ļ»æEpisode 142 - Iron Deficiency in Pregnancy
Mel:
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host,
Mel:
[0:03] Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD. And each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey.
Mel:
[0:25] Welcome to today's episode of the great birth rebellion podcast this topic has been one of the most requested topics i'm smashing through them this year i just did the risks of induction episode which was another big one and we're tackling lots of others including i did the rsv vaccine recently and today we're going to talk about iron deficiency anemia in pregnancy and its implications for pregnancy, birth, and postpartum. The reason I've avoided this topic is because like so many others, it's fraught. There's lots of different opinions on supplements, whether or not iron deficiency anemia is even a thing. Some people believe that we should be living in an anemic state while pregnant, a controversial idea. And so there's lots of conflicting information. So I'm aiming to keep it relevant and evidence-based for this episode so that you can make decisions for yourself if you're finding yourself having to consider what to do in this scenario if you've got iron deficiency anemia.
Mel:
[1:33] And if anyone's going to do this topic justice, it'll be myself and my guest who I've got on the podcast today, fellow private midwife and peer, Jamie Smith. So strap yourselves in. We're about to talk all about iron deficiency anemia, what it is, why it happens, how to prevent it, and how to treat it. And yes, we will talk about iron infusions and the root cause protocol, which some of you may have heard of, but there's so much more than that. Enter Text...
Mel:
[2:06] Before we launch into today's topic, though, you might have already heard about it, but you might not have, so I'm going to mention it. It's called the Convergence of Rebellious Midwives, and this 2025 conference is shaping up to be one of the best and biggest pregnancy, birth, and postpartum conferences in Australia. This event is happening in about six months, depending on if you're listening to this episode as a back catalogue or whether or not you're on target. So in August 2025, but also every year, we have this convergence of rebellious midwives and already 450 people have bought tickets and it's still six months away. And I know why all these people have booked tickets, because this conference is exceptional all the way from its speakers to the venue, to the experience, everything. I ran the first Convergence last year and I paid so much attention to how well loved everyone felt. So when I built it, I wanted the people who came to feel that it was the best conference I'd ever been to. And many, many people told me that. But most of all, I wanted people who came to feel loved.
Mel:
[3:27] So we ran the conference and afterwards we surveyed the people who attended and 100% of the people who responded to the survey said they would definitely come again. So for us that was a 0% dissatisfaction score. So given the feedback from last year, this year we got a bigger venue, which it's at the International Convention Centre in Sydney, Darling Harbour here in Australia. This allows us more space to not only increase the comfort level for people who come but also just the overall experience it's super luxurious it's in a holiday destination it just adds to the value of this conference now we want people to come not only to feel like they've learned something but also to feel like they've had a mini
Mel:
[4:16] holiday had a break and shaken off the general pressure of their usual work and usual life. And so the whole conference is built around the question, how can we love everyone who comes? And I want to honor their time and the financial commitment that they made to coming to this event.
Mel:
[4:36] And I only want to give you the best. If you're coming to the Convergence, I'm giving you my best. Now the lineup of speakers is also a once-in-a-lifetime opportunity. Any one of these individual speakers that we have could keynote a conference and draw a crowd.
Mel:
[4:57] But this year, we've got Ina Mae Gaskin. And if you Google Ina Mae Gaskin, it calls her the most famous midwife in the world. And she's gone above and beyond to create exceptional presentations for the conference. She is technically retired, but she's poured her time and energy into this. If you miss her this time, it's very possible that you won't have a chance to hear from Ina Mae Gaskin again. It's a once in a lifetime opportunity. So not only do we have anime, but we also have Hannah Darlan, Hazel Kittle, Barshi Hazard, Pam Douglas, Athena Hammond, Sheena and Anna Byron from the UK, Rick Safreeze from the US, Marina Weckend from Germany, I'll be there, Lanelle Moran, Kate Leavitt, Heidi Williams and Sarah Smiths. There's some others planned. I just can't list everything that's going on in this one little segment.
Mel:
[5:56] Honestly I could talk to you without end but I want to invite you to join us at the convergence of rebellious midwives it's not just for midwives you are all welcome everyone can benefit from what we're doing here tickets are on sale at melaniethemidwife.com all the details are in the show notes take advantage of the payment plan option so when you go to purchase at the cart you can divide your ticket payment over four payments and it's an opportunity to meet me and for me to meet you in one of the most beautiful cities in the world, Sydney Darling Harbour. My guest Jamie will be there too, she'll be there to greet you.
Mel:
[6:36] So there are many reasons to come to the Convergence of Rebellious Midwives. I'll be there to meet you, grab your tickets, The details are in the show notes. Righty-o. Let's get into this episode. Welcome to the podcast, Jamie.
Jaimee:
[6:51] Thanks for having me. It's great to be here again.
Mel:
[6:54] Yes, Jamie's been on before. That's right. So I invited Jamie to the podcast
Mel:
[6:59] today because we've been peers for a while now. Jamie is the midwife's midwife and she's a private midwife in Tasmania and she's delved deep into this topic and the research in preparation for a class that she teaches to midwives about anemias in pregnancy particularly iron deficiency anemia so she's the perfect person to join me today and i'll put the contact info for jamie in the show notes so that you can reach out to her if you're interested in her class or if you want to check out her other work at the midwives midwife so we'll get into it so iron deficiency anemia in pregnancy that's what we're talking about so many women have this and I personally as a midwife do screen well I offer screening to all of my clients for iron deficiency anemia particularly because it's just so common.
Mel:
[7:54] And so many women have been told to go on to supplements or get an iron infusion. But I just think there's so much more that could be done before you get to that point. And I know, yeah, and Jamie and I have spoken about this too. We actually have very different clinical ideas about some things, which is great because, and that was actually why I really wanted to invite Jamie on because I feel like she brings another perspective to the conversation. All right, so firstly, I want to just explain what iron deficiency anemia is because we have to mention here there's lots of different types of anemia and iron deficiency anemia is only one of them. It's the one we're talking about today. We can't really go broader than that. So this is completely isolated to iron deficiency anemia, which is one of the most common ones in pregnancy. But just know that if you've been struggling with anemia and nothing seems to be working, then consider the possibility that it's not iron deficiency or it's compounded by other issues. And so there might be a different management and treatment strategy to treating your particular brand of anemia. You can't just keep throwing iron supplements at everything and assume it's going to work.
Mel:
[9:13] So that was the first thing I wanted to make sure if you're listening that you're not going down the wrong treatment path with anemia by just thinking it's iron.
Mel:
[9:24] So iron deficiency, as I said, is the most common cause of maternal anemias, but the other ones include things like sickle cell anemias, there's thalassemias, deficiency in folate, B12 or both, malabsorption issues, some infections, and there's heaps more. Some are more rare than others the other one thing I want to mention before I go any further is that it's important to differentiate the research and understanding of anemias based on low middle income countries or low resourced areas versus anemias and iron deficiencies in well resourced countries it's it's kind of a completely different story and so I just yeah, Be cautious with the research because sometimes, you know, they talk about it as being really concerning for kind of maternal well-being long-term, but that's often the case in low- to middle-income countries or high-income countries where there's adequate health care. The story can be completely different.
