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Anemia During Pregnancy & Postpartum: what it is & what to do about it
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Anemia During Pregnancy & Postpartum: what it is & what to do about it

If you are like many moms, struggling with low energy can be a challenge during pregnancy. Understanding how to support your body as it faces the increased demands of growing a baby can help you to have a better experience, and improve your recovery during the postpartum weeks. For many moms, the lack of energy is due to low hemoglobin levels, which can be linked to low iron. There are many ways to boost these levels naturally, thus providing your body & baby with the nutrients they both need in order to thrive!

What is Hemoglobin?

In a nutshell, hemoglobin is component of your blood that carries oxygen to your cells. If your hemoglobin count is low, you can experience some or all of the following symptoms:

  • Low energy
  • General Fatigue
  • Shortness of breath (especially after climbing stairs or exerting yourself)
  • Heart palpitations
  • Dizziness or lightheadedness

How do I find out if I have low hemoglobin?

Having routine labwork performed during pregnancy can tell you where your hemoglobin levels are. In my practice, we often check these levels towards the beginning of pregnancy, and then again after you reach 28 weeks of pregnancy. As you progress in pregnancy, your blood volume expands, preparing you to be able to handle the blood loss that occurs with delivery. For many women, their total volume increases over 25%, and tends to peak by the time you hit the beginning of the third trimester. Testing your hemoglobin soon after 28 weeks tells us how your body has handled this blood volume expansion, and gives us time to really hit support should your levels be low at this point in pregnancy.

What if my hemoglobin levels are low?

If your results are low, my first step is to look at all of your lab results to see if we can get a clue as to WHY they are low. There are a few different types of anemia, and the two most common in my practice are:

  • Iron Deficiency: caused by a lack of iron, which can show up as low hemoglobin combined with a low hematocrit ratio on your lab results.
  • B12/Folate Deficiency Anemia: caused by a lack of adequate B12 vitamins and folate, and can be indicated by an elevated “mean corpuscular volume” (abnormally large red blood cells) on your lab results in combination with a low hemoglobin level.

In occasional instances, low hemoglobin levels can also happen if a mom bleeds excessively after delivery. This is one of the reasons that it is so important to get your hemoglobin in an optimal place before birth, as it increases the body’s ability to handle blood loss. But if your hemoglobin is low and you need iron support after having your baby, the following suggestions will also pertain to you!

What can I do to bring up my hemoglobin?

Some key factors to consider as you weigh your options for iron and vitamin support:

  • Typically natural-based supplements take consistency and time to really be effective. This is why to start helping your body early, as the body will then have time to respond. Many iron and vitamin supports will take one to two weeks to really start working to bring levels up.
  • Look for products and options that are whole-food or plant based when possible, as these will cause less constipation and be able to be more easily utilized by your body.
  • Pay attention to labels, and stay away from supplements that contain synthetic ingredients. This is particularly key when it comes to “folate”, as you do NOT want the synthetic form called “folic acid”. Due to genetic issues, many women are unable to adequately absorb synthetic folic acid and synthetic forms of B vitamins, which increases the specific problem of B12/folate deficiency anemia. To understand more about folate and the importance of methylated vitamins, check out this article here by Wellness Mama.

Now onto options for increasing iron levels!

Borderline anemia: if your levels are borderline, and you are looking for some general ways to boost your levels and provide more support to your body, these are some great ways to start:

  • Use cast iron cookware for cooking.
  • Eat foods high in iron (beans, lentils, red meat, liver, spinach, turkey, pumpkin seeds, broccoli, black strap molasses, etc.)
  • Increase your vitamin C intake with a high-quality Vitamin C supplement once or twice daily.
  • Make sure you aren’t mixing calcium supplements with your iron-rich foods or supplements (they will block the absorption of the other, negating the benefits of either one!)
  • Alfalfa Tablets, Moringa capsules & Yellow Dock tincture.
  • Drink several cups Red Raspberry Leaf tea daily during the 2nd and 3rd trimesters (and during postpartum as well), or drink several cups of NORA tea daily (a combination of Nettles, Oatstraw, Red Raspberry Leaf and Alfalfa). To learn my favorite recipe for Red Raspberry Leaf, click here or for NORA tea, check out this link.

