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Haemoglobin and Home Birth
With my first birth, my Hb started at 12.5 and gradually went down to just above 10 at my last antenatal before birth. Consultant did prescribe iron tablets but they really did not agree with me. I have no idea what my Hb was on admission. I had a completely physiological 3rd stage with placenta delivered after approx 40 mins and a blood loss of 300mls. There was some concern about anaemia but at no point did anyone dissuade me from natural 3rd stage or any other treatment mentioned.
This time my first Hb is 11.7 and I have started to take Spatone as a gentle
supplement as a small precaution. My community midwife (I'm booked for homebirth)
has said that it's only when Hb gets as low as 9 that homebirth will be reconsidered.
She may be happy with that because of uncomplicated 3rd stage first time. I'm
not sure.
I'm not a midwife but I hope this helps in someway.
J
Hi J,
I think your community midwife is absolutely right; and the one that said that
'we prefer an Hb of over 10.5 for a homebirth' needs some updating! The blood
of a pregnant woman goes through this marvellous, natural and terribly clever
process called haemodilution, during which the ratio of plasma to red blood
cells increases.
It's like pouring more water into a glass of ribena - the amount of ribena stays
the same! But the proportional amount of red blood cells in any sample that
they might take for a blood test goes down - hence Hb results often go down.
In a pregnant woman the 'diluted' blood flows more easily through the placenta,
and of course you can lose more of it afterwards without problems, because it's
been diluted. Then when you've given birth you wee and wee like crazy, the extra
plasma disappears, and gradually the blood goes back to its normal non-pregnant
state.
But lots of people tend to forget this, and try and make Hb stay the same throughout
pregnancy - like a man's!! Philip Steer did a good piece of research on this
some 10 years ago, which showed actually that women with lower Hbs (9 - 10)
at the end of pregnancy had better outcomes than those with high Hbs. More lovely
flow through that placenta!
Of course some women occasionally get anaemic in pregnancy, but this is not
the same as normal, natural haemodilution. There are other blood tests rather
than a simply Hb that tests for anaemia - mean blood cell volume (MCV) for example.
Any woman who is being muttered at about having a low Hb should ask for her
MCV to be taken.
I'm not sure if this makes any sense at all!!
T
Brilliant explanation T!. I just get so cross that some Registered Midwives
never seem to engage their brains let alone read anything more demanding than
"Hello" Thank you,
MC
A falling Hb during a pregnancy is NORMAL and is due to the increased blood
volume and haemodilution that is NORMAL in a pregnancy. Trying to have a pregnant
woman's blood picture = that of a non pregnant woman indicates a real lack of
knowledge of the physiology and haematology of a normal pregnant woman and would
make me concerned about what else the person spouting this rubbish did not know.
MC
LW updated April 28, 2005