Jaimee:
[10:30] I was just going to say that eye deficiency anemia is actually the most common nutritional deficiency affecting pregnant women worldwide, And I think it's about 17% of industrialised or developed countries and about 56% of developing countries. So that's often not recognised. And it really is like a subtle, slow, progressing disease. So I think that's also not recognised. So I'm really glad we're talking about this today.
Mel:
[10:59] Yeah. And I'm glad you mentioned the slow, progressive thing because I feel like often clinicians think it's just like all of a sudden, And, oh, no, you're anemic. We've got to get you on huge doses of iron supplements. And it's like this should not be a surprise to people because it's such a slow creep and slow crawl. So, yeah, exactly. So anemia itself is the condition of not having enough healthy red blood cells circulating in your body or the hemoglobin that's part of the red blood cell. And the hemoglobin is part of the red blood cell that carries oxygen around your body. So iron deficiency is just one of the things that can impact on the health and quantity of your haemoglobin, so the quality and quantity. So essentially, yeah, anemia is low levels of healthy, full-functioning red blood cells, and all the red blood cells have haemoglobin on them. So that's an important distinction here is that iron deficiency starts before anemia, right?
Mel:
[11:59] Anemia is like the end point, the disease process of being chronically iron deficient. So our bodies can function and adapt in the short term to iron deficiency by releasing stored iron so that we don't get anemic. But if it goes on for too long, then we get anemia as a result of being iron deficient or iron depleted for too long. So hopefully you're already starting to see here what Jamie mentioned just prior to is that anemia is completely preventable with some forethought and some early intervention. We can detect and treat iron deficiencies before it manifests as anemia. And we will talk about how to prevent anemia and how to identify it as we go through. And we'll talk about how iron deficiency and anemia is diagnosed and it's sort of two-pronged. We combine what we can find through blood test results with the individual experience of the woman.
Jaimee:
[13:07] Yeah, no, I wholeheartedly agree. I think we're always trying to offer woman-centred care and I think it's a mistake to just look at the numbers or to just look at the woman. it's definitely always for my practice a combination of the both. I've had women whose numbers look fine according to lab reference ranges which is its own topic but they feel really rubbish and they're definitely symptomatic and therefore they need support and I've had women whose numbers look really poor but they tell me they feel just fine and they don't want any extra support to boost iron stores. So yeah I agree it's definitely looking at the woman and the whole picture and the numbers that are support woman-centred care not to make her fit in with any particular number.
Mel:
[13:53] I have to agree. And I've had clients the same. They feel great. And you're looking at their blood results and thinking, you should not be functioning. And they're like, no, feel fine. It's no problem. And then I have, I actually recall a story of a client. She is actually a GP as well, a medical GP. And she was planning a home birth. And all the blood tests look great, no problem. And she said, I'm just so, so tired. Like, it seems unreal, you know, excessively tired. And I said I don't think it's your iron she said well I'm gonna do an iron transfusion.
Mel:
[14:28] Because you know I want one and I think it'll make me feel better and was like you just you don't fit the criteria and she went ahead and did it anyway obviously she's a GP she has access to what she what she feels she needs and she did feel brilliant afterwards despite her blood test results not looking anything like anyone I would suggest having an iron transfusion so yeah I think this goes way deeper than what we're led to believe so in order to diagnose it firstly yeah we ask you how you're feeling and women will express what's going on for them but then even early on right at the beginning of your pregnancy your care provider will offer you an antenatal blood test so personally if I'm writing these for my clients I'll always include iron studies and a full blood count in the antenatal bloods and often your GP or doctor will do this depending on who's looking after you and this way we actually have the information right from the beginning of your pregnancy to diagnose if there's a pre-existing iron deficiency or if you might be at risk of anemia because again anemia is different to iron deficiency it's it's a there's two things we can diagnose.
Mel:
[15:44] We can diagnose iron deficiency without anemia or iron deficiency with anemia. So the idea of these early blood tests is to see are you iron deficient but not yet anemic in which case we can prevent you from becoming anemic through your pregnancy. And this is where I love continuity of care, actually. And one of my issues with the oversupplementation of women with iron is that I think sometimes it comes out of this fragmented care model sometimes where nobody's noticed what's happening for this woman. And then there's like this rescue medicine at the end to try and bring her hemoglobin up when if somebody was just really paying attention to her through her pregnancy, this could have been picked up way earlier and the supplements and the strategies could have been gentler and more prolonged rather than this kind of rescue approach.
Jaimee:
[16:41] Yeah. And I think it's a bit of an uphill battle in pregnancy because I think pregnancy is actually the perfect storm for developing iron deficiency anemia because you have a greater demand when you're pregnant for iron. Like iron's needed for over a hundred functions in our body. And then And when we're growing a baby, a whole other person as well, they obviously need iron to function. Your placenta needs it. And so you might be fine with nutritional intake. And I'm guessing we'll talk about that, you know, the different ways that we can support iron or why we might be iron deficient or anemic. But, you know, usually it's not enough intake or too much demand. And I think pregnancy is the perfect example of a lot of demand. And so sometimes our normal adequate intake isn't enough in pregnancy. And if we leave it too late in pregnancy, I often find there's not the time or capacity to bring it up just with diet alone, sometimes not even with oral supplements alone. So, yeah, I agree with you there, Mel. We probably agree, actually. On most things, but I've just probably had more involvement with iron infusions than your clients. Like a lot more of mine have had access to that. So, yeah.
Mel:
[17:58] That's, I think, where we differ. I feel like we're on the same path most of the way. And then there's this moment of divergence, which is actually completely fine
Mel:
[18:07] because it's not about us. It's about our clientele and making sure they're getting the care they need. And so, you know.
Jaimee:
[18:14] Absolutely. really.
Mel:
[18:16] When we take your blood and we try to find out, are you iron deficient? Are you anemic? There's some things that we're particularly looking for when we're diagnosing iron deficiency. And, you know, I don't want to talk about like mainstream system versus what we would do. But generally, the things that your clinician will look for are your hemoglobin levels. And this is measured in your full blood count and this should be above 110 grams per litre if you're in Australia in the UK that's how we measure it but if you're in the US they might measure it as like 11 grams per deciliter rather than grams per litre so if you're in America and you're thinking whoa 110 that converts to 11 so just note if you're sitting there with your blood test results in front of you trying to work out am I anemic so that's the first thing hemoglobin above 110 so if it's below 110 quite potentially you are showing signs clinical signs of anemia, but then if we want to check if you're iron deficient you have to look at the iron studies.
Mel:
[19:28] And when you look at that one of the things you can look for is a thing called ferritin which is it represents the stored iron in your body so your body can have iron that's circulating through your blood that's one thing it there's hemoglobin then there's a stored iron which is ferritin.
