Originally Posted by moonglowmama
So, knowing that, I would think that it is risky to do anything which would lower one's ability to clot. Which I think is why birth becomes risky when the mom is on aspirin or heparin or lovenox. Does that make sense?
It's very tricky for moms who need blood-thinners to maintain a pregnancy in order to have a shot at a full-term healthy baby to weigh those risks compared to excessive/uncontrollable bleeding at birth. I'd love to hear some opinions of midwives.
eta: I realized I needed to answer some more. It's not a problem regarding blood flow to the baby through the placenta, presumably because increasing one's ability to clot does not equal increasing clots in the bloodstream. Anyone with clots in their blood is in a high-risk situation for their own life. I'm not sure that being more pre-disposed to having blood clots is reason enough to risk a hemorrhage, imo. But, I grant there is MUCH about this topic I don't fully understand.
Well, here's my two cents. When I talk about clotting in the context of pregnancy, I'm not talking about DVTs and PEs, but micro-clots in the placenta, often not even obvious on examination of a placenta unless it gets sent to pathology, a much lower amount of clotting than what would cause a DVT. In my mind, increasing one's ability to clot over normal levels through supplements or whatever is increasing one's ability to clot, period, not necessarily that different from having a clotting disorder. I guess it's a matter of perspective - I view clotting during pregnancy as a very bad thing because it can have such serious consequences for the baby (IUGR, stillbirth, m/c, abruption, etc.). My first child, when I was undiagnosed, had some growth restriction though ultimately at birth she was a few ounces over the official IUGR designation and we did not deliver early. No clots visible on the placenta and it was not sent to pathology (it was a section for breech). In contrast, my pregnancy outcomes on lovenox have been far superior. But I got off lightly compared to some moms with clotting issues - stillbirth is always a concern.
IMO, for women with clotting disorders, it's not a tricky call at all, but I'm guessing that the homebirth angle is what would make it tricky - I realize PPH may be a more scary risk in a homebirth situation. I can see why a midwife would want to prevent a PPH, if that could really be prevented by supplementation with alfalfa during pregnancy. I guess I think that's a much more tricky call, because pregnancy is already a hypercoagulable state, the third trimester is prime time for clotting to cause problems with the pregnancy, and a lot of people with inherited thrombophilias are undiagnosed this early in life.
I've been on lovenox or heparin at delivery three times now, all vbacs (lovenox for my premature delivery, switched to heparin prior to my term deliveries; my peri does lots of bloodwork to monitor dosing of both lovenox and heparin.) and just before my last one, my OB reiterated his point that the heparin, at a prophylactic dose (which is far lower than a therapeutic dose that a person with a DVT or similar would be getting) was only an issue with regard to the opportunity for an epidural because bleeding would be difficult or impossible to control in the epidural space. He said that vaginal or surgical, he was not at all concerned about bleeding from the birth (but of course that was in a hospital situation).
Is this supplementation with alfalfa very common? Just curious since this is the first time I have come across it.
just thinking out loud...