Tell me everything you know about clotting disorders

[Charmie981]

I don't know what factor is mutated, but my bloodwork found a heterozygous mutation and now they want me on Lovenox (that stuff is EXPENSIVE!), folic acid (4mg/day) and still the prometrium, although my progesterone was fine even without the prometrium.

Everything I'm reading, even in the medical literature says that to treat a pregnancy as high risk because of this disorder may be a little too conservative. I'm wondering...I always have early losses and I've made it to 6 weeks, so I'm thinking this must be a "normal" pregnancy unlike the ones that clot.

However, knowing that I have this mutation and that it makes me 10 times more likely to develop a clot (because I'm heterozygous and not homozygous), I'm not sure I could choose NOT to be on the blood thinners because if something did happen, then it would be my fault...kind of an ignorance is bliss thing, I guess...

And from what I understand from my reading, my knowledge of midwifery, and the doctor I'm seeing, the blood thinners are a contraindication to homebirth, not so much the clotting factor mutation right? But really, what can they do at the hospital that my midwife can't do at home for bleeding? When do I stop taking the blood thinners? Is a doctor going to want to induce me because I'm on blood thinners (so I can get them out of my system before I go into labor?).

I put in a call to my midwife about this, but she and I have some tension in our professional relationship right now and I honestly think she's avoiding my calls .

I have an appointment with the doctor tomorrow and I'll know more at that point (because I have a long list of questions!!). I also have a sonogram and DH and I are both praying hard for twins because we want 4 kids, but we don't want to face choosing a pregnancy when we know it will be managed like this.

[aswbarry]

You may have found this already but there is a thread in Health and Healing. I am sure you will find others who have had the same concerns about homebirth and clotting disorder treatment. Good luck to you!

http://www.mothering.com/discussions...d.php?t=351760

[Charmie981]

Thanks for that info. I subbed to the thread for future reference. Right now it may not matter anyway, as baby is only a sac right now and measuring 1.5 weeks behind my best guess at dates. : And to think, I had hoped to leave with ANSWERS today .

[mwherbs]

so 2 more things to take- magnesium and B12. folate and B12 cross over and do different things for each other -
factor V right.... having to do with protein C

here is a hemotologist web address- his handouts are fairly technical but good-

http://www.ohsu.edu/ohsuedu/healthca...ryhandouts.cfm

[Defenestrator]

I haven't worked yet as a midwife with a mom who had a severe enough clotting disorder to need to be on blood thinners, but I had a doula client once who switched from one form of anti-clotting medication with a longer half-life to one with a shorter half-life in the last few weeks of her pregnancy (I believe that she ended up on lovenox at the beginning of her pregnancy) with a plan to stop injections once she was in labor. She did follow that plan and had an uncomplicated birth.

I see no reason why your pregnancy would have to be high-risk as long as attention was paid to managing your medications and watching out for pre-eclampsia.

[Girlprof]

There's lots of info about this on the thread that was listed earleir, but just so it's here as well.

Standard procedure seems to be to switch women from Lovenox to heparin near the end of pregnancy. Lovenox has a longer half life and is not reversible, unlike heparin. Because the medication has to be managed at the end, a lot of OBs will want to induce. BUT, not all. I'm on Lovenox and my OB/MW practice does not induce. They expect me to have a normal, natural labor at the birth center. I don't know what my options would be for homebirth.

I'm sorry for your losses. I'm also heterozygous for MTHFR - I suspect that is the diagnosis you're looking at as well. It is definitely controversial to give Lovenox in that situation. I also faced the conundrum of not knowing whether I could face another loss (would have been my third) given that there was something I could have done to prevent it. I ultimately decided I could not so I'm taking the Lovenox. And I'm 17 weeks tomorrow!

If you do end up on Lovenox or heparin, there is a lot of info on taking these meds on the Lovely Lovenox Ladies on babycenter.com. Those women are crazy in favor of induction, but they have many many good tips on how to handle the injections. Good luck.

Sarah

[SweetTeach]

I'm sorry for your losses. Definitely check out the thread listed here. Early losses is a symptom of a clotting disorder that can be helped with the blood thinners.

I had a stillborn son with my first pregnancy and a live birth with my second ds and I was on lovenox till 36 weeks, heparin thereafter and we induced at 37w 2d because blood work showed my liver functioning was starting to be "off" and we didn't want to face the risk of another stillbirth.

The pregnancy, though some might consider too medically managed (by a homebirth mw and peri) was FINE for me and the induction was also very smooth. Ds2 was born after cervadil only, 12 hours after insertion. He and I were very healthy. I had a tear that bled quite profusely and it rattled my mw because of the blood thinners I had been on (more than 24 hrs after my last shot) but turned out it was fine. I was in a hosp. by the way and left after 24 hrs by my request.