Mel:
[19:49] So if your ferritin levels are low, but your hemoglobin is normal, then we would sort of suspect that you're iron deficient, but not yet anemic. So you have, your body is adapted and, you know, maybe it's finding stores and reorganizing iron through your body to prioritize hemoglobin. But we're getting like a warning sign that you're running out there's soon not going to be any stores and then when your stores run out then you start getting the signs of anemia.
Jaimee:
[20:28] Yeah so actually 70 percent of your iron is stored in the hemoglobin so there's not as much as we often think in the ferritin which is actually what we call our iron stores but I like to think of ferritin as your money in the bank. So when you have excess money, you put it in the bank. Well, you can do. If you're running out of money, you're going to budget and prioritize where that goes. And that's what happens with iron. And hemoglobin, where 70% of iron is stored, is one of the last priorities of the body. So if your body has budgeted in every other way and then it hits, like it still doesn't have enough, it's going to have to start taking the stores out of the hemoglobin. And that's when women start to become anemic and very symptomatic they're probably symptomatic before that but don't notice it because a lot of the symptoms overlap with other things in life just being tired and busy and pregnant so yeah I like to think of it like that once we're losing our hemoglobin iron stores our body is getting pretty desperate and really needing to get that iron from somewhere so yeah
Mel:
[21:30] That's right and I mean hemoglobin is what carries oxygen around our body so when you're symptomatic it's because you're in a state of like deoxygenation yeah because body can't adequately transfer transport oxygen around so you know we don't mess around really as clinicians we really want to solve this for women help women solve this and there is a train of thought and I'm kind of mentioning it early and I wanted to just flag it with people if you're searching on the internet and looking for things you might find a class of opinions that suggest that maybe in pregnancy we're supposed to be in a state of anemia or that a drop in hemoglobin is normal and appropriate and that maybe we shouldn't be dosing ourselves with iron I just want to say at this point that Jamie and I are not of that opinion So I'm to hear thinking, you know, we're going to bolster that theory. You know, I've engaged with that dialogue and tried to understand the science of it and it doesn't make sense to me. Based on what I know of what happens in the body. And yeah, so I...
Jaimee:
[22:47] And nor to me, and it hasn't been reflected in my experience. So I think you might be talking about the root cause protocol or the idea that hemodilution in pregnancy, like our blood volume increases by up to 50% in pregnancy. So yes, our red blood cells and our hemoglobin increases, but so does our blood plasma and that increases more than our hemoglobin. And so it makes our hemoglobin looked diluted. If you had like half a cup of red food dye and then you just added another half a cup of water, the red food dye is the same amount, but it looks diluted because there's extra water in it. And that's the idea of this hemodilution that in pregnancy, we have extra blood plasma and therefore it's just fake anemia or false anemia because it just makes it look like we have lower hemoglobin based on our blood volume. My issue with that is that there's actually an increased demand in pregnancy for more hemoglobin. So I don't think we can just write off that, oh, that's a normal state in pregnancy. For some women, they might be just fine. Like I said, it always comes back to the woman, but I'm really interested in making sure she feels well and often pregnancy demands more than what we're supplying. So, yeah.
Mel:
[24:10] And that process of hemodilution, which we will cover in detail as we go, yes, that's a physiological part of pregnancy is the hemodilution, but resulting anemia is not part of normal pregnancy.
Mel:
[24:29] Yeah, agreed. Yeah, we kind of have to realise that. Some clinicians, or maybe in some bigger systems that have more kind of streamlined care processes, they might not do iron studies early in pregnancy and not be looking at ferritin as a marker. And some places only rely on haemoglobin. And so just be cautious is that although you might not be anemic by looking at your haemoglobin, if your clinician hasn't done iron studies, then you've missed the very early opportunity to potentially prevent anemia so just throwing it out there so that's one thing that we look at with our iron studies and Jamie your master class on iron deficiency anemia explained the rest of the iron study data in a really succinct way as I was you know in I was watching it going great great explanation so I'm gonna throw to you yeah you've got sort of four other markers that we can have a look at in iron studies.
Mel:
[25:38] That can help us understand what iron's doing in our body and what direction we're heading are we heading into more anemia is our body looking for iron has it got enough yeah can you look us through the rest of those iron studies and what midwives could look for or clinicians could look for or even women will be able to look at it.
Jaimee:
[25:56] Absolutely and I think that's another thing I see a mistake clinicians make is they may order ferritin but not full iron studies but if a woman is especially if she's having iron supplements I'm very interested to know what the other components of iron studies are because overloading in iron is toxic and it causes cellular damage and death And so we really don't want to overload in iron either. And that's what the rest of the iron studies show. So like I said, the first thing I always look at is ferritin. That's like your storage container. How much storage have you got there or how much iron do you have in storage? And it depends who you talk to as to what you want to diagnose. I guess we might come back to that in a sec. But the other components of iron studies is something called transferrin. And I like to think of them trans as transporters that's what helps me remember it so if you like the little utes going around your body trying to look for unbound iron that's excess iron that your body doesn't need immediately and it wants to take that iron up and take it to where it's needed or put it into ferritin for storage
Jaimee:
[27:05] And so that's really important. We want our transferrin to be between our numbers, but to be between 2 and 2.5 grams per litre. If we've got more than 2.5 grams coming back on an iron studies, then that really shows we've got lots of transporters. So some people call that iron hunger. That's our body looking. It's looking for more iron because the body is indicating I'm really depleted. I need iron. And the transporters are trying to find it. And then the saturation part of the iron studies is saying how many of those transporters are being used, what amount of them is saturated or being used. So optimal is between 20% and 30%. So if our saturation comes back as over 30%, then that really shows that we're over-supplementing. And so we'd want to ease off on our oral supplements because the capacity of the transferrin to catch that iron and take it safely to where it's needed is already full and therefore that would leave dangerous unbound iron circulating in the blood and that's where people get worried about over supplementation and iron toxicity.
Jaimee:
[28:15] So it's really important that we know those and then the final number in iron studies or the area is just the serum iron. It's often just listed as iron. I actually don't even hardly look at that because that's kind of like if we stick with the money analogy that's like the cash in your wallet. That doesn't give a very good indication as to what your actual financial status is. So serum iron just happens to be the amount of circulating iron in your blood at the time you had the blood test.
Jaimee:
[28:43] What's far more important is what's being moved into storage and how much. So that's just a sort of an extra little thing that I don't put much weight in. So yeah, that's your iron studies and that's why it's really important to understand each of those. and I didn't used to understand them. As midwives, I didn't get taught this when I did my training. It's only when I went into private practice I thought, wow, I have a really big gap in my knowledge here. I want women to feel well and so I want to understand this. And I really love being able to get information into a simple, easier to understand way so I can apply it and so other people can apply it.
Mel:
[29:22] So, yeah. And often when you get the blood test results, the lab will tell you what the normal reference ranges are. So you don't have to go hunting for that. If you've got your own blood test in front of you and you can see that your iron studies are deranged, you've got the capacity to find out, okay, what levels are high, what levels are low. So, and you can ask your care provider, what does this mean? Am I looking down the barrel of potential?
