Blood Thinners and Home Birth

[mrsrobertson]

I was diagnosed on thursday with blood clots in my right lung, and have since been put on Heparin to thin my blood and prevent any more clots. I will be on this for the rest of my pregnancy.

I've heard 2 different options for delivery - induction and c-section (which wouldn't seem smart if you're worried about thin blood and hemmorhage.)

Neither of which I want. Honestly, I'm wondering if it would be so bad to stop the heparin at say 37 weeks and have my natural home birth (this would be the third). I'm currently 13 weeks, and have plenty of time to think about all this.

I'll deal with a hospital birth if I have to, but I won't just accept every little policy and whim they want.

I DO understand the risks of having a blood clots in my lung. The first doctor that told me about it (as I lay in the er with a heartrate of 115), made me think I would get surgery or die. (neither of which have happened ) I understand everything they've told me, but I'm still going to do my research and make my own decisions.
I'd just like some opinions and helpful criticism.

--
Michael

[mrsrobertson]

Seriously? no one has any suggestions? Is there somewhere specific I can post this?

[nashvillemidwife]

Sorry, I haven't been here in a while. I know it's not what you want to hear, but I don't think you're a good candidate for a home birth. Induction is the safest and most reasonable option for you and your baby.

[lillacfaerie]

Do you have thrombophillia, or just a randomn blood clot? I would think your safest bet is to get an opinion from a specialist in that area (not an obgyn or an er doc). They can help you make the best decision for your care, and may not be as biased against home birth as an obgyn. Blood disorders are really best taken care of by hematologists. My father is a hematologist, and used to be an obgyn. I can ask him what he thinks. He's quite supportive of alternative birth plans.

[marie1080]

I would only be comfortable homebirthing in those circumstances if I was within 5-10 minutes of a hospital and had concurrent care with an OB who I trusted throughout the pregnancy.

I'm an ICU RN having a homebirth, FWIW. Pulmonary embolisms are something I wouldn't want to mess around with.

I am so sorry you are going through this and I hope you find a birthing situation and care providers you can be at peace with.

[Kidzaplenty]

Originally Posted by nashvillemidwife

Induction is the safest and most reasonable option for you and your baby.

If you don't mind me asking, why is induction safer than going into natural labor? Just really curious.

[nashvillemidwife]

Originally Posted by Kidzaplenty

If you don't mind me asking, why is induction safer than going into natural labor? Just really curious.

You don't want to be on blood thinners when you birth so you need to control the timing of discontinuing the meds in relation to the birth. Induction is the only way to do that. You can't just stop taking the meds and wait weeks for labor to start, and it's too late to wait until labor starts to stop taking the meds.

[EdnaMarie]

I had pit to stop bleeding after both babies (at home, no induction, totally vaginal, no-drug births). I have no clotting issues and was not on any meds (other than, after the birth obviously, the one-time administration of pit). It is a common complication and you could go downhill fast. It's always possible, but on anti-clotting meds, er, it seems like it would be much worse!

I would not even consider HBing if I were on an anti-clotting drug, or if I were at risk for something like pulmonary embolism. That's just me.

I am so sorry about your condition and am sending healthy vibes your way.

[Kidzaplenty]

Originally Posted by nashvillemidwife

You don't want to be on blood thinners when you birth so you need to control the timing of discontinuing the meds in relation to the birth. Induction is the only way to do that. You can't just stop taking the meds and wait weeks for labor to start, and it's too late to wait until labor starts to stop taking the meds.

Ah! Thanks. That makes so much sense.

[lillacfaerie]

I asked my dad about your situation. Of course he only has the info you gave (you're not his patient so it's unethical for him to give you any real advice). He thinks your best bet is with induction in a hospital with a midwife present and an obgyn near by. As you know you need to be able to time your labor so you can be off the blood thinners for a while. I'm so sorry that you are going through this. I'll keep you in my prayers for a speedy recovery.

[Scrubsjm]

The safest choice really is induction. Not the most fun but the safest, I'm personally taking blood thinners this pregnancy and did for my last as well. It can be difficult to give up the birth you desire for the birth you need but I think ultimately what everyone wants is a safe birth and a healthy baby. When you have these clotting problems the best way to achieve that is by stopping the heparin and scheduling an induction.

[hapersmion]

I don't know much about this personally, but my friend was on blood thinners for a genetic clotting disorder throughout her pregnancy. She didn't need to be induced - when she reached term, they switched her to a different medicine than heparin, one that got out of her system faster. I think it lasted 12 hours, but it could have been only 8... At any rate, she just stopped taking it when she went into labor, no induction needed, no extra bleeding. Whether or not that would work for you probably depends on your health situation, but I figured I'd mention it.

[Asiago]

Originally Posted by hapersmion

I don't know much about this personally, but my friend was on blood thinners for a genetic clotting disorder throughout her pregnancy. She didn't need to be induced - when she reached term, they switched her to a different medicine than heparin, one that got out of her system faster. I think it lasted 12 hours, but it could have been only 8... At any rate, she just stopped taking it when she went into labor, no induction needed, no extra bleeding. Whether or not that would work for you probably depends on your health situation, but I figured I'd mention it.

Maybe some Protein C or S moms could give you some helpful info. Sometimes they are also put on heparin or blood thinners throughout pregnancy. I wonder what the regular protocol regarding birth/timing/med would be in their situation.

[jljeppson]

I would suggest cross posting this on the birth professionals page as well. I've never had a client with these types of problems, but I agree with nashvillemidwife about the induction. IF, as hapersmion suggested, a separate drug that metabolizes quicker is available to you than I suppose that may be a possibility for skipping the induction however it would still risk you out of a HB. Say it takes 8hrs to metabolize and you deliver in 4? You would still be at a major risk for bleeding out.

