Lower levels of iron (Hb or haemoglobin) are not uncommon in pregnancy and when you consider that women have around 40% more blood volume by the end of pregnancy, this is hardly surprising. What is considered ‘low’ can vary depending on local guidelines. There is research which suggests that levels between 9.5 and 11.5 g/dl are optimal in late pregnancy and another large study showed 8.5 – 9.5g/dl to be optimal. Some areas will have a ‘cut off point’, often around 10g/dl, which if Hb levels fall below will mean that a hospital birth may be recommended. Lowered levels of Hb do not increase the risk of haemorrhage but may mean you find recovery from blood loss harder than a woman with higher levels. You may want to look at your iron stores known as ‘ferritin levels’ as this may give more of an idea of how your body may cope with blood loss.

You may discover that your levels are classed as low through a regular blood test or you may notice you feel symptoms of lower iron such as feeling tired, weak, dizzy or experiencing shortness of breath, palpitations or being unable to concentrate. There are several ways to help increase your Hb levels besides the iron tablets commonly prescribed in pregnancy which can often make women constipated.

Eating iron rich foods such as green vegetables like spinach and broccoli, dried fruits like apricots and raisins, nuts and seeds, red meat and iron fortified breakfast cereals can help boost your levels and relieve symptoms. Ensuring you have good iron stores prior to pregnancy is a good idea too.

Other helpful supplements which can have less harsh side effects to traditional iron tablets are Floradix and SpaTone. SpaTone can be found in most pharmacies and large supermarkets and Floradix is available from good wholefood stores. Vitamin C helps with the absorption of iron so consider taking supplements and iron rich foods with a good quality fresh orange juice.

As with everything, the decision to give birth at home is only yours to make. When choosing to give birth at home with lower iron levels your midwife or doctor may recommend you have a managed third stage. This means an injection of synthetic oxytocin being administered after the baby is born which reduces the risk of haemorrhage. There is also an increased risk of you retaining your placenta with a managed third stage so you may decide to opt for a ‘wait and see’ approach. You can state in your birth plan that you would like a natural or physiological third stage and that if your blood loss looks to be above normal levels you would accept the injection of synthetic oxytocin. To reduce any risks of lowered levels for your baby consider leaving the umbilical cord to completely finish transferring all blood from the placenta to your baby. Most blood transfer will be completed when the cord has finished pulsing but some transfer will continue even after pulsation ceases. If you and your baby are still comfortable the cord does not need to be cut even after it has stopped pulsing to ensure maximum transfer.

Being proactive with food and supplements is the obviously the best approach but even with all these things some women will not be able to get their iron levels up to a level that their midwives are totally happy with. Consider what your iron levels are when you are not pregnant. It may be that lower levels of iron are normal for you and pregnancy unfortunately compounds this. There are studies which suggest ‘good’ or ‘high’ iron levels are associated with risks so as with any decision, it’s about weighing up the risks and benefits to YOU as an individual.

Further reading:
Michel Odent – Maternal emotional states and prenatal care

Michel Odent – Primal Health Research: A New Era in Health Research

Relation between maternal haemoglobin concentration and birth weight in different ethnic groups – BMJ 1995; 310:489-91

Homebirth.org – low iron section

Written by Lisa, who is anaemic when not pregnant and had a physiological third stage, at home with ‘low’ iron levels.