Jaimee:
[29:46] I was just going to say the tricky thing with the reference ranges from the lab, I know they vary from lab to lab, but for example, my reference range for ferritin is 20 to 160. And so I made the mistake early on in private practice thinking, well, as long as a woman's over 20, she's probably okay. 20 to 160 is a huge range. So the haematologist in my area who I've used a lot of his research, he's a professor of haematology and he would suggest that if your ferritin is 20 to 30, then you have severe iron deficiency. If it's between 70 and 100, you have mild to moderate iron deficiency and if it's over 100, it's unlikely to be iron deficient. So his numbers are very, very different to most clinicians.
Jaimee:
[30:34] And I think especially in pregnancy, women often do need a bit more iron and so I think his reference ranges are probably more accurate. I've had so many of my clients end up having extra iron through iron infusions and not one of them has ever regretted it. They have all felt better and some of them I've not been sure. I've looked at the lab results come back and I think, oh, I don't know. I'm not sure. She might be a bit symptomatic. I'll offer her referral to the haematologist and off she'll go because really I'm just wanting another opinion that's his area or their area of expertise and he if he gives them an iron infusion they what not one woman has ever regretted she's never said to me I wish I didn't do that most of them say I wish I had it earlier so that's why I've ended up probably having more clients have vine infusions than umel because I've had easy access to that and I guess over the years I've just realized women feel better for it in pregnancy I'm not saying that's necessarily the best management option for a non-pregnant woman you have time and there's all sorts of different factors when you're not pregnant
Mel:
[31:47] Yeah what Jamie's talking about too is I don't think I've ever had a client that I've recommended an iron infusion for that that one client that I mentioned earlier the GP is the first one he's like I'm getting an iron infusion and I was like are you sure mostly because I've always been able to well firstly early identification and then all of my clients have been able to get their levels up and improved with a particular oral supplement regime that I recommend I'll talk about later so yeah I just haven't kind of pursued it and possibly also I'm really you know finicky about sending women to places for more things but like you said if you've got easy access you can't you might be more willing to kind of go yeah off you go it's easy don't worry about it so we'll talk about iron infusions but that's where Jamie and my strategies differ is um you know not saying anything's right or wrong we're just kind of doing what we know absolutely yeah so those are the the blood tests but certainly probably if you're going through a mainstream system and you don't have an individual clinician who's really combing through your blood results thoroughly, then probably your clinician's going to use hemoglobin and ferritin as a way of diagnosing.
Mel:
[33:10] But if you look at the other things, the other things in your iron studies, that's where you would get more of information about what you need to do next.
Mel:
[33:19] So there's that one part of being able to tell if you're iron deficient or anemic, but then there's your personal experience and your personal symptoms.
Mel:
[33:28] So as Jamie said, it manifests as a lot of things that we already feel sometimes as busy women, but tiredness, breathlessness, actually visually pale.
Mel:
[33:41] So feeling breathless after just doing things, like if you've gone to the top of a flight of stairs that you always take and then you get to the top and you've really got to take a few big breaths and you're feeling really breathless, consider that your body's struggling to move oxygen around. Heart palpitations feeling just faint or dizzy foggy like just generally being unable to like just feeling constantly foggy through the day and headaches cold extremities but really it's all symptoms of oxygen deprivation and and the fact that your body doesn't have the nutrients it needs to properly function the other one is and people might be out there you know women might yeah they're going oh my gosh that happened to me there's a thing called pica p-i-c-a and it's this desire to sometimes women want to eat ice but they might also want to eat things like clay dirt bricks i've heard women talk about just wanting to like the mortar out of bricks and like lick the wall like this insatiable desire it's called pica it's a thing if you're thinking gosh I just want to eat that thing and it's not food think about what your body's trying to tell you maybe you're iron deficient in fact there are some places I had a client who was from India and she said in India they sometimes they'll offer pregnant women clay pills tablets to take.
Mel:
[35:11] Thinking like okay this yeah if you want clay he have clay but I'm like wait I think that's I, the beauty, it could be for a whole other reason, but I did have an Indian client, she goes, oh yeah, in India, we take clay tablets. And I was like, I know that could be a detoxification thing, but anyway. So there's all these symptoms that you could have that could be related to your iron status. So if you're not sure, you know, we do also just, if women are feeling that, maybe they do need more iron, even if their blood tests are not screaming that at us.
Mel:
[35:44] So let's talk about why this happens in pregnancy and why we monitor for it. And we alluded to it before that pregnancy is a time of huge nutritional demand. Your iron needs do increase to facilitate the growth of the baby and of the placenta. First, you've got to keep meeting your own iron needs, but then there's all these additional iron needs.
Mel:
[36:06] And there's also significant changes in your blood volume. So the amount of blood that you actually have in your body. And they've had a look to see what happens to blood volume and it increases by the end, you've got 50% more blood than you had before. So in the first trimester, it's about 5% more. It's about 25% more in the second and 50% in the third trimester. So if you started pregnancy with five liters of blood, by the end, you've got 7.5 liters. And that's a huge change in a short period of time. It needs high inputs.
Mel:
[36:45] And as Jamie said before there's this process of hemo dilution where your blood gets diluted there's less red blood cells and blood components per mil of blood and what happens is is your body increases the plasma which you know in our analogy is the water and you know red food dye or think about coitial for example if you've got a certain part one part coitial and you add water it keeps getting more and more diluted and this is the physiological anemia of pregnancy is the hemodilution so hemodilution is normal and your body can adapt to it gradually so long as it has all of the components it needs to firstly it could make new blood cells but actually what they also find is that the red blood cells that you already have adapt and they become bigger and more efficient at doing their job of carrying oxygen around. So although you're diluting the blood, your red blood cells sort of go, oh, time to adapt. We need to be more functional, more efficient, get a bit bigger so that we can.
Mel:
[37:56] Doing our job so yeah think about that as the the cordial extra extra plasma extra water your blood dilutes that's completely normal yes but anemia is not normal so how do we make sure we're getting enough iron but also not too much iron because there is this thing called iron toxicity because iron actually recycles in the body. So there's some nutrients that, you know, B nutrients and vitamin Cs, there's things that are water soluble and that actually also have, or fat soluble, but they have a mechanism for removal from the body if you have too much. The only mechanism that iron has for leaving your body is through blood loss. So that happens for women who are bleeding every month obviously you don't bleed hopefully while you're pregnant it's also why women are more just predisposed to anemias than men because men don't have regular bleeding events and in fact if there's a man that's iron deficient they start to suspect things like internal bleeding like where is the iron going so there's this balance you I wouldn't recommend just taking iron without checking if you first need it so it's not one of those things of like yeah you'll be fine it's like a b vitamin where you take it if you don't use it your body just wheeze it out and and off it goes.
Mel:
[39:20] Iron is super different so there is a possibility of overdosing on iron which is damaging and toxic to our tissues and that's the reason why our body is actually great at actively preventing.
