Women with blood clotting disorders - Page 31

[primipara]

Hi ladies! I am hoping to get some advice on a homebirth plan for those on blood thinners.

I am 9.5 weeks pregnant after 1 round of IVF, 2 FETs and 2 years total TTC. Naturally through infertility I had every test under the sun and they turned up a slightly elevated level of lipoprotein (a). As a result I was put on daily Lovenox shots from the first day of the transfer.  Now I have interviewed 5 homebirth midwives (out of 16 in my area) and the 2 that I liked the best, who seemed the most educated and responsible, were both very cautious to negative about doing a homebirth while I'm on Lovenox.

They both referred me to a homebirth friendly perinatologist for a second opinion. I am hoping that he says I don't need to be on it, but short of that, do you have any ideas for a homebirth plan that would reduce the potential risks, or about what to say to the midwives to convince them to work with me? I am happy to consult with an outside doctor and to have a backup plan, but at least trying for a homebirth is very important to me.

[sarahtar]

Do you need to be on the Lovenox until you deliver? The MFM we consulted with during my last PG had floated the idea of blood thinners with me, then ultimately decided they wouldn't provide enough benefit (for me) to outweigh the risks, but while we were still deciding, I had asked about homebirth implications. Every midwife will be different, of course, but my midwife had made it clear that as long as I had been OFF blood thinners for 3 (I think it was 3) weeks prior to delivery, she was fine with that, and the MFM said that she wouldn't want me on blood thinners at that point, anyway.

So assuming that they would stop the thinners as you approach delivery, that helps to change the conversation with the MWs you talk to. Maybe they would feel more comfortable if you offered to have a blood draw to show that your blood counts were all normal before delivery?

I mean, I wouldn't want to do a homebirth while on blood thinners - hemorrhage is scary and pretty hard to successfully treat at home by a midwife.

[primipara]

Thanks, that is really helpful. Stopping the Lovenox early seems like a good solution. 

[wennerk]

Hi primpara,

I don't know how Lovenox compares to Heparin, but I was on Heparin (for Factor V Leiden) all through my pregnancy and managed to do a successful homebirth while on it.  The doses are spaced 12 hours apart, so I was told by a perinatologist that as long as I didn't take a shot close to when I went into labor or until 12 hours after birth, I would be fine.  It ended up that I took my morning shot, went into labor in the late afternoon, and then didn't get my shot again until about 1pm the next day.  The midwife that attended my birth had never dealt with a woman on blood thinners before.  When I first interviewed her, she did some research on the subject and concluded that as long as DH and I felt comfortable managing the Heparin, she would leave it up to us.  That's just my two cents...

[airmide_m]

After over 5 years and many different infertility treatments while TTC #1, I'm doing some intensive research into implantation failure due to auto immune issues and clotting factors. 

I was able to get a few tests, but mostly they're saying I need to have 3+ miscarriages to justify testing. But if they can't implant, I can't get to the point of a miscarriage (not that I'd ever want that either of course!). 

I did find three things elevated and I'm wondering if those may be cause for any concern, or justification for treatment with lovonox?  Fibrinogen 427 (range 150-400 mg/dl) and under Coag Study, Von Willebrand, Von Will Ag 162 (range 49-153%) and F VIIIC Act 138 (range 65-130%).

I'd also love to hear if/how anyone has been able to get testing for other disorders without having prior recurrent miscarriages? I have Hashimoto's hypothyroid and insulin resistance which I've read increase the chances of clotting disorders and associated implantation failure or miscarriage. I also have (possible TMI warning til the end of this paragraph) excruciatingly painful periods with heavy bleeding, clots and mid cycle spotting (I've had a laprscopy - no endometriosis). And when I was 19 I had a reaction to sulfa antibiotics which involved GI bleeding to the point that my stool was basically pure blood for the better part of a week, and the doctor seemed surprised when I came in for a follow up and wasn't dead. So I'd think some of those things might be some justification, but I don't know!

Thanks for any help or advice anyone can provide!

[jcwmama]

Can anyone in the Roanoke oy Lynchburg area of Virginia advise on a good OB or midwife for a women with clotting disorders?  I'm currently 7w and on generic Lovenox once a day.  I'm not happy with my current OB and practice and looking for someone famaliar with clotting disorders.  Any information or suggestions on where to look would be greatly appreciated!

[jcwmama]

Hi ladies- looking for a little advise.

I'm 8w and I have antiphosopolipid syndrome with anticardiolipin antibodies.  I'm on a once daily 40mg Lovenox injection and once a day 81mg aspirin.  I've miscarried 3 times before in the 7-9 week range. I made my first ultrasound with this pregnancy for 11 weeks because of all my negative experiences with ulrasounds around the 7-9 week time frame.  Now I'm wondering if I should go in for an ultrsound this week, around 8.5-9 weeks.  Can anyone let me know if they know of any reason this would be beneficial?  Is there something that could be seen on the ultrasound that could indicate that my dosage is incorrect and could be adjusted?  I don't want to wait until 11 just because of emotional reasons and then at 11 weeks the ultrasound show something that the OB says we could've fixed had we known earlier.  Does that make sense? 

I lay awake at night worrying about...well.. everything and I'm wondering if the u/s now would calm my nerves. 

If it helps, my number for the anticardiolipin antibody was 47 (though I can't remember the units right now) which the OB said was just inside what is considered 'treatable'.  Apparently 40+ units is treatable. 

Any advise would be most appreciated.  Thanks for your time!