I just got the results from my third trimester blood test and my hemoglobin is 10.5, which sounded great to me because it was something like 11.5 in my first test at 8 weeks (this is not unusual for me, I'm used to seeing 11-12). I had actually expected that it would be more like 9 or 9.5, which I remember being the case during my last pregnancy at this time, so my first thought was that I'd done a good job of keeping my iron levels up (I've been taking Floradix).

However my midwife is concerned. She said that normal test results are 12 and above, and if I drop below 10 it would risk me out of a homebirth, because I could be in danger if I lose a lot of blood at the birth. She would like me to take more Floradix and try to get the levels up more. I'll do as she advises, but is 10.5 really low enough to mean I should be extra concerned about blood loss at the birth? If so, maybe I should also be making a concerted effort to bring the levels up by taking other supplements like chlorophyll?

Yes, take Chlorophyll!!!!!
I started out at 11.4 at the begginning of my pregnancy and then right around 20 weeks dropped to 10.9. After that my hemoglobin kept dropping until it was at its lowest at 10.2 @ around 28 weeks. I tried floradix when I first found out I was low and took the whole bottle as directed. iIalso ate all of the iron rich foods. My levels barely increased. As soon as I added iron from liquid chlorophyll though my levels are now back to 10.9 @ 34 weeks. I too was worried about my levels dropping below 10 and putting my chance of homebirth at risk. I take Natures Way liquid chlorophyll 2 TBSP a day. I think liquid is much easier and better absorbed than pills. 10.5 is o.k but I doubt she would want it going any lower so just to be safe you try and raise that hemoglobin level.
Good Luck!!

Has your midwife mentioned physiologic anemia of pregnancy? I understand her concern and yes to avoid anemia late in pregnancy you need to be careful about iron, folate, and Vit. C all through your pregnancy. You need all of those to make new rbc's

So, back to the physiologic anemia. About the 28th week of pregnancy your blood volume has fully expanded and you production of red blood cells has also greatly increased. So you have more rbc's than any other time in your life, but because the volume (liquid part of the blood) has increased at a faster pace it looks like you are becoming anemic. You aren't.

If you would prefer not to do chlorophyll, or in addition to, eat this every day and use cast iron cookware whenever you can (your food will absorb iron from the skillet):

handful of raw nuts
handful of dried fruit
yogurt
salad with anything other than iceberg lettuce
a meat high in iron such as turkey

There is also an herbal tincture combination, but I don't have it at hand right now. Also have your midwife look up what Michel Odent wrote about anemia in pregnancy. Mom with a little lower level actually do a better.

Egads! Normal levels in your third trimester is NOT 12 and above!!!! Yes, yes, YES to what mothercat said! YESSS!!!

Your blood volume has EXPANDED, which means it SHOULD be lower than what you started with. It's a good sign!

Here is more info: http://sagefemme.blogspot.com/2007/03/fe-struggles.html

If your midwife doesn't buy this, she should read Anne Frye. I think it's a common misunderstanding of our pregnant physiology. :(

And lower hemoglobin does NOT put you at risk for postpartum hemorrhage.

Thanks!!

But now I'm confused. From what you wrote, pamamidwife, it sounds like my test results are a good sign because they indicate increased blood volume. However, does this also mean it would be a bad thing to try to get my levels back up with supplementation at this time? I'm reading the Odent quote, "... when the hemoglobin concentration fails to fall below 10.5 there is an increased risk of low birth weight, preterm birth and pre-eclampsia." I'm assuming however that the increased risk would come about when hemoglobin above 10.5 indicates insufficient increase in blood volume, rather than when it is the result of supplementation?

no, it's only a negative when supplementation is started before or at the rise of the blood volume.

Your iron levels are pretty normal for third trimester. I was below 10 at 29 weeks and up to 10.5 at 33 or 34 weeks, it's normal for levels to drop. I don't think that supplementing will hurt you, but you may not have anything to worry over. I would take some precautions, but not be overy worried.

Is having high iron levels near the end of pregnancy bad for some reason?

My iron is always high. My midwife said she had never seen such high iron levels and asked if I did anything special, but I didn't.

High levels aren't an issue, as long as your levels have dropped from the early part of pregnancy.

Thanks. I don't remember what my levels were at the beginning, but it is something to keep in mind for next time.

Though it didn't appear to cause me any problems.

When you talk about iron levels, are you talking about the actual level of iron in your rbc's or are you talking about hemacrit and hemoglobin?

Iron levels would require iron studies and has several components. It is used to differentiate the types of anemias and whether there are iron deficient, thalessemias, microcytic or macrocytic anemias etc. Taking iron supplements for an anemia that is not related to iron levels can actually cause complications. It is interesting that when taking iron there are three different forms that are used and the most common in ferrous sulfate, which is the least absorbable (bioavailable). The amount you absorb with any iron supplement is inversely related to how much you absorb. High doses mean you absorb less of the total consumed and the excess is what causes black stools.

You also need to be sure you are getting adequate Vit. C and folate because they are also necessary for making new rbc's and w/o them all you have is more circulating iron.