Pumping Iron

I might have mentioned that I’m pregnant. I’m about a month out from D-Day. Throughout this pregnancy, I’ve been struggling with anemia. I haven’t really posted much about pregnancy in general, or this pregnancy specifically, but I wanted to put what I learned about anemia up here, because it’s information I wish I had had before I got pregnant (and some of it, I actually looked for at that time, but really couldn’t find).

I didn’t have any idea until my midwife did a blood test at 28 weeks. She had been asking me if I was “feeling anemic,” which she described as being very tired, but I kept thinking, “I have a toddler who doesn’t always sleep through the night. I’m making a new person. Yeah, I’m tired.” I was about as tired as I expected to be. Well, then I found out that I should be paying more attention to my iron. After a month of strategic supplementing and eating a little differently, I managed to get my hemoglobin number from 9.5 to 10.8. Normal range for women is 11-15, 11-12 for pregnant women. I felt pretty awesome as I approached normal range. After that, I’ll admit, I kind of slacked off about it. Toddler. Summer. Storm damage. Life. You know?

Then my midwife decided I should have it tested again, at 34 weeks. It was down to 9.9. I really didn’t feel any worse than I had at 10.8. I wasn’t too concerned, frankly.  From what I had read, unless my numbers were way lower, the baby was getting what it needed (my body would take care of the baby first). I felt okay. Then my midwife started explaining that labor is much riskier for someone with low iron. “Since hemoglobin supplies oxygen to your muscles, they get tired faster if you don’t have enough,” she said. “So your contractions are less effective, which can make labor longer. After the baby is born, the uterus might not contract effectively enough to stop any bleeding, which is where the increased risk of hemorrhage comes in. My normal cut off is 10.5.”

That got my attention. “When you say, ‘normal cut off,'” I asked, “you mean the point at which you would refuse to do a home birth for somebody?”

“That’s the point where I think it’s a really bad idea,” she said.

I think homebirth is awesome. I’m so glad that we chose it for Silas, and I’m looking forward to doing it again. I’m not stupid, though. I’m a very low-risk homebirth candidate–I’m young (ish…), not overweight, don’t have any chronic diseases at all, don’t smoke, have no scary family history, and have seen homebirths before. I’ve been very comfortable with the risks entailed because, for someone as low-risk as I am, it’s every bit as safe as the hospital, and with less risk of unnecessary intervention. But. This anemia thing was apparently dangerous enough to move me out of this low-risk category where I feel very comfortable. It was definitely time to work on that iron issue.

One thing that I wish I had known before I got pregnant is that women who space their births two years apart or less are at double the risk of anemia than those who have their babies further apart (click here for science). Now, I’ve mentioned this to a few people, and they’ve said things like, “My friend’s babies were only fifteen months apart and she didn’t have anemia.” I shouldn’t have to say it, but that is not how science works. This doesn’t mean everybody. It means that around 20% of women who have their babies further apart will be anemic at some point in their pregnancy, but 50% of those whose babies are close together do. Your friend is in the lucky 50%.

One thing I’m really kicking myself over is the fact that I didn’t learn that fact before I got pregnant. I remember asking lots of people, including my general practitioner, if there was anything I should have tested or should work on supplementing before I got pregnant again. After 15 months of nursing Silas, I felt depleted. I was underweight, to the point that my friends started staging interventions. I didn’t feel as strong or healthy as I had going into Silas’ pregnancy. I looked for this information. My GP just told me to start taking my prenatal vitamin and some extra folic acid, if I was concerned. Dr. Google pretty much said the same thing. Now I wonder if I have actually been slightly anemic since Silas’ birth. My midwife tested my hemoglobin during that pregnancy (11.7), but I don’t think she checked it afterward. The number one symptom, of both anemia and new parenthood, is tiredness, right? So how would I even know?

If you are thinking about having a baby and you current baby is still pretty baby-ish, talk to your doctor about iron.

So, I found out two weeks ago that my iron was low again, and it was low enough to endanger my plans of a peaceful homebirth. Time to jump into action. After only one week of supplementing and modifying my diet, I moved that hemoglobin number from 9.9 to 11.9. Here’s what I did. Remember, everyone’s body is different; your mileage may vary.

