Anemia of Pregnancy and Iron Foods (part 1 of 3)

Why do we stereotype pregnant women as tired and dizzy?  Why are pregnant women more likely to become anemic?  What is hemoglobin and why should I care about having it checked during pregnancy?  The answer may be “anemia.”  I will discuss these questions and more in this three-part series on Anemia of Pregnancy.

Every cell in the body needs oxygen, which is delivered on the red blood cells.  They contain a lot of iron, and oxygen sticks to iron like a magnet.  The hemoglobin check is one way to measure the body’s oxygen delivery system.

During pregnancy, the body must make three to four quarts of extra blood to support the growing baby and protect the mother from hemorrhage after the birth.  Almost a gallon of extra blood is created in the first 30 weeks of pregnancy!  First the body adds more “water” to the blood to expand the volume of blood.  Like adding water to a pot of chili thins out the soup, this extra fluid thins out the red blood cells.  When the blood becomes thinner, there are fewer red blood cells per drop of blood.  If it becomes too thin, the person has anemia.  

Because the body naturally adds fluid to the blood before it starts filling it up with new red blood cells, a dip in hemoglobin in early to mid pregnancy is a good sign the blood volume is expanding as it should.  This should be considered a normal condition that we want to see during pregnancy and not an illness that needs to be cured.

If the hemoglobin is checked, normal hemoglobin is around 11.0 to 13.0.  Less than 10 indicates anemia, higher than 13.5 can indicate other problems.  Symptoms of anemia include tiredness, exhaustion, dizziness or blacking out when standing up too quickly or for too long, paleness, and pale nail beds.  The lower the hemoglobin goes, the worse the symptoms.

The best iron to support the body’s efforts in creating new red blood cells comes from organic iron sources.  The word “organic” in this sense does not mean the food is stamped with a government-approved “organic” label!  Organic means it comes from living organisms.  It is living iron!  The chlorophyll of plants contains this living iron.  Plants are the best at taking the iron salts (ferrous iron) from the soil and changing them into living organic iron.  

A chlorophyll molecule differs from a hemoglobin molecule by only one atom!  When a person is eating plenty of dark leafy green vegetables or taking herbal supplements containing chlorophyll, the hemoglobin number rises in just a couple of weeks.  This quick increase in hemoglobin cannot be explained by the weeks-long process of forming red blood cells from bone marrow.     My theory is that the quick increase in hemoglobin using organic iron supplements is because the chlorophyll molecules are transformed into hemoglobin.  I am not a scientist, but I bet the liver pops the magnesium atom off of the chlorophyll molecule and sticks on an iron atom in its place, quickly forming hemoglobin from chlorophyll!

Foods that raise the hemoglobin include:

• All the dark green vegetables like broccoli, green peppers and asparagus
• Leafy salad greens like romaine lettuce, spinach and kale
• Dried apricots (containing the most easily assimilated form of dietary iron!),
• Raisins, prunes, dried black cherries
• Sea vegetables,
• Molasses, especially black-strap molasses (careful, it is sweet!),
• Nutritional yeast - sprinkle on food (delicious on popcorn!)
• Egg yolks, and
• Organ meats like organic liver.

If the woman is already consuming these foods and is still anemic, she can supplement with concentrated herbal iron sources like:

• Alfalfa tablets or capsules - up to 2 or 3 with each meal.  I think of these as a compressed salad!
• Liquid chlorophyll - Liquid chlorophyll comes in plain and spearmint flavored.  I think the plain tastes like grass clippings pulled them fresh off the lawn mower blade!  But some people prefer the plain to the spearmint.  They both work great.  Put a tablespoon in a glass of water once or twice a day.
• Chlor-Oxygen drops, follow the label for dosage because it is much more concentrated than regular liquid chlorophyll
• Nettles tea - high in iron and many other minerals, drink at least a cup a day
• Red Raspberry leaf tea - also high in minerals, good for pregnancy and all times of life
• Vitamin C - 500 mg per day, helps with iron assimilation
• Hemaplex capsules, 1 per day
• Floradix liquid iron, up to 2 teaspoons, twice a day
• Ferrofood from Standard Process, follow label instructions
• Homeopathic ferrum phos - a homeopathic cell salt that enhances iron absorption, once or twice a day
• Spirulina
• Chlorella
• Dandelion leaf (good for the liver, too), up to 3 capsules per day
• Yellow doc tincture - up to 3 dropperful three times per day (high in iron and supports the liver)

Hopefully this discussion has whet your appetite for iron rich foods!  Come back next week to hear more you can do to boost hemoglobin levels in pregnancy using simple exercises!  