True Anemia Support: for those who need to seriously boost their hemoglobin levels, here are some additional supplements to consider, in addition to the list above:

Many moms have found this combination very effective at bringing up their iron quickly (combined with some of the above suggestions):

  • Liquid Chlorophyll (drink 2-3 tablespoons daily, and 1/4c. daily during the first week postpartum)
  • Hemaplex Tablets (make sure it’s these tablets, as they do not contained the synthetic forms of folate)
  • Desiccated Liver capsules (grass-fed organic is best)

Others have found the combination of Chlorophyll with one or two of the following to work for them:

For additional information on anemia during pregnancy, I’d encourage you to check out the following links:

And for more suggestions on anemia in general, Aviva Romm has some great suggestions here: Aviva Romm on Anemia

I’d love to hear from you: what has helped to bring your hemoglobin up, and help you have adequate iron levels during pregnancy and postpartum?

Preparing for Postpartum Recovery
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Preparing for Postpartum Recovery

The first few hours, days and weeks after having a baby are special times to treasure as you recover from birth, transition to mothering baby from the outside, and spend time bonding and adjusting. Being adequately prepared ahead of time can make a key difference in helping postpartum to flow smoothly and successfully. Here are a few tips to consider as you prepare and plan for AFTER baby arrives. Remember that adequate rest, low stress, nourishing food, good support and planning ahead will help you to heal and promote a better overall experience for baby’s first few weeks. It’s important for your physical & mental health to take recovery seriously, and provide your body with the things it needs to continue nourishing a baby while recovering from the demands of pregnancy & birth. You won’t regret being adequately prepared!

Before the Birth:

  • Consider your support system. Do you have a close friend or family member that would be willing to be a resource to answer questions, let you talk with when you’re feeling low emotionally, or just need a listening ear? Is there someone you can trust and feel comfortable with who could come into your home to help care for the household (especially if there are other children) for a few days or weeks so that you can adequately rest and recover? Is Daddy able to take some extended time off of work? How does support look to you? Do you have some babysitting options?
  • Meal Planning: consider having some wholesome family favorites stocked in the freezer so you don’t need to think about cooking. Does your church or support group have a plan for after-baby meals? Do you need to reach out to someone to coordinate this? Would you have a friend willing to start a “meal train” after your birth? And just a note to Gentle Delivery clients: if an online “meal train” is something that would bless you, your midwife is very glad to start this after your baby arrives!
  • Consider stocking up on disposable plates, cups, silverware, etc. in order to simplify clean up and household chores.
  • Shopping (consider the below suggestions, and try to have these things together before your baby is due):

Immediate Postpartum (first hours after birth)– have these things handy in a basket or box for immediately after delivery.

  • Newborn Diapers & Baby Wipes
  • Preferred first outfit for baby, along with a swaddle blanket, socks and hat.
  • “Adult Diapers” or Depends (or whatever type of pad you prefer for heavier postpartum bleeding).
  • Comfortable Nightgown or Pajamas that are nursing accessible and easily work for skin-to-skin contact with baby.
  • Ibuprofen and/or tincture (such as AfterEase or After-Pain Relief) to help with after-pains.
  • Pre-made “padsicles” or perineal ice-packs and/or an herbal healing spray such as this one from MotherLove.
  • Heating pad or rice sock to help with sore muscles and after-pains.
  • Rhoid Balm, Tucks or other soothing support for hemorrhoids.
  • Large Water bottle that is easy to use, to remind & encourage you to drink lots of fluids!
  • Nourishing foods, drinks and snacks (think bone broth, energy bites, juice, etc.).