Mel:
[39:36] Or allowing iron to enter the bloodstream or not so there's a process that your body has already to choose to decline iron absorption where it's sort of like nope you can't commit even if you eat high iron foods or you're taking supplements your body has the capacity to do that but, And I don't want to be too, like, scientific about it and wordy about it, but there is a compound called Hepcidon, which every time I hear that word, Hepcidon, I think of Poseidon. And so anyway, I call Hepcidon the goddess of iron.
Jaimee:
[40:13] That's brilliant. I love it.
Mel:
[40:16] Hepcidon, goddess of iron. She controls who comes and who goes. And it's like, yeah, it's like Poseidon, but Hepcidon.
Jaimee:
[40:23] Yeah, that's brilliant. I love our analogies, Mel. We're going with red cordial and utes and goddesses.
Mel:
[40:29] Yes. Brilliant. The queen, the boss, the goddess, she kind of stands guard. And hepcidin decreases the level of iron. So the more hepcidin you have, the less absorption of iron you have. So so she reduces dietary absorption and inhibits iron release from cellular storage so if you've got some stored but you've just had this huge dose of iron somehow she'll stop iron from being released from your stores because we don't want that free floating iron just floating around our blood volume causing damage so hepcidin is interested in keeping it either locked up or out of our bodies. Hepcidin production increases when iron levels rise above the normal range and therefore inhibits unnecessary absorption. And so this is the protective mechanism against iron toxicity.
Jaimee:
[41:28] Yeah, it also increases throughout the day. So you have lower levels of hepcidin in the morning and higher levels in the evening. I guess that's naturally in case we eat too much iron throughout the day.
Mel:
[41:40] Yes, that can periodically stop us from absorbing too much and and this role of hepcidin you might be like why are you telling us about the goddess of iron this will become important later as we start to discuss iron supplements and it's our body's natural way of making sure that we don't overload on iron and this is where my question is around iron infusions because it's hepcidin's really responsive to iron deficiency and iron overload so it'll regulate it so if you're iron deficient your hepcidin will reduce which means you've got more capacity to uptake iron from your diet or when you take oral supplements but if you've overloaded it won't allow that so that's kind of a digestive barrier so my question and my thoughts are when we override that digestive barrier and that capacity of our body to prevent iron absorption and we do direct IV or you can also do injectable intramuscular iron, What are we doing to our body's natural capacity to resist it? And have we forced iron into a bloodstream that we didn't want it or need it in the first place?
Jaimee:
[43:03] For someone who's really depleted in iron or really iron deficient or anemic, it can be very slow to be able to get iron into stores orally because of hepcidin. And we actually only absorb a very small amount of iron out of iron supplements and so yeah an iron infusion bypasses that and speeds up the process which is why I think it's valuable in pregnancy if a woman's really depleted and symptomatic it's a fast way to boost her iron stores and give her the iron she and her baby need so the only time we will actually store iron is if we have excess iron in our blood and so it's a very delicate dance trying to do it orally because yeah hepcidin will jump in and try and prevent us having too much excess so therefore the process is slow and sometimes especially in pregnancy we don't have the time to boost our iron slowly and therefore that's probably why there is a place for iron infusions at times some people have absorption issues in their body there's all sorts of reasons for that they might have some sort of irritable bowel syndrome or thyroid issues affects their stomach acid and therefore they can't absorb iron very well that way and you actually need iron to create thyroid hormones and so if you don't have enough iron you're not making the stomach acid to absorb the iron and it's a vicious cycle.
Jaimee:
[44:27] So some people just can't win with the oral supplements and therefore I think that's the place for iron infusions. My first route is always go as natural and as close to biology and physiology as possible. So I don't jump to iron infusion straight away. I suppose my take is I'm grateful they're there when we need them for certain seasons in life. But I agree. I think we are probably doing something. It's quite an intervention, but some people do seem to need that because other systems in their body are out of whack or they're just healing from other things and they just can't get what they need morally or through their diet.
Mel:
[45:05] And particularly if women find themselves kind of like oh my gosh nobody really thoroughly checked and here I am and when when Jamie says like it's slow to recover we're probably talking I mean from experience if I've recognized that a woman needs iron supplementation I notice a change in her bloods I wouldn't check any sooner than like two weeks and may and that's only if she's getting close to the end of a pregnancy, probably ideally I'd check again in four weeks to see what.
Mel:
[45:40] What impact the supplementation has been having. You should see a difference within four weeks. If anything's going to happen, you'll start to see things creep. But it's not like going from if your hemoglobin was 100, all of a sudden in four weeks it's going to be 120. It might be 104 in four weeks. And then it might be 110. I feel like it's this exponential creep. Once it starts to change, then it really changes. But, yeah, it's a slower creep. Hence why I think early intervention is a really great approach is rather than waiting and seeing what's going to happen, we know that your hemoglobin is going to go down theoretically. We know that your ferritin stores are going to be used up and depleted. We know that you have increased iron needs. So why sit and wait and see what happens when you prevent it from happening in the first place? And you know you could consider something like second daily supplementation rather than daily supplementation or lower dose because it's not like if you have a supplement or some food with iron in it it's not like oh great i had all this iron it's not just going to soak into your body.
Mel:
[46:57] You know and be used there's a it'll your body will only take a certain amount of iron per day which is why there's this slow creep. Like it doesn't matter how much you put in, it'll only let in a small amount. So yeah, what you take is not what's absorbed. And then even more so the type of iron impacts, you know, you mentioned earlier, the bioavailability of that iron. There is some ions are more bioavailable, so actually available for absorption than others.
Jaimee:
[47:32] And that differs from person to person too I had one woman on spirulina only and she took up so much iron from that we had to stop it and other women it doesn't help them enough at all so each person like what works for me might not be what works for you either and that's really worth remembering and understanding it's a bit of trial and error yeah it
Mel:
[47:56] Is and it also depends on what your dietary needs are so people who are vegetarian or vegan or pescatarian who are having less red meats which is a really valuable source of iron you can definitely still get iron from other sources but you have to be conscious about it you know when you eat red meat you can, sort of not accidentally but you know systematically keep topping up your iron quite easily whereas you have to be a bit more thoughtful about it if you're getting it from vegetable or other sources.
Jaimee:
[48:28] And if you're eating vegetable-based iron in food sources you'll absorb that better if you have that with meat so obviously high iron foods would be like beef lamb liver sardines but there's also iron in things like yes spinach lentils spirulina beans quinoa kale nettle cacao things like that but you will absorb those plant-based irons better if you have any sort of meat with it so even like chicken or poultry or seafood like it will just help your body take it up better and if you have sort of citrusy foods anything with vitamin c in it will help you absorb it better too. So strawberries, capsicum, tomatoes, broccoli.
Mel:
[49:12] Even vitamin C supplement. Yeah.
Mel:
[49:17] And so vitamin C increases the uptake of iron.
