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The Repeat CBC
The CBC is a Complete Blood Count, a test that quantifies different components of blood. It is one of the blood tests performed at the beginning of pregnancy, is offered again around 28 weeks of pregnancy, and if anemia is found, it is offered a third time around 36 weeks to see how treatments for anemia are working. Occasionally, it is requested every week after 36 weeks until a comfortable value for out of hospital birth is achieved. The midwife will go over your values with you after every test.
White Blood Cells
The first blood component listed in most lab result forms is the white blood cell count. Values that are abnormally high could be a sign of an infection. Your midwife will ask questions to try to identify the cause. An infection from a UTI, common during pregnancy, can cause complications such as preterm labor, and treatment options would be discussed. Sometimes, the culprit is seasonal allergies, and although uncomfortable, are benign.
| Item | Complications for Pregnancy |
|---|---|
| White Blood Cells | Low: may require referral for followup High: infection/inflammation, may require referral |
Red Blood Cells
Your midwife is very curious about two parts of the red blood cell count; hematocrit and hemoglobin. Together, these values can identify anemia. It is a common misconception that anemia causes postpartum hemorrhage. Rather, the relation anemia has to postpartum bleeding is how well a person will tolerate any amount of bleeding.
The Hematocrit is the percentage of the blood that is made up of red blood cells. Together with the other components of the red blood cells tested, an indication is given that the cells are in normal range for the size of the cells and how many are present. Hemoglobin is the part of the red blood cell that carries oxygen to all the tissues and organs. When a person does not have enough oxygen to their tissues they will feel chronically tired and weak. When they don’t have enough to their brain, they will feel light headed and may pass out.
| Item | Complications for Pregnancy |
|---|---|
| Hematocrit, Hemoglobin |
Low: Iron deficiency, recent hemorrhage, may require referral if genetics are believed to be involved High: Dehydration, impending toxemia, high altitude, toxemia, may require referral when reason unknown |
Therefore, when a person has low stores of red blood cells, or anemia, even minimal blood loss from childbirth will have a negative effect on recovery. They easily faint, are extremely weak and have rapid breathing and heart rate to get oxygen circulating to the vital organs. Caring for a newborn is very difficult while suffering from anemia. When anemia is caused by excessive blood loss, as in a postpartum hemorrhage, milk supply can be affected.
A drop from the baseline value gathered at the first OB appointment is expected by the 28 week CBC collection. Blood volume is expanded, diluting the amount of red blood cells. No drop from the baseline can be a sign that preeclampsia is developing. Even with a normal drop, the midwife will ask for signs of preeclampsia such as headache, visual disturbances, bloating in the face and hands and under the ribs on the right side of the body, along with checking blood pressure at every visit.
Platelets
Platelets are blood cells that bind together when a blood vessel breaks, causing a clot to stop the bleeding. They are essential for the body to control bleeding for severe perineal tearing during childbirth and at the placenta site after the baby has been born. This is the part of the blood that prevents postpartum hemorrhage.
| Item | Complications for Pregnancy |
|---|---|
| Platelets | Low: Postpartum hemorrhage, may require referral High: May require referral for followup |
Other Possible Issues
CBC values that are out of normal range may be an indication of an underlying condition or disease. Midwives are trained in normal pregnancy and give recommendations to keep pregnancies normal to low risk. The complications listed are specific to pregnancy in part because it is out of scope of practice for a midwife to make a diagnosis. A midwife may make dietary recommendations for anemia and remedies for seasonal allergies causing inflammation, but abnormal values on the CBC may need a referral to a physician for a proper diagnosis and treatment plan to be made.