Iron Deficiency in Pregnancy: Part Two

Here I sit, 38.5 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 K. 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 M 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?

2 thoughts on “Iron Deficiency in Pregnancy: Part Two

  1. No experience with such low levels or iron. I hope you manage to get it sorted. I have had the oxytocin shot for both pregnancies and it was fine for me. The placenta came out quickly and barely any blood loss.

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