Blessings!

:) Deborah

What is a Midwife?

A midwife is a healthcare provider of prenatal, birth and postpartum care for healthy women.  The word midwife means “with-woman,” a helper for the woman during pregnancy, birth and postpartum.  Most midwives are women, but men can be midwives, too.

Women helping women in childbirth has been the standard of care in childbirth since the beginning of the human race.  In some parts of the world, there have been attempts to eradicate midwives while other parts of the world have an unbroken tradition of midwifery with skills handed down from midwife to apprentice for generations.

Although midwives do a lot of the same things an obstetrician or other doctor may do, like checking blood pressure, measuring the baby, listening to the heartbeat, and attending the delivery, midwives do so in a more personal way. Midwives spend an average of one hour per prenatal visit with her client, so when the time comes for birth, they know each other very well.

Certified Professional Midwives (CPMs) mostly attend births in homes, birth centers or other out-of-hospital settings.  They are trained in handling unexpected complications like cord around the neck, shoulder dystocia, postpartum hemorrhage, etc. and maintain certification in Adult and Infant CPR and Neonatal Resuscitation.

What Do Midwives Do?

Typical Care During Pregnancy:

• Offer a free consultation (Initial Interview) where the mother and family get to know the Midwife and her training and experiences.
• Provide women and families with written disclosure of the midwife’s education, training, years of experience, number of women assisted, outcomes and statistics for her practice, list of risk factors and emergency back up plan.
• Support Families and their decisions.
• Screen for “high risk” or complications.

• Consultation and referral to another health care provider when indicated.
• Access to extensive lending library and videos.

• Remain available to the family via phone, pager or mobile phone throughout pregnancy.

A Typical Prenatal Visit Includes:

• One hour prenatal visits, monthly at first, increasing in frequency as pregnancy advances.
• Childbirth education.
• Nutritional counseling.
• Getting to know the family and their needs.
• Blood pressure.
• Urine analysis.
• Measure fundal height (measuring growth).
• Palpation to assess baby's position.
• Listening to baby's heart tones.
• Lab work.

Typical Care During Labor and Birth:

• Monitor Baby's heart tones frequently and keep an eye on Mom's vital signs.
• Keep Mom well fed and hydrated.
• Let labor progress on Mom's timetable.
• Make sure Family is cared for.
• Assessment of cervical dilation.
• Observance of the situation so when something abnormal occurs it is recognized immediately.
• Use of warm compresses during pushing.
• Give encouragement and suggestions as needed.

Typical Immediate Postpartum Care:

• Immediate skin to skin contact for Mom & Baby.
• Continue to monitor Mom and Baby's vitals.
• Check the uterus to verify that it is contracting as it should after the birth.
• Make sure that Family is fed.
• Make sure birth site is returned to original state.
• Newborn examination within two hours of birth.
• Stay as long as needed after placenta has been born and Mom and Baby are both stable.
• Make sure there is adequate household help.

Typical Postpartum Care:

• Revisit home between 24-48 hours and again at 7-10 days, or more if indicated.
• Intermittently monitor Mom and Baby's vitals.
• Help mom and baby establish a successful breastfeeding relationship.
• Postpartum visits at 3 weeks and again at 6 weeks, or more if indicated.
• Continue to remain available to your family via phone or pager for the 1st 6 weeks postpartum.

