Here I sit, nearly 38 weeks pregnant, with iron levels that have dropped through the floor.
When I last wrote about my low iron levels, I was confident that a regular supplement and some high-iron foods would reverse my problem. I took Palafer, which is a supplement designed for pregnancy, and it worked well when I was pregnant with Little Oats. But at 32 weeks, I had a bloodwork follow up. And not only were my iron levels low, they were dismal. My ferritin levels (stores of iron) were also extremely low.
I headed to the midwife and the naturopath for help; I had 8 weeks to get my levels up. It certainly explained why I have felt so awful this pregnancy; with iron levels like mine, it was any wonder I could get out of bed in the morning. Both the midwife and the naturopath told me to get on a liquid iron supplement as soon as I could (doubling the standard dose), and continue with the iron rich foods.
I started on Floravit, a liquid supplement that provided around 30mg of iron daily, plus the Palafer I was already taking. I ate every food I could think of that was high in iron, but I stopped at liver; pregnant or not, I really didn’t think I could stomach it. I was given three weeks to see how I would respond to this new, intense treatment; if it didn’t work, we would consult an OB and see what was next.
The Floravit was like drinking pennies, the Palafer was ridiculously constipating, and I don’t think I want to look at spinach for a long, long time. I was feeling very confident when, at 36 weeks, I had the bloodwork redone.
Less than 24 hours later, my midwife was on the phone. “I’m not quite sure what’s happening,” she said, “But your hemoglobin and ferritin levels are lower than before.” My hemoglobin is hovering around a 9 (normal starts at 12), and my ferritin levels are too low to register (‘less than 5’ is the official note on the report). These levels aren’t low enough that I need to be hospitalized for iron infusions (I believe that starts at about a 6), so while we’re working on getting these levels raised, it doesn’t make my pregnancy (or delivery) a ‘risky’ one. It does, however, mean that we need to keep a careful eye on the amount of blood lost during delivery. It means that Baby Oats could have low iron, or that he might be low-birth-weight. It also means that a few of my options post-delivery are limited.
For example, I’ve been given the choice between ‘active management’ of delivering the placenta, or natural delivery. With natural delivery, the placenta is delivered through a series of further contractions, with your body taking the lead in expelling it. This can last from 10-60 minutes, and has a higher risk of postpartum hemorrhage (slight). With active management, however, you receive a shot of oxytocin (either in the thigh, or through IV), which causes contractions and expels the placenta faster, usually with midwife assistance (pushing on the uterus, gentle pressure on the cord). This process usually lasts 5-10 minutes.
Due to my iron deficiency, and the danger that is postpartum hemorrhage, it has been strongly recommended that I pursue active management. While yes, I could still refuse, its in my best interest to go with their recommendation. This terrifies me a little; I couldn’t tell you why, because after delivering a baby, what’s a needle in the thigh?
I had my iron checked again yesterday, following a week of triple doses of iron supplements. And, like I expected, the results have remained exactly the same. No change whatsoever, despite all of my best efforts. I’m worried as to what this might mean. I’m going back to the naturopath next week, and my midwives and I are going to consult with an OB who specializes in issues like this.
I hate having unresolved issues, especially when the clock is ticking and delivery is right around the corner. I’m sure there will be a follow-up post to this one in the next little while; what the OB recommended, how we managed delivery, what my iron levels were like post-birth. But for now, I’m just waiting to see what happens.
Does anyone have experience with this? Any reassuring stories…or even tips to help me out?
guest
I had really low ferritin levels for years (mysteriously, my other iron counts were always normal). I was symptomatic and it took awhile to find a doctor who took me seriously. I tried every supplement I could find, but could not handle the constipation. I got iron infusions two years ago, and they were awesome! It was a series of two infusions, outpatient at a hematology clinic. My ferritin went from 2 to 200. I’m now pregnant and my OB has been monitoring me every 6 weeks. I’ve been low (20) but not low enough to treat. I’ve read a lot about low ferritin and it seems like many people are symptomatic below 50. I wish there weren’t such a broad range of “normal”! The infusions were quick and painless and worked great. I’m almost hoping my numbers go down quickly in my third trimester so I can get an infusion before giving birth. I would push your providers to consider infusions. Supplements are clearly no working and the infusion would be safe for you and the baby and would make everyone a lot less nervous approaching delivery. Infusions should not be a last resort for emergency situations! I will say that I don’t have specific medical training myself, but I’m faculty at a medical school and have discussed this with a hematologist here. Keep advocating for yourself! You deserve to have more energy and feel better quickly! I can’t imagine trying to take care of a newborn and an older child while trying to recover from birth with the added problem of ridiculously low iron!
