Anemia is a condition where there are not enough oxygen-carrying components (called hemoglobin) in a person’s red blood cells, or there are not enough total red blood cells in the body. This condition is concerning for all individuals, but in pregnancy it can cause particular problems such as: low birth weight, preterm birth, low iron stores in babies, and increased susceptibility to infection. It can also cause complications from bleeding following birth, and can increase rates of maternal mortality.

It is important to understand that your blood stream is what is responsible for carrying oxygen to your baby, and that if you do not have enough red blood cells, or they cannot carry very much oxygen, then the circulation to your baby becomes increasingly compromised (not good!).

Some symptoms of anemia include: weakness, fatigue, dizziness, shortness of breath, rapid or irregular heartbeat, chest pain, pale skin, lips, and nails, cold hands and feet, and trouble concentrating.

How Can We Tell if You Are Anemic?

We can tell if you have anemia by doing lab tests during your pregnancy to check your hemoglobin and red blood cell levels. These tests are done at your first midwifery visit, and again at 28 weeks gestation (since your blood volume expands and changes throughout your pregnancy). We may also test you at 6 weeks postpartum.

One of the criteria for birthing safely outside of the hospital in Oregon is whether or not you are anemic.  If your first blood tests show that your hematocrit is less than 33, or your hemoglobin is less than 11, we will recommend additional supplements to help bring up your iron levels in time for birth. This, alone, does not require you to see a physician but we will still recommend treating your anemia.

A hematocrit of less than 30 at your 36th week gestation or hemoglobin less than 10 gms/100 ml means we must have a more thorough conversation about the risks out-of-hospital birth may pose you and your infant, and transfer may be necessary. In addition, we will likely need to consult with a physician about your case.  If we cannot get you in for a consult prior to labor, or if the physician feels you are no longer a candidate for a safe out- of-hospital birth we will recommend delivery in the hospital. You may return to our clinic postpartum care!

Anemia can be caused by a variety of factors, but the most common reasons in pregnancy are vitamin B12 deficiency and iron deficiency. This can be easy treated with diet changes and supplements and we will work with you to improve your blood-work throughout the course of your pregnancy!

Food As Medicine

One of the simplest and most effective ways to treat anemia in pregnancy is to regularly eat foods which are rich in Iron and vitamin B12. Pairing these foods high in vitamin C also aids in the absorption of iron. You can also intentionally cook your foods in cast- iron cookware to increase their iron content (the iron from the pan leaches into foods, particularly acidic ones like tomato sauces).

Some great foods to make sure you are eating regularly are:

  • 150ml (5oz) of pomegranate juice daily (no sugar added). This is a rich source of iron, vitamins A, C and E. The ascorbic acid present in this fruit also boosts the iron content in the body regulating the blood count.
  • Lean turkey, chicken or fish. These are high in zinc and B12 which help body produce more iron and platelets.
  • Carrots, pumpkin, kale and sweet potatoes. These foods are rich in Vitamin A also help the body produce platelets (a clotting factor in the blood).
  • Wheatgrass juice comprises over 70% of chlorophyll and it is one of the best sources for the nutrient. Take half cup each day. Chlorophyll has a very similar structure to natural hemoglobin (the oxygen carrying iron factor in your blood).
  • Foods rich in Vitamin K include eggs, liver and kale. Vitamin K helps to keep blood production at a maximum in your body.
  • Foods rich in iron: Spinach, beef, dark meat chicken, pine nuts, sesame seeds, blackstrap molasses, tofu (at least 1⁄2 cup).
  • Foods rich in folate and B9 also act as a blood-builders. Folate rich foods include asparagus, orange juice, and spinach.
  • Foods rich in vitamin C including: Citrus fruits, acerola cherries, alfalfa sprouts, cantaloupe, strawberries, broccoli, tomatoes, green peppers. Vitamin C aids in the absorption of iron by the body.

Supplements:

  • Chlorofresh: If you aren’t a big fan of wheatgrass juice, this supplement offers an alternative with the same great benefits!
  • Floradix: This is a liquid iron supplement that is generally gentle on tummies and doesn’t tend to cause constipation.
  • Yellow dock tincture: This herbal supplement is fantastic for building blood and is a great addition to floradix for treating iron-deficiency anemia.
  • Garden of Life Raw Iron: This whole-foods based iron supplement is also vegan and a very digestible form of tablet iron.
  • Garden of Life B12 Organic Spray: This is methyl B 12 sourced from whole foods, and is appropriate for those with the MTHFR genetic mutation (as well as everyone else!). As a bonus, its raspberry flavored!
  • Vitamin C: Taking a vitamin C supplement daily can help to aid in the absorption of iron coming from your supplements.
  • If we cannot get your iron levels to the minimum required by law for out of hospital birth, we may need to send you to a hematologist for an IV iron supplement therapy (a rare situation).

Have more questions or concerns about anemia? Lets talk about it at your next appointment! Call the clinic to get scheduled.