten intolerance is chronic anemia and it can be coupled with weight gain problems, and/or what tests have been done to try and diagnose the causes of anemia? do you have thalassemia or another globin synthesis problem or do you have complex anemia both micro and macrocytic anemia - because very often liver disease (hep B will fit that) will cause macrocytic anemia - no quick fixes here but would recommend that you do some liver supportive dietary things like eating veggies and taking milk thistle or even eating a some artichokes everyday-
I actually do not find fainting and blood sugar crashes to be "normal" and it does tend to make me think that the anemia issues are symptomatic and the blood sugar that mom is not eating enough protein and or just not eating frequently enough in general - midwifery care may still offer some benefits but in your case trying to create a situation that is more comfortable for you over all- maybe an in hospital midwife who has a peri back up....

[CrazyCatLady]

My two favorite mdc midwife's replied. Yay.

Well I can promise that I wasn't any more crazy at 40 weeks than I was when they signed me on. I'm not a drama filled client, calling all the time or anything. I come to my appointments and go home with out any grief or baggage. No one ever seemed put off by the Hep B either. I don't have an active infection, I'm just a carrier and all the midwives were able to just order the immunoglobin and vaccine for after the birth.

They really just seemed freaked about the anemia. Fear of me hemorrhaging seemed to be the biggest worry even though I've yet to. I also forgot to mention I have super low bp when pregnant. So I bet that could have factored in as well. I guess I'm just annoyed because for the last two pregnancies, I made it real clear that I was going to be very anemic at the end...it's just the way I am. I wish they would of just told me "no thanks" from the start.

But I understand that maybe they thought they could help improve things for me. And some of them sure did try everything to help fix the anemia.

Thanks for the helpful insight. I think midwives just may not be for me (despite the fact I've had three super easy births) and I'll do some mix of treating myself at home and seeing my favorite family doctor when I have issues. Haven't decided where I'll birth yet.

Thanks again.

[MsBlack]

So now I'm pretty curious--

just what was your hemoglobin (hgb) in late pregnancy? Surely there is some record of this....

what is your b/p? My own pregnancy b/p tended to be 90/50, which is considered by some to be 'too low'. However, I never hemmorhaged or even felt fainty after giving birth--always had healthy pregnancies. I've helped a woman whose b/p hovered (sometimes more, sometimes a bit less) around 85/40--she also had no postpartum issues.

Are you typically 'fluffy'--a large woman? Or do you tend to weigh in/near the suggested range for your height? Or skinny--below suggested range?

What was your weight gain with the pregnancies?

How large were your babies?

Fainting/blood sugar crashes soon after birth CAN be normal in 'abnormal circumstances'--that is, they can be a normal response to stressors like not eating during labor or at least immediately afterward...hospital pitocin induction sounds like a recipe for fainting/b.s. crashes to me! But I don't know the details. Also, some women do go through a more-or-less normal phase of feeling shakey/faint after birth, between the effects of adrenaline and their body's need to make rapid compensations for the rapid changes that occur when the baby is born. That is, with baby's emergence you just lost a bunch of weight, fluid, some blood; your heart/circulatory system/b-p need to adjust...some women sail through this easily, remain bright eyed and totally oriented--some react a bit harder or I should say their bodies compensate slower, bringing such reactions as faintness/chills that generally pass off once they lay down, get warm, get some fluids and food into them. Also, some people just tend to faint way more easily than others....hard to say from the basic info, which is true for you.

As for the mental issues--you are saying that you have some sort of diagnosis, and treatment plan going on, and that you have remained stable during your pregnancies/births? "Mental Issues" sounds a little ominous, TBH! But I've certainly worked with women who had, for instance, chronic anxiety and were on medication during pregnancy--no problems really, just another 'basic matter' to attend to, perhaps looking into dosage adjustment and related things as needed (much like paying attention to nutrient-intake adjustments common to pregnancy care).

Well--answer my nosy questions if you feel like it....and maybe look into mwherbs' suggestions about the possible reasons for chronic anemia.

[mwherbs]

so I can agree with MsBlack fluids/and food not only thru labor but right after the baby is born too- thinner women I would like to see get some salt in as well-
I really do not expect to see women feel faint- especially if they haven't hemorrhaged, that is why I don't think it is normal. now we do some careful things like be sure someone walks with mom to the bathroom the first time incase she does feel faint but it is not a common thing to have happen- I can only think of 2x when it was not related to hemorrhage both were thin moms who chronically under ate- like maybe 2 teaspoons of yogurt and they are full or 1/2 piece of toast , eat 1/2 a hamburger with no bun... so I think of it as yes post workout/burning alot of calories in labor low blood sugar along with major organ shifts- I just expect to see most women have more buffer/compensation- and I debated on saying I don't think it is normal but in my heart I don't, it can be fine and is usually fine but it is something we do treat or try to avoid by treating before hand-
I too am very curious about everything but I also think that this is what gets her lead down a path everytime and I do think that even if the anemia is the KEY element the other things go into the mix- I have seen many midwives hang with anemia but you add in the other stuff starts feeling above your head/like am I missing something- it is just from over the years I know enough to want to investigate the anemia with lab work to get a dx- because anemia is a symptom not an illness state on its own- where is the problem production, destruction or loss
but this is why I say go see a perinatologist because putting this puzzle together to make sense would take someone like that who is familiar with most of the tests and results and the treatment if any - do you have any family members with chronic anemia? or how about family members who have autoimmune disorders like RA or psoriasis?
the low BP to me is neither here nor there other than to be sure that mom gets enough sodium and it can contribute to light headedness if there is any blood loss- but it is very common where I live to see moms who have low bps sometimes I think we should be using a smaller cuff because it is close to out of range for size-