[Defenestrator]

I wouldn't recommend a home birth to you, but I think that it might be a totally reasonable plan to give birth on your body's own time instead of having an induction. Heparin has a relatively short half-life and you can stop dosing yourself when you go into labor. It also can be reversed with high doses of vitamin k, unlike other blood thinners. Some pregnant women are prescribed lovenox for the bulk of their pregnancies and then switch to heparin at the end so that they can take care of these advantages.

If you are dedicated to pursuing the homebirth option, I would recommend seeing a hematologist in the beginning of the third trimester to discuss your risks and medication options so that you can make an informed choice. Most OBs don't really know how to manage this stuff in a sophisticated way and you will have better information from a specialist.

[hapersmion]

Originally Posted by jljeppson

I would suggest cross posting this on the birth professionals page as well. I've never had a client with these types of problems, but I agree with nashvillemidwife about the induction. IF, as hapersmion suggested, a separate drug that metabolizes quicker is available to you than I suppose that may be a possibility for skipping the induction however it would still risk you out of a HB. Say it takes 8hrs to metabolize and you deliver in 4? You would still be at a major risk for bleeding out.

It probably depends on the person and the timing, since you'll only have to wait out the whole half-life if labor starts right after you take a dose. Otherwise you might already be 3, 4, 6 hours into the dose when your labor starts - and I would think that if labor looked like it was going really fast and the medication would still be active, you could then transfer to the hospital if you were close enough. Just some things for the OP to consider if appropriate.

Also, Defenestrator is right - now that I'm thinking about it, I remember my friend saying that she had to go to a special doctor to get someone who really understood what was going on.

[jljeppson]

[QUOTE=hapersmion;14297547]It probably depends on the person and the timing, since you'll only have to wait out the whole half-life if labor starts right after you take a dose. Otherwise you might already be 3, 4, 6 hours into the dose when your labor starts -QUOTE]
Good point.

[mrsrobertson]

Thank you all for your replies.

To give more information, I am seeing a maternal/fetal medicine doctor to monitor me and baby. Checking my lovenox levels once a week via blood draws as a precaution to make sure they're doing their job. Giving myself the shots twice daily. I'm being very diligent with it all.
I am also seeing a hematologist. I have no blood issues. All my tests came back completely normal. No protein S issues or anything (which I know they looked for specifically)
They did mention a half-life dose in my third trimester. Then taking me off before induction (which i don't want)
The clots just happened to be one of those freak things that happen during pregnancy, possibly from my flight home... and should be resolved with the aid of the lovenox.

I am still doing a lot of research, and talking with caregivers.. and personally I feel like I would rather stop the injections 1-2 weeks before my due date and start labor naturally. That's one risk I'm willing to take. My husband and I have considered the possibilities - the very worst. But it's a decision we'd like to make.
And even if things go well during the entire pregnancy, and I stick with my homebirth midwife, I will still continue with the maternal/fetal medicine doc and the hematologist for the very best of monitoring. I'd like myself and my caregivers to work as a team on this, no matter where I birth.

It's not homebirth or nothing... just having had 2 homebirths before - and knowing the hospitals in my area as a doula... frankly - they scare the crap out of me. The only good doctors I know of are at least 2 hours away. Which doesn't work for our family.
There's a lot to consider. I'm 16 weeks, I still have plenty of time to do my careful considerations, ask my questions... try and find a good doctor that I can truly trust - who won't just tell me what I want to hear. (My clients get that a LOT).

[moondiapers]

Originally Posted by mrsrobertson

Thank you all for your replies.

To give more information, I am seeing a maternal/fetal medicine doctor to monitor me and baby. Checking my lovenox levels once a week via blood draws as a precaution to make sure they're doing their job. Giving myself the shots twice daily. I'm being very diligent with it all.
I am also seeing a hematologist. I have no blood issues. All my tests came back completely normal. No protein S issues or anything (which I know they looked for specifically)
They did mention a half-life dose in my third trimester. Then taking me off before induction (which i don't want)
The clots just happened to be one of those freak things that happen during pregnancy, possibly from my flight home... and should be resolved with the aid of the lovenox.

I am still doing a lot of research, and talking with caregivers.. and personally I feel like I would rather stop the injections 1-2 weeks before my due date and start labor naturally. That's one risk I'm willing to take. My husband and I have considered the possibilities - the very worst. But it's a decision we'd like to make.
And even if things go well during the entire pregnancy, and I stick with my homebirth midwife, I will still continue with the maternal/fetal medicine doc and the hematologist for the very best of monitoring. I'd like myself and my caregivers to work as a team on this, no matter where I birth.

It's not homebirth or nothing... just having had 2 homebirths before - and knowing the hospitals in my area as a doula... frankly - they scare the crap out of me. The only good doctors I know of are at least 2 hours away. Which doesn't work for our family.
There's a lot to consider. I'm 16 weeks, I still have plenty of time to do my careful considerations, ask my questions... try and find a good doctor that I can truly trust - who won't just tell me what I want to hear. (My clients get that a LOT).

I'm switching from lovenox to regular heparin at 36 weeks because it has a shorter halflife and can be more easily reversed if I go into labor early. Ideally you should be off of it 48 hours before giving birth. Right now my plan is for an induction at 39 1/2 weeks. BUT regular heparin is reversable and some docs dont' have you discontinue it, but have you stop it once labor starts then give an injection to reverse it.

[Asiago]

I spoke to my friend who was on Heparin for her last two preganancies. She said she was taken off of it 12 hours prior to delivery. She wasn't induced that I know of, so not sure how they figured out the timing.