Her perfectly shaped eyebrows raised in surprise as she flipped through my blood results.

“How are you feeling?” she asked in genuine concern.

“Depleted,” I said flatly, “like death warmed up.”

“It’s no wonder,” she said in amazement, “you are low in everything! And your iron levels have plummeted from 43 to below 10 in just four weeks.”

“Oh, that explains it,” I said breathlessly.

The typical range for ferritin (iron) is 20-250 ng/ml (which varies slightly depending on the pathology center). They say that to feel even slightly normal your ferritin should be greater than 30; mine was less than 10.

She listed off my blood results (of the few things we got tested).

Low iron.

Low protein.

Low zinc.

Low b12.

Low magnesium.

Low vitamin D.

Low calcium.

These babies had literally sucked the life out of me.

It seemed as though the only thing I wasn’t low in was folate (B9) and that’s because I’d been taking a high dose Folic Acid (5mg) as both embryos took (in order to prevent neural tube defects like spina bifida) – and it was the only supplement I could stomach in the first trimester.

My determination, as a midwife, to take prenatal vitamins in the first trimester ended up being an epic fail, leaving me humbled and profoundly empathetic.

In clinic I would try my hardest to emphasize the importance of vitamin supplements in pregnancy, telling women – with an extravagant flare of my arms – that babies will extract the calcium out of your teeth and bones if necessary, in order to get what they need to grow – literally sucking the life out of you (and I only recently learned that they also extract the omegas directly out of your brain for their own growing brains).

Now, there will always be those people who believe vitamins and supplements to be a scam; they clearly have NEVER felt the way I did as I sat in the dietician’s office that day.

I stared at her stunning Greek features as she straightened her glasses. I felt incredibly frumpy with my bulging varicose veins on my atrophied legs, my massive belly and my edematous (swollen) face.

“We need to get you feeling great,” she said with determination.

I laughed, “Is that even possible?”

“Well, this blood work is horrendous. We need to fix you as best we can.”

With this, she began compiling together a mound of supplements:

Protein powder

Iron supplements (a new generation of iron called ferrous glycinate which is better absorbed – more bioavailable – and doesn’t make you constipated)

Zinc tablets

Magnesium powder

Calcium supplements

Activated B Vitamins

Vitamin D supplements

Omegas (pure EPA/DHA – vital for brain development)

Pregnancy Probiotics

And Prenatal vitamins

At this point I still had some residual nausea, so I gagged at the thought of all these pills, but I was determined to do what was necessary to feel better. Plus, one of the main reasons I had gone to the dietician was because I had no idea how to nutritionally support growing twin fetus’. Plus my obstetrician, very wisely, includes a free consult with a dietician as a perk of her package.

Along with these supplements, she also encouraged me to take extra Vitamin C (which can significantly increase the absorption of iron – and has a whole other slew of benefits (see The Vitamin Research).

She encouraged me to increase my fluid intake (which I eventually was able to achieve – not with water, but with apple juice) and take Benefiber to help with my constipation (the probiotics and the magnesium powder also have the added benefit of helping with constipation).

We discussed a meal plan high in calories (as I didn’t have the physical space in my stomach to eat big meals), and high in non-heme iron/plant iron (as I don’t eat red meat).

I loaded up my meal plan, and ALL of my supplements and walked back breathlessly to the car.

One week later I arrived at my follow-up appointment grey and even more breathless.

The dietician stared at me in shock.

I could hardly converse, and I hadn’t even been sure if I was going to make the appointment that day.

She measured my hips and pursed her lips in worry.

“You’ve lost weight,” she said with concern, “you’ve lost two centimeters around your hips – which is ALOT. You need to call your obstetrician. I think you need an iron infusion. Every cell in your body will be sluggish. NOTHING in your body can function normally without iron.”

Of course!

An iron infusion!

Why hadn’t I thought of that?

Being a midwife, so far, seemed to have brought me very little value in my pregnancy because I was so incredibly impaired that I was completely unable to function or reason normally.

I immediately called my obstetrician and she sounded shocked that I hadn’t called her earlier to let her know how I was feeling.

There was a slight “You know better than this, Katrina” tone to her voice.

I saw her in clinic the next day and she was extremely concerned by how pale, breathless and tachycardic (fast heart rate) I was.

“We usually try to reserve the iron infusions for your third trimester, ” she informed me, “but you are way too unwell and symptomatic. Even though you are only 20 weeks pregnant, we need to give you an iron infusion now.”

She called the hospital and booked in an appointment for me.

“I hope you notice an immediate difference,” she said hopefully, “but it usually takes about three weeks to feel the full effects of the iron infusion.”

“You also realise you won’t be going back to work anytime soon, right?” she said sternly as she typed out a medical letter for my employer.

I sighed.

I had really hoped that by twenty weeks I would be able to return to work, but at this point I could hardly breathe or walk and I already looked 6 months pregnant. Perhaps I should resign myself to the fact that I may not be returning to work after all.