B-thal minor pregnancy and the labor/delivery experience

Hello everyone,

I'm looking for information specifically on the labor/delivery experiences of b-thal minors on this site.

I have read every b-thal minor post on this forum related to pregnancy and they have been extremely enlightening and helpful.  Like everyone else, I discovered that none of the ob/gyns I have visited (I have been to three different ones) really know anything about b-thal minor and certainly weren't aware of the elevated risks in pregnancy.  My b-thal has always been well-managed and I have very few symptoms as long as I am eating well, taking my folic acid, and exercising on a consistent basis.  I have known I was a b-thal minor since early childhood. 

My hemoglobin was 11 at twelve weeks pregnant, and has dropped down to 9.2 at 28 weeks.  After reading these posts, I don't think I am taking enough folic acid (I'm taking 800mcg in the natural "folate" form which apparently is less absorbable to the body) and will immediately start taking more.  I already take 400 iu of natural vitamin E and have since the beginning.  Actually the first three months I was taking 800 but then dropped down as one ob/gyn was concerned about "bleeding."  I'm not sure if I should go back up to 800 iu or not: any thoughts on the proper dosage for vitamin e would be helpful.

I was really committed to a midwife-assisted home birth until my last reading just came through at 9.2, which was lower than I expected (because I feel great, really not especially anemic at all).  I was really surprised by the low reading.  The hospital is about 7 minutes away by car from my house should the need arise, and the midwives I have been working with are very conservative: meaning, if you are not progressing for any reason or they have concerns, they take you to the hospital speedily.  I am interested in avoiding a lot of unnecessary medical interventions such as the IV, electronic fetal monitoring, not being able to eat or drink (this is especially important to me as a b-thal minor because I feel at my best when I eat small frequent meals, and cannot go long without food without feeling a bit weak), having to labor on my back, side effects of an epidural, etc.  The extensive research I have done actually shows that a lot of these "normal" procedures actually can end up putting your baby at risk, or lead to other subtle effects later on.  A homebirth is just a lot more "me" (I am one of those slightly crunchy types that avoids genetically-modified food and only eats organic beef, etc.)    But of course I won't do it if it is going to put my baby at risk, or if I think there is a higher than normal chance that I will need to be in an emergency hospital setting when I give birth due to my b-thalassemia.

Has anyone with b-thal minor attempted a homebirth or non-hospital birth?  One of the primary risks to women in homebirth is hemorrhaging, and I know we are at higher risk actually for blood-clotting, so I wonder if there is any elevated risk of hemorrhaging during delivery for b-thal minors or not.  Obviously I am not going to do anything that is going to harm my baby, but I am also interested in her longterm health and flourishing, which I do not think is best served by a lot of the unnecessary interventions that happen in hospital births in the U.S. (hepatitis B vaccine on the first day, Vitamin K shot, eye ointments, etc.), or the much-increased risk of C-section when women are not allowed to labor naturally and have such things as their membranes prematurely ruptured by the doctor, etc.  So at this point I am pretty conflicted about what to do.  A birthing center attached to a hospital would be the best bet, but that is not available where I live.

Any discussion on natural childbirths (no epidurals) that b-thal minor mothers have had, or their labor/delivery experiences in general would be VERY appreciated.  Did you require transfusions in the hospital, special monitoring of the baby, did you hemorrhage more than usual, did you have any other complications during delivery related to your b-thal, etc.?  So far my baby is growing well and ultrasounds show on-target growth for her due date in October.

Very much appreciate the forum and the wealth of knowledge and experiences available here.

Sara

Hi Sara,

Your Hb level is still strong and no cause for concern. I would agree that 800 mcg folic acid is too low and should be raised to at least 2000 mcg. 400 IU is a good daily dose of vitamin E. Problems with thal minor pregnancies do not usually happen in a sudden way and you will have some prior idea if things are going smoothly. As far as the delivery, if the baby is positioned right, there should really be no problems.

My wife has had 4 of our 5 children at home and one in the hospital. The home births were much better emotionally and we encountered much less interference. An episiotomy was done with the hospital birth but never with the home births. My wife suffered some minor tears during the deliveries but this was much easier on her than the episiotomy and there was very little blood loss from the tears. We had various adventures with some of the births, with one daughter being very stubborn and taking her sweet time about coming out and one son out of position but the work of the midwife got him turned and the delivery was smooth after that. Even our last son who was 9 lbs and 14 ounces presented little problem. I am a real believer in home birth and think there are many advantages. If you have a good midwife who knows how to handle the various minor issues that may arise, you should have no problems. However, when your midwife says it's time to go to the hospital, don't argue the point. With our first child, our midwife had a prior bad experience that affected her confidence and we ended up in the birthing room at the hospital. There is nothing you can do once the midwife makes that decision, so be prepared for all eventualities.