Jaimee:
[49:22] It sort of inhibits hepcidin from blocking it. So they're the two approaches to helping absorb iron better. You could take your supplements every two days. they reckon that hepcidin probably if you have an oral iron supplement hepcidin then comes to the party more than just from a diet and it hangs around for about 24 hours so that's where the idea came from of taking oral supplements every two days so you can do that to try and counteract or to absorb as much as you can without hepcidin blocking it or you can take a thousand milligrams of vitamin C with your iron supplement every day and that will help block hepcidin from blocking the iron if that makes sense.
Mel:
[50:05] For those who are supplementing with iron just know that a lot of iron supplements are not what we would call food-based. They don't just rummage through food find the iron and put it in a tablet and give it to you. That's not how most iron supplements are that, So the common ones that your clinician will put you on if you're kind of going through a more, you know, medically trained people, you know, Ferrograd C and Moltofa are the really common ones that I've seen. These are not what we would call food-based ions. And they can have the side effect of constipation because it's kind of a, it's a formulated medicine, obviously, for iron deficiency. And they're really high doses. So I feel like these particular types of supplements do put your body on high alert, but also they don't have great bioavailability and then they also have side effects. The benefit of a food-based supplement is that you reduce some of those side effects.
Mel:
[51:08] The bioavailability is better because your body is already available to food sources of nutrition. and I believe it doesn't pique your hepcidin as much as the other types of supplements. So when I say food-based supplements, you know, some women talk about beef liver capsules, awful capsules, herbal supplements that are high in iron or magical fairy water as I call it. I just want to say, I definitely had an opportunity to get sponsorship for this podcast. Yeah. I consciously decided not to.
Jaimee:
[51:51] I wondered, are we saying brands?
Mel:
[51:53] Yeah. So here's where I'm mentioning this. Is there are three particular brands of iron supplements that I routinely and kind of have forevermore used in my clinical practice to help with iron deficiency. And again as I said could have definitely sought out sponsorship for these particular brands but I decided not to because I just want to let everybody know that I have been using these forever and I'm not mentioning them because I'm getting any kickbacks or anything like that this is an unsponsored podcast episode but the supplements that I choose to use seem to be more food-based they're lower dosage, And, yeah, I've had excellent results. So I will.
Jaimee:
[52:39] Well, we're just talking about as midwives, aren't we, what we've seen working in our practice. So this is not because we are affiliated with any brands. We're just telling you what's worked for people based on our clinical experience.
Mel:
[52:52] Correct. Good. Yes. There's only been that one single client of mine who's gone ahead and had an eye transfusion and everybody else has managed to avoid it with this particular protocol. So I'm going to tell you what I do for my clients. again this is rooted way back in when I trained as a naturopath originally before I was a midwife so I have some residual nutritional knowledge and obviously a lot of knowledge about the body but, so I use a particular product called Floridix which is a herbal iron supplement super low dose I think it's about 10 milligrams per dose which is you know if anybody said what that's going to do nothing but really bioavailable because it's a liquid and it's food based then there is this other product called spartone and i wish i had another way to describe it but they do essentially they've found this stream of water that is high in elemental iron it must be minerals coming off some kind of you know somehow into the water they collect it in sachets and sell it as the product Spartan.
Mel:
[53:59] Honestly, with those two things alone, Floridix and Spartone, most of my clients have managed to recover from any form of iron deficiency in their pregnancy before it's become an issue and before we need to go to something else. If those two things don't work, I recommend this third supplement and I recommend they take them all together, not not together in one go, like just scatter them through the day. There's another product by a brand called Bioceuticals. it's a practical brand but you can get it over the counter like it's behind the counter if you go to a chemist or a health food store and it's called iron sustain again low low doses if you told people you were using these to correct iron deficiency they would laugh at you because the doses look so low but they have high levels of bioavailability yeah which means that yeah more of that product is available for absorption into your body than in some other less food-based products.
Jaimee:
[55:02] Have you tasted Spartone, Mel?
Mel:
[55:04] I have because I took it through my own pregnancy. I had the weirdest thing happen. My hemoglobin when I was first pregnant was 148, which is quite high.
Mel:
[55:17] I've never even seen anybody's hemoglobin that high. So much so that we thought maybe I might have hemochromatosis I don't I knew I didn't but I thought my gosh I'm gonna be totally fine when I rechecked when we rechecked things and I don't even know if I had iron studies actually because I just thought I've never had a problem yeah why would I check it but my hemoglobin dropped to like 107 from 148 it was insane and for the first time in my life I had to think about iron supplementation and I started taking it and there wasn't a lot of effect initially and then I spoke to a naturopath friend of mine because you know I've still got naturopath friends and she said there's lots of other ways that you can increase iron absorption and so she said don't have the iron supplements anywhere near dairy food caffeine obviously add the vitamin c like we've already mentioned and she recommended things to help improve my digestion she told me to eat bitter greens and at the time you know and I still am an avid gardener so I had things like dandelion leaves and rocket so like bitter greens to get digestive juices started to sort of prime my digestive system to be at peak you know absorption and.
Mel:
[56:44] And so I did all those things and the supplements, like really low doses, and it came good just fine.
Jaimee:
[56:52] To me, I struggle with the aftertaste of Spartone. It tastes like liquid blood. Not that I've ever drunk blood, but I can taste it's got that metallic taste.
Mel:
[57:01] It's got a metallic flavor.
Jaimee:
[57:02] But I tried an apple-flavored one that someone gave me, and that was much more tolerable. So if you're sensitive to taste, that might work better.
Mel:
[57:11] You can also put, if you freshly juice some oranges.
Jaimee:
[57:15] Yeah, that's a great idea.
Mel:
[57:17] Yeah, try not to get store-bought orange juice. There's all kinds of stuff. But if you can freshly juice a few oranges and then I just put the Spartone in the orange juice and you can't taste it. It looks like water. Yeah, it does. Yeah, you attempt to just chug it down and you can. It does have metallic taste though.
Jaimee:
[57:36] Yeah I had a client whose numbers were bad and she told me she felt just fine and I had a heap of Spartone samples from a conference I'd been to and they left them behind and said could you give these out or use them I said yes thank you and she took Spartone only and felt so much better for it over time and she said I didn't realize how rubbish I was feeling until I corrected it so So yeah, I think it's very effective if you can find a way to drink it. The other food-based supplements I really love is Ancestral Nutrition. They have one called Primal Energy and it's full of organ meats, which is really our original superfood and most of us are not eating organs anymore. And that's probably why many of us are iron deficient, if not anemic. Foraged is another company that do a beautiful food-based supplement. It used to just be as like a little shot and it has organ meat in it as well. But now it's in a capsule as well so I love those two as well so I think it's good to start with food-based options and whole whole foods and looking at that holistic approach sometimes though like you had happened Mel like you thought you were just fine and then you check at another point in pregnancy and you really dropped or crashed sometimes women need something else that's
Mel:
[58:54] Right and so those food-based ones typically yeah you I wouldn't even suggest rechecking until three or four weeks after yes you're not checking for complete.
Jaimee:
[59:03] Cure you're
Mel:
[59:05] Just checking for are we heading in.