First Few Days– since you’ll be resting and nursing and taking it easy the first few days, you’ll want to consider having some of these items purchased ahead of time, and ready to be used during the initial few days after baby arrives, in addition to the items above (which you’ll continue using throughout the first few days/weeks).

  • Comfortable nursing-accessible clothes and nursing bras (remember that you may go through multiple changes of clothes due to leaking milk, bleeding and/or baby messes!). Comfort is key, since you will be resting and sleeping whenever possible.
  • Belly Support Binder (can use a Rebozo or scarf, or you can purchase something like Belly Bandit or MamaStrut).
  • Breastfeeding helps:
    • Disposable or reusable Nursing Pads for your bra.
    • Small flexible ice packs or Breast Soothies to relieve engorgement the first week.
    • If you have experienced challenges with milk supply, have supplements such as MaxiMilk or Legendairy products available to start once your milk begins to come in.
  • Stool Softener or Magnesium to help the first stools pass easier.
  • Pads/period underwear for a lighter flow (be sure to check out non-toxic options such as these JewelPads).
  • A journal or baby book to jot down thoughts and memories.
  • Something to read or do as you spend hours nursing your baby!

And finally, feel free to print/download and post this list of visitor guidelines to aid you in navigating the stress and joy of baby visits during those first days!

Do I Need a Doula if I’m Planning a Homebirth?
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Do I Need a Doula if I’m Planning a Homebirth?

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So you’ve heard of the advantages of having a doula with you if you’re planning a hospital birth. The positive aspects include such things as: continuous support that doesn’t change shift, possibility of laboring in the comfort of home knowing someone will help you decide when it’s time to go in, someone who can help you and your spouse keep perspective and act as a liaison with the medical staff, a friendly person to call directly with questions during those last days before labor, and the list goes on. All of these things sound good, but if you’re planning a home birth, then you don’t need all this, right?!? You already know who your caregiver will be, you’re staying in your comfy home, your midwife will provide support and perspective, and you can call your midwife directly…which means that a doula is totally unnecessary, correct?!? Well, that’s a question I hear often, and I wanted to take some time to explore how a doula can actually be a great benefit at a homebirth, as well. If you’re trying to decide whether or not you want to add a doula to your birth team, hopefully this post will give you some help, and maybe even answer some of the questions you have.

To get some input on this subject, I contacted several different groups of midwives, doulas and birthworkers, and asked them to tell me from their experience how homebirths could benefit from doula support. Their responses were very helpful, and provided the bases of what I am going to share below.

When it comes down to it, a midwife and doula offer to distinctly different services. While both are attempting to provide women with personalized, professional care, they are coming at it from two different angles. A midwife’s job is to help ensure that mom and baby both maintain the low-risk status. She is concerned with providing a safe, professional and knowledgeable environment to women seeking out-of-hospital births. This means that she must put mom and baby’s safety first-which sometimes means that she will have to stop providing labor support in order to monitor heart tones, for instance.  There are also those times when the midwife will need to conserve energy in order to maintain the needed mental and physical alertness needed for the actual delivery, which may mean not being able to constantly apply back pressure for hours on end! For some mamas, especially those who appreciate privacy, a midwife and her assistant may be all that she needs in order to feel supported and cared for, but there are others where this may not feel like enough. As a midwife myself, I seek to provide labor support whenever I can, but I am also always acutely aware of what is going on medically. The role of a doula is that of providing consistent emotional support and physical support. Because she does not have to be responsible for the medical aspects of birth, she is free to focus on helping the couple work together, and helps mom to achieve the space and birth atmosphere that she desires, without distraction.