Good luck with the rest of the pregnancy. I will note that most minors don't even know they are minors when pregnant, so you can be sure that some percentage of those opting for home births are unknowingly thal minors and experience no specific problems as a result. If a woman is healthy and does not have a history of low Hb or an enlarged spleen, the likelihood of a normal delivery is excellent.

Sara,

My Hb is typically around 10, but dropped into 8's during my pregnancies.  When it was checked at the hospital during labor, it was back up at 10.  I think maybe your body prepares itself.  Also, my sister typically runs in the 9's and dropped into 7's during her pregnancies.  she had great pregnancies and deliveries, no complications.  Don't be discouraged if your energy and mood doesn't bounce back as quickly as your friends' or if nursing (milk production) is more of a struggle than you anticipated (which it always is the first time, anyway).  Of three sisters with thal minor, one of us did great after and nursed longterm (she has the highest Hb), and two of us learned to expect a more dramatic need for recuperation and tried to nurse but could never meet babies' needs.  I think knowing what to expect makes it easier.

I hope this is helpful,
Katrina

Thank you Andy for the information and the encouraging reply.  It's great to hear that your wife had 4 home births!  One of the biggest issues with b-thal minor and pregnancy is just the scarcity of information; where I currently am (in Southern California) no ob/gyns have had much experience and the midwives I am working with haven't (knowingly) assisted in a home birth of a thal minor.  So any real-world examples are so valuable.  The midwives are ready to go for it though and on board as long as there are no higher risks for hemorrhage.  I will increase my folic acid to 2000 mcg and stick with the 400 iu for Vitamin E.  Thank you again VERY much for your response.

Thank you also Katrina for your helpful notes about your hb numbers during pregnancy and your sister's. It's very interesting that your numbers rebounded in time for delivery: perhaps this is because of the time it takes for the body to adjust to the increased blood volume that happens at the end of second trimester/beginning of third. 

Thanks again to you both.

Sara

One quick question, Andy:  I has assumed that your wife who had the home births had b-thal minor, but then I realized you hadn't actually said that.  Does she have b-thal?  Thanks so much for the clarification.  Either way, the information is very helpful, but if she had b-thal minor and had the successful home births, that will be important information for me to take to my midwives as they try to decide whether I qualify as a "low-risk" labor or not.

Thanks!!

No my wife is not thal. I mentioned the home births for the general comparison. As long as the Hb doesn't drop to the 8 range, there is little reason to be concerned about the need for transfusion during the birth. Keep in mind that Hb drops in pregnant women through dilution and this does not reflect the true oxygen carrying ability of the blood.

Thanks for the reply!  I had my blood count checked again and it has increased from 9.2 to 9.8.  The homebirth midwives are not worried about it and we are going ahead with plans for the homebirth.  I did increase folic acid supplementation, and also started taking spirulina and wheatgrass tablets every day for a month before the retest.  I have no idea if those measures helped or if it was just a natural increase back up once my body had time to adjust to the major blood volume increase.

Sara

Hi sara,

Some people do respond to spirulina and wheatgrass, so it may have had some effect on your Hb level. Even if not, both are worthwhile supplements with positive properties. Whatever the case, the rise in Hb is very encouraging and the opposite of what would normally be expected as the pregnancy progresses, and very reassuring in terms of being able to have a home birth. Best wishes on a safe and healthy delivery.

Thanks so much again!  I'm only about a week from my due date, so I'll update everyone on how the homebirth goes once it happens.  But just an update in the meantime: I tested again one month after the last test and my red blood cell count was 10.6!  As I am normally at 11, this is really as good as I can expect right now and I was very pleased. 

So, this means in three months I went from 9.2 to 10.6, after supplementing with additional folic acid, spirulina, and wheatgrass, from approximately 6 months pregnant to 9 months pregnant.  My gynecologist had said that I definitely wouldn't see an increase, but she was obviously wrong.  I am grateful for this site and the wealth of information on it, which is vastly superior and more extensive than anything I have encountered from any doctor I have ever had in the U.S.