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Safe Hemoglobin Levels for Homebirth

post #1 of 11
Thread Starter 

I am 32 weeks pregnant and have been struggling to raise my hemoglobin counts. My hemoglobin (Hb) has measured between 10.5 and 11.5 since 20 weeks pregnant (was 10.5 at 31 weeks). My midwife said I'm anemic and gave me suggestions for the following supplements and dietary recommendations:

 

Floradix (30ml 2x/day)

Liquid Chlorophyll (2 TBSP 2x/day)

Chelated Iron (18mg 2x/day)

Beef Liver Extract (Nature's Life brand w/ 28mg iron/day)

Kale and/or Collard greens (2x/day)

Red Meat (minimum 5x/week)

Nettle and Red Raspberry Tea (2x/day)

 

Despite my taking more than 100+ mg of iron a day (not including the iron in my diet), my Hb count has not risen. I make a point to take in Vitamin C and B12 with every dose of iron to ensure proper absorption and never take my prenatal vitamins or calcium supplements within 2 hours of the iron ones. Additionally, I'm ingesting very little dairy and never within 2 hours of taking iron supplements. 

 

Last week, my MW informed me that in order to have a home birth I needed a 12 or higher for my hemoglobin. This was a bit disheartening and prompted me to look into anemia levels further. I found limited resources that suggest that due to increased blood volume, it is normal for healthy pregnant women to have Hb counts in the 9-11 range. Others say that a decrease of 2 from pre-pregnancy Hb counts is normal during pregnancy. I've also heard that other midwives have a minimum of 10 for home births. 

 

I understand that lower blood viscosity could lead to increase risk of hemorrhaging (which I know is a potential complication that any midwife would fear). 

 

I'm very healthy and have felt no signs of anemia. I'm extremely energetic for 32 weeks pregnant, feeling AMAZING and finding it hard to believe that my pregnancy and blood are anything but perfectly normal. 

 

Could it be that 10.5 is normal for me and it is safe for me to have a home birth at these levels? 

 

Any input or experiences would be greatly appreciated!

post #2 of 11

If your midwife is going to risk you out, are you going to find a new one? Or is she still leaving the choice with you? Based on your post, it sounds like she has a strict cut-off?

True, you could have a low "normal for you" hemoglobin levels, but you could also have a "naturally" elevated risk of hemorrhage. Of course, your absolute risk could possibly still be low... but I don't quite see how being someone with naturally low hemoglobin levels adds up to not having elevated hemorrhage risk.

post #3 of 11
Thread Starter 
I'm not sure about her risking me out because despite months of "low" hb counts she only mentioned home birth not being an option with hb <12 last week. She was positive and encouraging about getting my counts up but the more research I do the more it seems that 10 is the cut off for many midwives concerning home birth. It would be great to hear from other midwives or women who've had similar experiences, especially because of the potential side effects of such high iron intake.
post #4 of 11

Mine uses 12 as her cutoff, though I am not sure how strict she is about it (I think she said "I like it to be at least 12").  Mine was 10.2 about a month ago, and is up to 11.3 with about a month to go.  I started off trying cholorophyll but it lead to GI upset.  I am tolerating regular iron pills just fine.  I am about 15 minutes from a hospital and don't think I would chance a homebirth with a lower hemoglobin-- just my comfort zone.  If I were 5 minutes away, I might be comfortable with a hgb as low as 10...

 

Though with homebirth, many interventions that lead to post-partum hemorrhage are less likely, the risk if you do have a hemorrhage are greater.  Occasionally women do need stat transfusions...  severe hemorrhage can lead to pituitary necrosis with lots of later effects including not being able to breastfeed.  Having a higher hgb at baseline makes me more comfortable. 

post #5 of 11

Is your MW doing just the thing where you get a finger prick and she uses just a drop of blood on a piece of paper thing in a monitor? Mine did that and my Hb was always low (like 9 ish). She suggested that I should go to my doctor and have a more thorough lab test done because those meters are often a bit wrong. When I went to the dr. they did a blood draw (like, with a torniquet...) and sent it to a lab. It came back fine.

post #6 of 11
CBCs (complete blood counts) are nice anyway because they tell you platelet levels too.

12 is pretty high for a pregnant lady.
post #7 of 11
post #8 of 11

I drink a quart of nettle tea a day, cook in cast iron, add black strap molasses (I've heard one of the best sources and great in muffins) to cooking, eat a ton of kelp (wakame for seaweed salad!) and also eat a lot of dark greens like spinach and collards and kale, as well as plenty of lentils and plenty of shellfish. Since adding in the regular nettles and seaweed salad during this pregnancy my levels went from 12 to 14.5. 

post #9 of 11
Mine was 11 when checked. I've had 4 homebirths and don't know if mine has ever been 12. I take liquid chlorophyll and drink raspberry leaf tea daily.
post #10 of 11
Quote:
Originally Posted by IdentityCrisisMama View Post

Have you asked your MW about other alternatives to pit?

 

http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000002507/ann-Prevention%2520of%2520PPH%2520with%2520Misoprostol_Annotated_2012.pdf

Oops, I think I posted this in the wrong thread - this should go in the "how far would you go" thread. Sorry, OP!  

post #11 of 11

In Oregon, anemia, defined as hematocrit less than 30 or hemoglobin less than 10 at term, is considered a non-absolute risk factor, which means that the midwife is required to consult with another licensed healthcare provider but it doesn't necessarily mean being risked out of a home birth. It is up to the individual midwife.

 

I would be comfortable with a client whose hemoglobin was 10.5, 11+. 

 

This article talks about anemia in pregnancy and what is normal for pregnant vs non-pregnant women:

 

http://emedicine.medscape.com/article/261586-overview

 

Quote:

 In an iron-replete population, anemia defined as a value less than the fifth percentile is a hemoglobin level of 11 g/dL or less in the first trimester, 10.5 g/dL or less in the second trimester, and 11 g/dL or less in the third trimester.

Many centers define anemia in a patient who is pregnant as an Hb value lower than 10.5 g/dL, as opposed to the reference range of 14 g/dL in a patient who is not pregnant. 

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