At a homebirth, a doula can:

  • Give valuable input and educational support during the prenatal period.
  • Provide early labor support, and help the couple decide when it’s time to call the midwife to come.
  • Free dad up to focus on mom by paying attention to other details (like keeping the tub water warm, setting up the bed, changing linens as needed, keeping birth atmosphere tidy, etc.).
  • Keep mom and dad fed and hydrated.
  • Help the birth team to remember mom’s preferences-whether it’s the desire for quiet and privacy, or a certain music playing at a certain time, she keeps everyone aware of what mom wants.
  • Help with comfort measures such as massage, positioning techniques, etc.
  • Provide positive encouragement about progress and what is happening.
  • Give mom support during pushing, especially for those families where daddy wants to catch, and mom still needs support by her head that is focused on HER.
  • Assist with childcare as needed, especially if children are present for the birth.
  • Help the mom to feel an extra measure of help and support, through extended availability before and after, and checking on mom’s emotional well-being during the initial postpartum period.
  • Protect and nourish the new family’s space as nursing and bonding are taking place.

A doula is especially beneficial when:

  • A mom is expecting her first baby or is planning a VBAC. The potential for prodromal labor and/or need for extra physical and emotional support make a doula an especially good choice for these moms! For the same reasons, moms who have a history of long labors may also find a doula an excellent addition to their birth team.
  • Mom is lacking other support systems. For single moms, or those who have no family or close friends nearby, a doula can be a tremendous asset in providing a consistent, dependable support person during the pregnancy, labor, delivery and postpartum periods.
  • When using a very busy midwife, or if your midwife has travel plans over the time you are due. If you know there is a good possibility that you may be using your midwife’s backup, then having a doula whom you have already connected with can help make that a smooth transition, as you won’t have to totally “start over” with your birth team.
  • If your chosen midwife usually practices solo (without an assistant). In these cases, it may be hard for her to provide consistent labor support, as she will have many responsibilities to stay on top of.
  • When mom knows that she needs extra hands and extra support. Some moms prefer quiet, privacy and extreme “hands-off” during labor, while other moms know that they would relax better when surrounded by encouragement, positive input, touch, massage, etc.
  • If you’re planning to have your children present at the birth, and don’t have a specific care-giver for them. This can allow dad to spend time with mom or with the other children, and know that no one is being neglected!

So, to tie all of these comments up, you can see that a doula can be a lovely complement to a planned home birth. The moms who have experienced doula care at a homebirth made comments such as “I wouldn’t do it any other way”, “it was the ultimate support group”, “I gained a trusted friend”, “My doula could be someone my midwives could never be (though my midwives were awesome and perfect for me)…All her energy and focus went to me, she had no other obligations”, “she provided a different perspective”, “the little things made a big difference…her doing things that allowed my partner to stay with me was key”. The midwives who have had doulas present at births say, “Doulas are worth their weight in gold, literally!”, “The women who have both feel SO supported”, “Having a doula…helps to share the load, and each individual has something different to bring to each unique situation”, “Doulas provide a different type of connection”,  “I think there are some births where there is plenty of work for many hands…and some where there isn’t”.

All that said, I do want to underline the fact that each mother and each birth is unique. While having a doula can make your birth experience even more special, I totally understand that it is not the choice for everyone. For some mamas a more private, intimate and quiet birth environment with as few people as possible is better.  And this is totally okay. It’s one of the beautiful things I appreciate about the option of birthing at home…the birth team can be personalized to suit the preferences of the individual mom. Each mom/couple has to figure out what is right for them, as this is what will enable them to relax and give birth in the best way. The goal of this article is not to make you feel like you HAVE to hire a doula! But for those who have wondered if a doula could be beneficial, my hope is that you now have a better picture of how a doula can fit in to your homebirth plans, and how this option can make a mama feel even more supported.

Did you use a doula for your homebirth? Or have you been a doula at a homebirth? I’d love to hear about it! And if you’re looking for a doula, be sure to check out www.doulamatch.net in order to find out about doulas offering services near you! For those living in central PA, I’d be glad to refer you to some excellent doulas who serve the surrounding areas.

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