pineapple / 12053 posts
No experience with the low iron, but I had to have a shot of the pitocin to get my placenta out due to an almost hemorrhage and while that part was actually the most annoying part of my delivery (I already pushed out a kid, why are you still bothering me?!) id much rather them just get it out than take the risk. I had a natural labor and delivery otherwise!
pomegranate / 3604 posts
I typed this whole big thing and lost it.
1) you won’t feel or even much notice the needle.
2) go balls-to-the-wall with this; get it dealt with and quickly. If you have to do weekly transfusions of inno-fer, DO IT. My iron levels dropped to 73 and 3 last July (a month before delivering #2) and have remained chronically low ever since. It’s not fun, and now it’s affecting my current pregnancy in a big way.
guest
It might be late in the game already but i was going to suggest seeing a hematologist for other suggestions. I was referred to one during my first pregnancy for another blood issue.
pear / 1547 posts
Was IV iron discussed? That’s how I would treat my patients like you! Or people who couldn’t tolerate oral iron. I’d much rather have higher stores going into delivery – not to mention want more for baby! I would personally be proactive about that.
blogger / honeydew / 7081 posts
@sera_87: @MenagerieMama: I just had my consult at the hospital yesterday, and I will be starting IV iron twice a week until delivery. They figure, even if it doesn’t increase my stores drastically before delivery, it will help afterwards with how I’m feeling!
nectarine / 2115 posts
No advice on your anemia (I’m so sorry! How frustrating!), but I wanted to reassure you about pitocin to deliver placenta. I had this and didn’t even notice the needle. nothing to worry about at all!
guest
Don’t suppose you’re itchy?
My iron was always low but I also became itchy during the third trimester. My OB sent me for a special blood test and discovered I had HELLP a form of pre-eclampsia. I hadn’t ever heard of before, ended up delivering 3 weeks early.
wonderful pomelo / 30692 posts
I don’t have experience with anemia, but I have low platelets, which got lower during pregnancy. I received pitocin and a midwife pushing on my stomach to help expel my placenta. Not going to lie, with Xander, it HURT. According to my husband, my placenta was as big as Xander (almost 9 lbs) and having a midwife push on your stomach is no joke! But it’s pretty quick and I was glad to get it over with.
guest
I typed up a long comment (twice) on my phone, but it didn’t show up! I’ll try again. I’m so glad to read that you’re getting infusions! Two years ago, after suffering for several years with chronically low ferritin (values 2-5) that supplements didn’t touch (although they did cause terrible constipation!), I finally got an APRN to take me seriously and got referred to a hematologist. He prescribed two infusions, and my ferritin went up to over 200 (it settled back around 140 after that initial spike). My symptoms went away for about 18 months, which was awesome. I really hope they work as quickly for you!
I’m now 25 weeks pregnant with our first and my OB has monitored my ferritin levels throughout. Even though I’m pretty symptomatic again, my levels aren’t low *enough* to treat (15-20), and a lot of the symptoms overlap with typical pregnancy symptoms, so there is no plan to address the ferritin at this point. I really hate the huge range of “normal” for ferritin – someone with a value of 12 just cannot be the same physiologically as someone with a value of 150! And most anecdotal accounts I’ve read online suggest that many people are symptomatic under 40-50. I wish they’d revise the range, at least for athletes and/or pregnant women! I’m secretly (or not-so-secretly) hoping my levels really drop in the next few months so I can get another round of infusions before delivery. I’m pretty worried about surviving the fourth trimester sleep-deprivation and chaos without adequate iron stores!