Jaimee:
[59:07] The right direction are
Mel:
[59:09] These supplements going to do what we need them to do or like do we need to do something different and actually i had another client who So her and her son were on Moltofa, the more pharmaceutical iron recommendation, and they.
Mel:
[59:29] She was on it for three years, as was her son, who was only little. He wasn't even at school yet, and both still really struggled to get their iron levels up, and they were still constantly anemic. And I said to her, well, you've tried it for three years. How would you like to try something else? And she's like, oh, I'm open to it. I mean, she's like, I'm on it, but it's not doing anything. I put her on the Floridix, Spartone, and Biosuiticals combination.
Mel:
[59:59] Within weeks she was like I feel amazing she put her son on it too he wasn't on the iron sustain just the two liquid irons at that point and we checked it and you could just see their bodies like soaking it up like yeah like summer rain and she was so angry at her GP for not offering her something different and she was so inspired that she actually went off and studied naturopathy in the end. I can't believe this has happened. You know, the doctors told me to do this and it didn't work and no one listened and, you know, there's such a simple solution. Over-the-counter food-based iron supplements did the trick and I think when you combine lots of different ones, you also increase the bioavailability again, all the options. And actually, you mentioned it earlier too, hepcidin is lowest in the morning. So aim for iron supplements in the morning. But then also not just like loading it all. If you can scatter it through the early part of the day and kind of drip feed it, you might actually increase the absorption than putting a whole bunch in at one time.
Jaimee:
[1:01:09] Absolutely. And that's what I always say to my clients too. And so it really depends if you're talking about heme supplements or non-heme. Most oral supplements are non-heme. So they're more of a plant-based supplement, but they're bound up with all these other things like Ferrograd C, which is one that most people have probably heard of, is very commonly prescribed by GPs like Maltifer. But it's like it's ferrous sulfate, like it's probably you only absorb between 1% and 15%. So it has a big number on the front. So there's elemental iron and the chemical compound on the front of your iron bottles. it'll have a big number like ferrograd C says 325 milligrams of ferrous sulfate and So you think, wow, I'm taking in a lot of iron. But actually, that's not the number to look for. You want to look on the back of your supplement and it has the elemental iron. So ferrograde C, the elemental iron is 105.
Jaimee:
[1:02:07] If you're only going to absorb 1% to 15% of that, you're only actually absorbing 1% to 16 milligrams of iron. And that's why women have all sorts of gastrointestinal issues or it just doesn't work very well. And because that's a non-heme iron like yeah that's going to be blocked by all sorts of things like not just tea and coffee and calcium but magnesium, turmeric, whole grains, soy, nut, legumes, fibres, pretty much anything that you might eat at breakfast time and you're needing to have it one to four hours away from all those things that will block its absorption. So it's really problematic. You can see why people don't actually get very much iron from some of these mainstream oral supplements.
Mel:
[1:02:53] That's why I just think the food-based iron is such a hack because your body's used to just receiving that kind of nutrition.
Jaimee:
[1:03:04] The opposite to non-heme would be a heme oral supplement and they're animal-based or meat-type supplements. So they're still considered an oral supplement, but their absorption's way higher, like at least 35% up. and you don't have to have all the co-factors like the vitamin C. You don't have to avoid any meals like you can have it with your meals. So I really love that. My favourite brand is Three Arrows Simply Heme. Once again, I have no association with any company but I just find that works. It's hard to get in Australia so I also use a lot of the ones that you have said already for women that are on oral supplements and sometimes a combination.
Mel:
[1:03:44] And also I think one thing that deters women from choosing the food-based supplements if they are more expensive. Yeah. But they're way better quality and I do believe you're going to get better results. The chemist ones are cheaper but they're not as effective and they're the ones that have theā€¦ All.
Jaimee:
[1:04:04] The side effects, yeah.
Mel:
[1:04:06] So, yes, you know, just acknowledging that, that some people are like, I can't spend.
Jaimee:
[1:04:11] Yeah, that's right. And that's actually some of the reason my women have, some of my women have chosen, my clients have chosen an iron infusion because it actually has worked out more economical for them in terms of what they're spending?
Mel:
[1:04:26] Well, let's talk about iron infusions because a lot of women are being offered it. Now, when I first started in private practice, it was really quite unusual to have an iron infusion and now it feels like they're just doling them out to women all the time. Women often get offered it and it's usually closer to the birth where they're like, oh no, we need to get your haemoglobin up before the birth because thinking of you, you know, when you lose blood through the labour and birth process, that, you know, that's going to impact you afterwards. But, I mean, iron is super important all the way through your pregnancy. I feel like this as well. It's like it's not just this rescue mission at the end of your pregnancy to just get this hemoglobin number on your blood test results so that you can stay in the home birth program or stay in the birth centre or feel really good after the birth. It's actually like how do we have sustained wellness all the way through our pregnancy. But, yes, so an iron infusion, it's IV, so intravenous through your vein that will insert a cannula and you get it directly from.
Mel:
[1:05:39] And there is also intramuscular I've seen used. It's not as common anymore. They're a little bit sore because they go into your muscle. So they still actually take some time to work because your body still has to go through that process of soaking it all up, storing it away, converting it into hemoglobin. There's a lot of processes. So even then, it's not kind of the quick fix. So, yeah, they give you a single dose and you don't have to have any supplements after that. So some women like that. They're like, put it in and off I go. I don't have to think about daily supplementation. It's all there. But you still need to wait about two weeks to feel the full effect and to actually see that change on your blood test. So it's not like I'll have my iron infusion yesterday and then today I'm all good. There's still a process that we have to wait for. Jamie, how do you describe the process of getting an iron infusion to women?
Jaimee:
[1:06:38] There's been quite a few different types of iron infusions over time, but the two most common ones that most clinicians will be familiar with, one of them is called iron polymaltose. That has to be given over about a 90-minute period, so you're talking an hour and a half. It's one dose of up to 2,000 milligrams per year. It's considered safe in pregnancy, they'll often give women a test dose, like a small little 100 milligram dose over half an hour first, just to check that they're not going to have a negative reaction.
Jaimee:
[1:07:09] And they'll often give women now antihistamines or low dose steroids before they have the iron infusion, just to reduce their potential reaction to it or any negative side effects. So that, when I started in midwifery practice 10 years ago, was certainly the main ones we were doing in hospitals but there's another one now its common name is pharyngect or it's it's the ferric carboxymaltose and that's a quick iron infusion that's given over 15 minutes and it's also considered safe in pregnancy both iron infusions based on the research that i've looked into is considered to be better tolerated than oral or more effective obviously that at quickly raising ferritin and haemoglobin than oral supplements. And this pharyngect is also considered more effective than the polymaltose that's over a longer period of time. So it really rapidly restores iron. And the research that the haematologist in my area has done and published shows that much better outcomes for mums and bubs when they do have their iron stores boosted. And I think with all iron infusions, women usually sit for about half an hour afterwards just to once again check for any reaction. So some of the side effects from iron infusions, like a common side effect, which is considered one in 10 women might experience these, would be like headaches, some dizziness, maybe some high blood pressure temporarily,
Jaimee:
[1:08:37] A bit of flushing, nausea, or sometimes a site reaction where the drip went in.