What Midwives Do Not Do

• Practice Medicine!  However, midwifery and medical practices may include some of the same procedures.
• Prescribe drugs or administer narcotics.
• Perform abortions.
• Interfere with normal labor and birth.
• Attend “high risk” births or perform cesarean section surgery.
• Use continuous electronic fetal monitoring (EFM).  Monitoring often leads to partial or total restriction of movement which can domino into more pain due to lack of freedom to assume a better position and/or trouble with the baby descending properly, which is often aided by movement.  Use of continuous EFM during labor has not been shown to improve outcomes when compared with intermittent fetal monitoring with fetoscope or hand held Doppler.
• Offer drugs for pain relief like Epidurals, which can lower the mother's blood pressure too much, decreasing the amount of oxygen for the baby, and increasing the risk of fetal distress.
• Routinely offer internal exams late in pregnancy.
• Routinely cut episiotomies. Episiotomies increase the risk of major tears and usually require many more stitches than a natural tear. Episiotomies have a higher rate of infection and a higher rate of serious complications.
• Tell a Mother where, how and in what position she must push.
• Make Mom lie flat on her back during labor or pushing.  This is physically bad for baby because it restricts blood flow to the pelvic region, reducing or cutting off the baby's oxygen supply and has been shown to be associated with fetal distress.
• Use forceps or vacuum extractors.
• Withhold food and drink. 
  
  In my practice, I prefer to use my hands and simple tools for most routine examinations, reserving the use of technology to assist only when necessary.  For example, I palpate (feel with my hands) the mother's abdomen to determine the baby's position and estimate the size of the baby.  If I have a doubt about my findings by palpation and we need to know the position for sure, I refer the mother for an ultrasound.  
  
  


• Once I was palpating a 19-week baby and felt sure the baby was breech with its back facing towards the mother's back-left.  The baby's position at 19 weeks is not important, because baby will change positions many times before birth.  But this woman was going to her ultrasound appointment immediately following her prenatal visit with me, so it was a good test of my palpation skills.  I asked her to text me the baby's position as soon as she found out.  I was right!  Of course, I cannot always determine the position for sure, especially at 19 weeks, but it was fun to have verification that my palpation skills are good!
• 
  
• Blessings!
• :) Deborah

Hands Off

The mom looked up at me, her big eyes wide in the dim light coming through the open door.  “This is really happening,” she said.  I nodded in agreement.  And smiled.  I was so proud of her.

In the next moments she calmly said, “The head is in my hand.”  The water in the birth pool barely made a ripple as she balanced with one hand unseen.  This moment was the pinnacle of years of work for my client.  

Studying birth and becoming a doula did not heal the trauma of the interventions she had endured during her first birth in the hospital.  She learned what she did and did not want for her next birth from her studies and participation in birth, both in hospitals and at home.  Now was her moment of truth.  After three days of labor with very slow progress, dilation had suddenly progressed from 6 to 10 centimeters.  Now she was catching her own baby, half in and half out.

Moving around behind her, I tried to see what my hands so badly wanted to touch.  I couldn’t see anything but her half-squatting body in the birth pool.  Reaching into the water would ruin this sacred moment.  I kept my hands to myself, longing to “see” with my fingers, to know what position the baby’s head was in, feel the fetal scalp pulse, determine how far out it had already been born and if there was a cord around the neck.  But doing any of those things would ruin this task she had waited so long to do.  So I took a deep breath and waited… trusting birth, trusting this mother, trusting the baby, and trusting God.

The baby slipped into the mother’s hand and she brought her up out of the water and onto her bare skin.  Triumphant.  Beautiful.

Witnessing this perfect, timeless moment is my reward for sleepless nights, speeding tickets, blood, stench, sweat, burden, biohazards, long hours, missing family milestones, worry, pain, and exhaustion.  The price for triumph is giving all, filling back up, and giving all again.

I am honored to be called ‘midwife’ by the women I serve.  Each woman has her own story, her unique past and present situation, and her own unique future.  They share and reveal themselves as they grow to trust me as midwife.  Boldly supporting women to give birth as they choose sometimes ‘ties my hands’ by limiting what is appropriate to do or say, or which of my “tools” the mother will allow me to use.  But birth isn’t about the midwife.  It is about the woman and baby.  It’s about healing past pain and opening a new door for the future.  The wrong move at the wrong time can ruin all the work she has done, building up to the moment of truth.  To remain still and wait is a practice in self-discipline and trust.

I would like to share some of what I’ve learned through my practice as a midwife, wife and mother, covering topics like nutrition, fertility, birth, pregnancy, etc. I want to share what I consider vital information for women to have, whether they are my clients or not. I am passionate about birth, natural healthcare, and helping others to learn all they can to make educated decisions for themselves and their families.  I hope you enjoy reading along and would love your feedback on future posts.

Blessings!

Deborah