HELLP is a serious complication that can sometimes occur in the last trimester of pregnancy. The letters HELLP represent Hemolysis, Elevated Liver enzyme levels, and Low Platelet count. It can cause bleeding problems in late pregnancy, during labor, and during the postpartum period. Women can lose a lot of blood from this complication, particularly during the time when their placenta is detaching (third stage of labor) and the uterus is involuting, in the immediate postpartum period.

Hemolysis = The destruction of red blood cells

Elevated Liver enzymes = Lab test results which indicate liver damage

Low Platelet count = Low levels of platelets.

Platelets help stop bleeding by helping with clotting, and low platelet counts can cause large amounts of blood loss during surgery or during the third stage of labor and postpartum.

[Low platelet counts can also be caused by the use of Heparin (sometimes used in pregnancy), but Heparin-induced thrombocytopenia (Heparin-caused low-platelet-count) also causes very high rates of thrombosis (the formation of clots that obstruct blood vessels)].

See more about the issue of HELLP and the Brewer Diet here on the FAQ page

At the first sign of a rising BP, pathological edema, pre-eclampsia, IUGR, premature labor, or HELLP, a Brewer Diet counselor should sit down with the mother and help her to evaluate her lifestyle and her diet to see if any adjustments can be made to optimize the fit between her pregnancy, her diet, and her lifestyle. For example, to compensate for her salt and calorie losses, she can cut back on her exercise program and her work schedule, she can stay out of the heat (outdoors, at work, or at home), she can postpone a move until after the birth (and 6 weeks postpartum), and she can increase her salt/calorie/protein intake. One way that she can increase her diet intake is to add 200 calories and 20 grams of protein for each of the following situations:

Multiple pregnancy is the only exception: each extra baby requires a nutritional supplement of thirty grams of protein and five hundred calories per day. Higgins comments that this requirement can be met most economically by adding one quart of whole milk a day to the expectant mother's diet (to be drunk, used in cream soups, custards, milkshakes, cream pies and tarts, or as exchanges in yogurt, ice milk, and natural cheeses). Of course, there are many other ways to increase the protein and calories during pregnancy by eating an additional four-ounce serving of meat, fish, shellfish, poultry, or meat substitute as detailed on the diet list.

The above information is reprinted and adapted from the work of Agnes Higgins, and Gail Brewer's "The Complete Pregnancy Diet: Meeting Your Special Needs" from Eating for Two, by Isaac Cronin and Gail Sforza Brewer, 1983.

Please be aware that traveling and moving can break up your eating routine just enough to trigger a low blood volume problem which can start the rising BP/pre-eclampsia/HELLP/premature labor/IUGR/abruption process. Putting the brakes on that process can be more difficult than preventing it. Sometimes just being aware of this danger is enough to help you to remind yourself to continue providing for your nutritional needs, in spite of any changes and stresses which may be going on in your life.

See here for information on adjusting the Brewer Diet to fit your lifestyle, as a way of preventing HELLP

Eating for Two, by Gail Sforza Brewer and Isaac Cronin, available here

The following is reprinted from The Brewer Medical Diet for Normal and High-Risk Pregnancy, by Gail Sforza Brewer [Krebs] with Thomas Brewer, M.D. (1983).

I had my first two children fifteen and thirteen years ago and was "knocked out" both times. My second husband and I are looking forward to sharing our coming birth, but I'm worried about bleeding. I hemorrhaged both times before. Does your diet help prevent this? (p. 189)

By staying on your excellent diet during pregnancy, you've taken care of the main factors associated with excess blood loss during childbirth: premature separation of the placenta (abruption), failure of the uterus to contract and control bleeding at the placental site after the placenta is delivered, trauma to the genital tract from too hurried a delivery or one that required instrument assistance, a Caesarean operation, and coagulation disorders caused by an inadequate supply of nutrients to the liver.

When you have met the nutritional demands of your pregnancy, the placenta does not shear off prior to the birth of your baby, the uterus behaves as it should in staying firmly contracted in the hours after birth, the chances of having a major tear or requiring forceps or a Caesarean are minimized, and your liver keeps up with all its 500 metabolic functions--including the manufacture of essential clotting factors.

General anesthesia and/or large doses of pain-relief medications given during labor are also significant hemorrhage-inducing agents. They relax the uterus so completely that it has difficulty contracting after your baby and placenta are out, so, as you learned, you bleed considerably more than someone who has been able to make it through labor with little or no medication.

A final obstetric practice you should discuss with your doctor is not hurrying the third stage of labor (delivery of the placenta), either by hormone injections or by exerting traction on the cord to hasten the separation of the placenta from the uterine wall. Generally speaking, it is safer to allow the uterus to separate and expel the placenta spontaneously--there is less chance that fragments of the placental tissue will remain adherent inside the uterus. When this happens, blood vessels behind the still-attached tissue open up--usually within the first twenty-four hours after delivery--in an attempt to dislodge the material and cleanse the uterus. In other words, you hemorrhage.

Put your baby to breast shortly after birth or have your husband massage your breasts to stimulate uterine contractions; the placenta should come out within the next fifteen minutes. This shouldn't be too long to wait in the interest of reducing the incidence of hemorrhage.

As we've mentioned in connection with other questions, should you need to have a Caesarean or some other procedure that increases your blood loss, the expanded blood volume you've developed as the result of your good pregnancy diet serves as protection against shock--even if you lose an extra two or three pints of blood. So keep eating!

The Brewer Medical Diet for Normal and High-Risk Pregnancy available here

The following is reprinted from Metabolic Toxemia of Late Pregnancy: A Disease of Malnutrition, by Thomas H. Brewer, M.D., 1963 & 1983. (p. 63)

Much clinical interest has been focused on hypofibrinogenemia in abruptio placentae, but it develops in a relatively small percentage of cases. I agree with Pritchard that this hypofibrinogenemia is related to loss of fibrin from the blood. In some women the liver is unable to synthesize fibrinogen fast enough to keep up with the loss. Hypofibrinogenemia has recently been reported in a variety of bleeding complications of pregnancy including placenta praevia, abortion, ruptured ectopic pregnancy and postpartum hemorrhage. Further research will elucidate this question.

Metabolic Toxemia of Late Pregnancy available here

See more about the issue of HELLP and the Brewer Diet here on the FAQ page

Email me if you have any questions: pregnancydiet@mindspring.com