Jaimee:
[1:08:42] And they're usually transient side effects, some uncommon ones. So the ratio for that is considered less than one in a hundred. So it would be an actual allergic reaction to the iron infusion, sometimes tingling, numbness, a racing heart, low blood pressure, shortness of breath, some sort of pain throughout the body. And then sometimes if the drip has leaked into the woman's arm, you get a permanent tattoo like stain. So that's something to be aware of. If you're offered an iron infusion, just keep an eye on it. Make sure someone's keeping an eye on it. And obviously, a rare side effect would be an anaphylactic reaction to the iron.
Mel:
[1:09:23] Is it commonplace to offer an antihistamine or a low-dose steroid prior to...
Jaimee:
[1:09:29] Yeah, well, it seems to be here in the clinic that I'm near. The women often tell me that they're offered that. Yeah, and that's meant to help just reduce reaction, I believe.
Mel:
[1:09:42] Yeah. So I guess for women listening, just know that if you're considering the iron infusion, there might be additional medicines that go along.
Jaimee:
[1:09:50] Yeah, that's right.
Mel:
[1:09:51] Depending on the philosophy you have about what you want to do.
Jaimee:
[1:09:53] Yeah, exactly. And you can decline those, obviously. You always have the right to get the information you need and make a decision that feels right for you.
Mel:
[1:10:04] And I think ultimately, as with everything, prevention's better than a cure. So early on, if you, you know, those early blood test results pay extra special attention to the iron stores, your iron studies, your haemoglobin, how you're feeling as a woman, also your history. Are you typically running anemic anyway, prior to being pregnant? Something to really focus on, especially if you want to avoid an iron infusion, if that's the philosophy that you have, then you're, Yeah, just being consciously topping up all through your pregnancy.
Jaimee:
[1:10:41] Yeah, I agree. Like if you can raise your ferritin, your iron stores before you fall pregnant, you'll do much better. Once they drop, it's harder to get them back up in pregnancy, once again, because of that demand. If you can sort of boost yourself beforehand in a natural way through your diet or food-based supplements, yeah, I think that's a great idea.
Mel:
[1:11:02] Absolutely. So one last thing I want to talk about, And the only reason I want to talk about it is because if you're anemic and you're looking for solutions and you start Googling, you will probably come across something called the Root Cause Protocol. I certainly don't endorse it, mostly because it just doesn't make sense to me. From a naturopathic perspective, you know, I have multiple health degrees. You know, some of them are in complementary therapy. There's a lot of research and work that I've done in anatomy and physiology, nutrition, nursing, midwifery. I feel like I have the capacity to understand a lot of things, but I really tried. I really tried to understand the root cause protocol. I went through their website. They do have a course, which I did not purchase, but I just couldn't make sense of how they were trying to explain it. I did take away that they believed that we were supposed to be in a low hemoglobin sort of hypoxic state by the end of pregnancy and that that was somehow a normal physiological part. I also think, Jamie, that they're against the storage of iron in the body. And they don't, yeah, they don't believe that measuring ferritin is even an accurate measurement for diagnosing anemia.
Jaimee:
[1:12:24] Yeah, I don't follow them either and don't agree with the underlying philosophy, but my understanding is that they've written an article called The Deceit of Anemia. So they are more interested in or believe that cause like problems in someone's body isn't from anemia it's from an imbalance of other minerals like magnesium copper and iron together and i think they do look at ferritin but they're happy as long as it's above or around 30 which the hematologists in my area would define as severe iron deficient so yeah they actually tell people to stop taking iron supplements to stop taking vitamin D which helps you absorb iron they tell people to donate blood so it seems to be the exact opposite of what I have found to be beneficial to clients and to women yeah
Mel:
[1:13:19] And they had a protocol they've got some kind of 10-step protocol things on their website again I just I really tried to read some of their blogs and they were very hard to decipher like the The information wasn't forthcoming. So just if you come across it, I mean, go right ahead, see if you understand it. If it's right for you, then please feel free. But I personally couldn't understand the philosophy and the idea behind their recommendations. And I also think that pregnancy is actually a really short time and it seems like the protocols that they're recommending take quite a while if you're looking. And, you know, their protocols, they applied to general sickness outside of pregnancy. So maybe some people would have time to experiment and work with some of those protocols, maybe not to any ill effect. But I think in the short period of time that you've got during pregnancy that, you know, going through something like the root cause protocol, it's kind of not in the interest of like a speedy recovery from what you're feeling. Like if it doesn't work, you need a lot of time to change your mind.
Jaimee:
[1:14:30] They do talk about kind of holistic care and food-based supplementation. So we would agree in that respect. But actually, Mel, you and I are also looking at the true sense of the root cause. We're looking at the whole picture for a woman. We're not just looking at an isolated eye. And we recognize that it's in the context of her whole body and reasons she might be. And I think that's what we want to do, take a really holistic approach and help a woman feel as well as she can because if she goes into her postpartum feeling boosted, she's much less likely, research shows she's much less likely to have postnatal depletion or postnatal depression, which makes sense. If you are anemic, you feel pretty ordinary. We want to give women and help them to have really good starts to their postpartum. I think that's Yeah, we look at the broad picture as well. And if your clinician's not necessarily doing that, you can do that. Find what you need. Look at your diet, your supplement. That's kind of what my masterclass was for. It's aimed at midwives and clinicians, but I've had family and friends and clients use it and find it helpful as well because I've tried to keep it in very everyday language and make this information really accessible because so many of us are probably anemic or iron deficient at least, even when we're not pregnant.
Mel:
[1:15:53] It was a great class. I really enjoyed it as well. And I think too, if you feel like you don't have access to a clinician who can really pay attention to, you know, if you're not feeling great in your pregnancy and maybe you're in a fragmented care model where you don't really have a lot of time with your practitioner or you see somebody different every time or, you know, you say, I want to check my iron and they say, you don't need to check your
Mel:
[1:16:17] iron, we've already checked it. It's okay to race off to your gp if you have access to a gp i really want to check my iron studies and my full blood count because i think i might be iron deficient but i just don't have access to these tests through my maternity care that's completely fine too it's actually completely within the scope of a gp to be able to find out if you're anemic it's it's not complex and and in fact you may even be able to decipher your own blood test results and make your own decision at this point.
Mel:
[1:16:49] Great. Look, I feel like we've given just the right amount of information in this episode. Thanks for being here, everybody. That was this week's episode of The Great Birth Rebellion and all of Jamie's details are in the show notes if you want to pursue her resources further. To get access to the resources for each podcast episode, join the mailing list at melaniethemidwife.com and to support the work of this podcast wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com follow me mel @melaniethemidwife on socials and the show @thegreatbirthrebellion all the details are in the show notes.
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