[CrazyCatLady]

I think you are both right. I am underweight and remain very underweight during my pregnancies thanks to anorexia/emetaphobia/and other food anxieties. I don't eat enough and I barely drink enough. I tend to exrcise two hours a day while pregnant. My son weighed almost 10 pounds and I gained only 6 during the entire pregnancy. I especially don't eat or drink during labor...even when I've been begged to I avoid it because of fear of vomiting during transition (I just go with IV's). My mental diagnosis is schizo-affective.

Not sure what the exact numbers were with the anemia. I just remember it being so freakishly low that I was shipped off to a few different doctors and specialists. One of them thought I might have a rare disorder that generally white women aren't supposed to get? And my bp while pregnant is usually 80/40, but my pulse is always in the 90's.

Another weird thing is that I always go 2-4 weeks overdue.

I think this pregnancy may be better. I'm making a huge effort to take better care of my self and I have an Ensure prescription for when I can't/don't feel like eating. So I should gain weight this time.

This thread has been very helpful. It mad me realize that I am a difficult patient. I'm very polite and easy going, but it must be frustrating for these midwives to be so worried about me and my weight gain/health all the time. I can be stubborn. I can understand now why I might get shipped off to regular doctors for liability reasons. I'll probably stick with a regular MD this time. Since even though I'm trying, I know I'm still going to have problems taking the best care of myself. I don't want to annoy any more midwives.

You guys have been so thorough and helpful. This is why I have loved all my midwives. Thank you so much for all the help.

[MsBlack]

You're welcome....glad to have been a help in your sorting this out, and it does sound like mwherbs and I have given you a little perspective.

For me, it's usually not about being 'annoyed' with a client, but concerned...for her, her baby, my own liability of course. Not always a simple thing to wade through.

Your comments made me think about how we generally come to see ourselves as 'normal and ok' within our given/chosen natures and habits--not just see ourselves that way, but actually achieve a state of normal and ok for ourselves that works pretty well in daily life. And it does sound like you have been so far pretty normal and ok with growing babies and giving birth. But when seen in a comparative light--such as hgb or weight gain numbers compared to 'most healthy women'--that is where the dissonance enters in. We humans have such incredible capacities to adjust, modulate, compensate-- physically, emotionally, mentally-- to achieve our own usual normal state in spite of sometimes very great external stressors or internal conflicts or physical/biochemical issues! And yet hb mws have to walk a careful line, ever-ready to 'clinically justify' her choices according to that 'normal for most' data-set.

[mwherbs]

glad to be of some help,
this is also exactly why I like to work with other midwives, bigger pool of info and more people to remember the info

[MsBlack]

Yes, mwherbs...not to mention more minds to analyze and synthesize info, see connections, patterns, etc.

CrazyKat--you know, given your history of pregnancy and birth on the positive end, I would not (theoretically) rule you out as a client. If you are ok with hospital birth, then that is good...but perhaps you might find a mw who will work with you at home--one who also can see that despite presumably 'obvious problems' w/respect to anemia and weight gain, you *have* achieved a normal-for-you/babies kind of state. I don't know...just saying...

All the best, in any event.

[scottishmommy]

Just a thought...have you seen a hematologist? I'm just wondering if there is a bigger blood issue going on that is cause your mental problems and your anemia in pregnancy. If you have some bizarre blood disorder it could easily be affecting your mood/anxiety level.

[CrazyCatLady]

Just a thought...have you seen a hematologist? I'm just wondering if there is a bigger blood issue going on that is cause your mental problems and your anemia in pregnancy. If you have some bizarre blood disorder it could easily be affecting your mood/anxiety level.

I haven't seen a hematologist actually. It's probably the one specialist that I've not had a chance to visit yet. Never occurred to me that I should. What would be my reason for asking for a referral?

Because with my mental health history, they have a habit of treating me like a hypochondriac even though I'm not at all. So I'd need a very good/specific reason for asking for a referral. I only have medicare, so it's not always the best.

Thanks for posting. Stuff like that is very helpful to me.

[mwherbs]

intractable anemia-- a hemotologist can be very much on top of all the tests to do- and will probably be pretty clear if you have x-y or z--
as for the gluten intolerance - you could see if your GP would run a blood test- it is not completely conclusive because sometimes there are cases that come up and dx with scoping that aren't found with blood work--