Supplementing

The first time around, at 28 weeks, I supplemented my diet with Floradix and liquid chlorophyll. 

Studies have shown Floradix to be pretty effective. My midwife recommended it because it has very few of the unpleasant side effects that women experience with other kinds of iron supplements. It’s all plant-based, which is nice, too. However, it is crazy expensive. It’s about $18 per week. This is part of why I stopped taking it once I got my iron numbers up. I figured I would recognize the bone-crushing tiredness of anemia if it came back, and I could start taking it again. I was wrong about that, or maybe my hemoglobin numbers get into the ugly range for a good while before I start to feel that tired.

Liquid chlorophyll is interesting, because it’s basically like taking a blood transfusion from a plant. It’s kind of crazy to think about, actually. I believe that it, in conjunction with the Floradix, definitely helped me solve my problem (and it’s much less expensive than Floradix), but it tastes terrible and it stains one’s teeth really badly.

This most recent bout, I tried a different supplement, called Pur Absorb. This is a good deal less expensive than Floradix–about $18 per month. I only have to remember to take it once each day (as opposed to twice for the Floradix), and I’ve had no side effects. I felt okay about trying out a less expensive supplement because I planned to get my blood tested after a week, so if it wasn’t working, I could do something else. As I said above, it changed my number by two points in only a week! Wow.

Vitamin C

For both of the supplements, I almost always took them with a glass of orange juice. Vitamin C increases iron absorption.

Calcium

Calcium binds iron, which makes it hard for your body to absorb the iron. Having cheese on a hamburger decreases iron absorption by 50-60%.

I’m trying to be really mindful about not mixing calcium-containing foods with high-iron foods (or supplements). This is harder than it sounds. I eat lots of high-calcium foods, including yogurt for probiotics (and deliciousness) and almond milk to combat heartburn. My definition of “mixing” is “eating within two hours of each other.” This means that if I take my supplement first thing in the morning, I can’t have yogurt and granola for breakfast. Since that’s my favorite breakfast, it makes me really sad. But, it’s clearly helping, and it’s only another month or so.

What is the deal with iron-fortified breakfast cereals? Which practically everyone would eat with…milk?

Caffeine

Caffeine is my drug of choice. I’m not a big drinker; I’ve never smoked anything. But a nice, dark cup of coffee–that really is a daily ritual, and an important part of my sanity. When I was pregnant with Silas, I gave it up almost entirely. I think I had about five caffeinated beverages during my whole pregnancy. He ended up lacking any desensitization to caffeine, which meant that I also couldn’t drink coffee for the first six months of his life, because any little bit of it in my breastmilk would make him super wired. We actually conducted a double-blind study of this, because I wasn’t giving up coffee lightly. With this pregnancy, after the first trimester, I’ve been allowing myself one cup of tea every day, or coffee every other day. Now, I’ve totally cut it out because I know it can interfere with iron absorption, too. Sad face. Only a month!

Meat

We normally are nearly vegetarians. I don’t worry about this much. When I gave blood in college, at a time in my life when I was even more vegetarian, the Red Cross people were surprised at how high my iron was. I’ve always been good about eating high-iron foods. I love beets and sweet potatoes and chard. I eat oatmeal several times each week. But meat has never been a big part of my diet.

About six hours after I got that second low iron number, my mother-in-law called to ask if we would like some venison. JC’s grandfather was cleaning out his freezer in preparation for hunting season. I told her to bring us whatever he had! In a normal year, I might have red meat a dozen times. Last week, I had three different meals, plus leftovers, of venison. I’m sure that really helped, too. When I was researching the iron content of some common foods, I was surprised to learn that meat has, not only more iron than most plant foods, but a lot more. It’s also heme iron, which is easier for the body to use.

I’m not thrilled about the changes I’ve made in my diet–especially eating so much meat, which is really hard on one’s system if one is not used to it–but I am absolutely thrilled that my hemoglobin numbers are well within normal range, actually a bit on the high end for a pregnant woman. If it means I get to have my baby here at home, where I feel safe and very much in control, well, bring on the burgers! And hold the cheese.