c-section on blood thinners

[kohlby]

I was wondering what other women's experiences were with c-sections when they were on blood thinners like heparin/lovenox. If you knew ahead of time that you had to have a c-section, when was it planned for? If you went into labor while still on the blood thinners, what happened?

I ask because my peri normally does an amnio at 36 weeks for women in my situation. And then gets the babies out ASAP. However, she was willing to wait until 39 weeks for me and I thought I was comfortable with this. I recently learned that she wants the heparin out of my system for at least 24 hours, not at least 12 hours, before the c-section though. So, I'm more nervous now and wondering if a c-section at 38 weeks makes more sense. I haven't discussed this with my OB yet, and will be getting her opinion on Thursday. I'm not going to be 100% comfortable with it either way so I'm gathering as much info as possible before I make my decision. There are real risks either way which is why my peri is letting me make the decision.

[Kells97]

I was in a similar situation, though I had to take the 36-week-immediately-after-amnio route, so it played out a bit differently for me.

What is/are your concerns about going to 39 weeks? Generally it's better for babe to stay put as long as all is well. My plan was to go to 39 weeks until it became apparent that it wasn't in my or baby's best interests. I think 38 week babies can vary a lot in how ready they are.

eta: When I discussed my options with my ob, my understanding was that the reason I had to switch to heparin from the lovenox is that if something were to happen, like I went into labor or baby had to come out right away, is that they can reverse the heparin. It can be dealt with in an emergency situation. They would prefer to be able to schedule the last dose, but if they have to reverse it because they don't have that 12-hour window, they can.

[AllyRae]

I was only on daily aspirin (my blood condition can cause hemmoraging and clotting, so I couldn't be on the stronger thinners for more than a couple days). We knew we were having a 36 week c-section and didn't do an amnio (but I had the corticosteroids several weeks before). For my condition, it was riskier, with or without medications, to let the pregnancy go on any longer than it did.

Two weeks before my c-section, I began weaning off the aspirin, and 7 days before the c-section, I took my last aspirin. I was told not to go cold turkey since the blood could start clotting faster in response.

I did make sure I was very active and well hydrated during those two weeks--basically anything I could to to prevent clotting without medications, I did.

24 hours after the c-section, they put me on lovenox for 4 days until I was discharged (now I'm back to daily aspirin).

Oh, and I also had a perinatologist and a hematologist supervising the entire pregnancy, including the 2 weeks before birth. I had 4 NSTs during those 2 weeks and was told to come to L&D immediately if I felt like the movement slowed for any reason (I didn't have to do that). So, during the weeks without the blood thinners, we just monitored the baby very closely.

[kohlby]

My concern with waiting 39 weeks is what if I go into labor beforehand - since I have to have a c-section. I was never on lovenox. I've been on heparin the entire time, and it is the heparin that my peri wants me off on at least 24 hours beforehand. (And just two weeks before for the baby aspirin, so I'm not nearly as concerned with that. I hadn't heard to wean off it - I thought since the aspirin was such a small amount and just a precaution that it wasn't a big deal). I thought heparin was easily reversed too, but it's not an easy process which is why they prefer to wait it out. It wasn't until I started researching how they reverse it that I understood why they try to wait it out instead. And they're not always successful at reversing it. 12 hours to wait it out doesn't seem like a big deal to me - I do go into labor immediately but I have a history of progressing in slow motion. (Though my other two kids were enormous and this one is pretty much normal sized, so I'm not sure if that will effect things).

I fully agree that it's best for babies to stay put until at least 39 weeks - especially c-section babies. But it's all about weighing the benifits vs risks, which is why it gets a bit murky in a high risk pg situation with blood thinners.

I've had NST and BPP every single week since 27 weeks and will continue to have them once a week. I do have way more braxton hicks contractions than I'm supposed to - sometimes more than the 6 an hour. But that happened when pg with DD by this time too and I wasn't dilated at all until after 40 weeks with her! I was told I had an "irritable uterus" with her. They also check my cervix by ultrasound when they do the BPP and all is closed. But when pg with DD, I wasn't dialted at all at an appt and went into labor the very next night.

[Kells97]

Originally Posted by kohlby

But it's all about weighing the benifits vs risks, which is why it gets a bit murky in a high risk pg situation with blood thinners.

I think the murkiness is one of the most frustrating things about a high risk pg. If someone had ever told me that I would choose a c-section at 36 weeks, I would have thought they were crazy. But the risk-benefit analysis showed that to be the option I was most comfortable with.

And you're right, the heparin reversal process is not easy; just because it can be done doesn't mean it shouldn't be avoided if at all possible.

I'm sorry if you thought I was being insensitive; I was just trying to understand your concerns a bit better. I really do understand how difficult this is.

[kohlby]

Nope, I didn't think you came across as insensitive at all! Since you had to go the 36 week route, I knew you had to understand to some degree! That's why I posted this question on this website. On other sites, they don't seem to understand how lucky they are to have low risks births and should wait until 42 weeks if possible!

[snowmom5]

Just wondering if there's an update on the OP. My last pg, at 38w I spontaneously went into active labor two hours after doing my heparin shot and had a vaginal delivery (vbac, my third). I had to forego the epidural that I had wanted, but otherwise everything was fine. I was also on low dose aspirin, as I have been in my last three pgs, and no one cared about that at delivery.

I believe my OB said that delivery, whether by section or vaginal, doesn't matter with regard to the heparin, that the big concern is epidural or spinal due to the risk of paralysis from uncontrolled bleeding in the space - I guess there's no way to shut it down. I was on 10,000 units 2x per day. (I switched over from lovenox at 36w.)

My guess is that if you go into labor spontaneously before your scheduled section, they'll go ahead with it, though if not enough time has passed you might have to do general anesthesia.

I assume the doc eventually answered this question? update?

[kohlby]

Actually, the perinatologist is worried about the risks of hemmoraging being much higher if I'm still on the heparin, not just spinal vs general.

My c-section date was set, for 39w4d pg! I'm 37 weeks now and having way too many contractions but still not dilating. My OB said that if I show signs of early labor at my next appt, at 38 weeks, then a c-section would be done the very next day. I'm not sure what the chances of this are since I tend not to dilate at all until I'm in labor. So, I'm holding out and just keeping my fingers crossed that I don't go into labor on my own.