Factor V Leiden

[636Jen]

A friend of mine has Factor V. She told me she was pregnant at a BBQ a few weeks ago. She jokingly said, "Hey, you can be my midwife" knowing I am only in the beginning stages of being a student.

However, it got me thinking. She probably would be considered high risk having this condition, right? Her chances of having a homebirth would probably be slim because she is at risk of developing clots....even though she takes her shots.

Her doctors said a C-section was the only way she could give birth. She's pregnant with her second baby right now. Is there any hope for her to have a natural childbirth? Thanks.

[CookieMonsterMommy]

I work high risk OB (RN in a hospital).

It depends on how you define "natural", but we've had plenty of FactorFive moms deliver vaginally. Some with the CNMs here (under close eye of the docs).

Does she also have a previa or some other condition that would prevent vaginal delivery?

Kelly

[moondiapers]

I have a factor V mutation AND anticardiolipin antibodies. I've had two vaginal births Surgery is going to make her even more likely to clot because she'll have even more wounds to heal!!! My doc. said the new protocol is heparin shots for the first 20 weeks only. And that if I wanted a homebirth it'd be fine because the meds will be out of my system by then, so no extra risk of bleeding out. If she gets a clot, it's not likely to happen during the birth, but in the days and weeks later. So she may want to have her blood drawn periodically afterward if she's worried. I didn't know I had a factor V mutation until last week, we've just thought it was the anticardio.... all this time. I was tested after yet another misscarriage So the second I know i'm pregnant I have to start heparin and progestrone. Lucky me Anyway this is just anecdotal evidence but my own OB doesn't prescribe c-sections for factor V. He said it's unnessary and might even be more risky.

[636Jen]

Thanks for the replies so far. I plan on forwarding this info on to her. Here was our recent conversation:


ME: Hey Chica! Just a quick question....

Why did you have a C-section with Brianna? We are discussing Factor V and I wondered if that was a reason for it. Thanks!


FRIEND: I think it was part of the reason because I had asked for an epidural but for some reason I don’t think they could give it to me because they didn’t know how my blood was because of being on heparin. Also, I know another reason why was because her heartbeat was up and he thought if he let me wait any longer that she would go in distress. Does any of that make sense? I just hope I don’t have to have another c-section…we’ll see.



Thanks for the continued responses ladies! She has the same OB as with her first pregnancy.

[Girlprof]

Not a birth professional, but I have mild APS so I'm on Lovenox. A lot of this story sounds kind of strange to me. With Lovenox you can't have an epidural. Usually you switch to heparin near the end of pregnancy because my understanding is that you CAN have an epi with heparin. Heparin is also (I think) reversible so they can give you something to counteract it (Can't do that with Lovenox). In the US, docs usually induce women on heparin because they want to be able to control the timing of labor. So you take your last shot, wait a bit, get induced, give birth, then go back on meds. But, this is not standard protocol outside of the US.

I've been lucky and found a practice with MWs who are very used to dealing with all this stuff. I will have to switch to heparin, but no induction and I plan to give birth in a birth center. There is a ton of information on Factor V Leiden and similar issues on the thread about blood clotting disorders under Health and Healing.

Sarah

[hopefulfaith]

I had to chime in; you've gotten great advice here, and I also agree that it makes no real sense...an epi is a black-box no-no when patients are on Lovenox, and as for must-have-a-c-section, that is the most ridiculous thing I've ever heard.

I had two completely natural births (I'm hetero FVL). My MD told me to take myself off the Lovenox when I started to feel like I was within a few days of delivering (she's good like that). I did, and then went back on after delivery - 24-48 hours later, I think.

The precaution against epis while being anticoagulated is to prevent spinal hematomas, which can cause paralysis, but according to the literature, as long as your patients are off heparin for 48 hours prior to the epidural, there doesn't seem to be a problem.

A FVL patient can safely deliver with a midwife as long as there is close monitoring for bleeding and clotting issues. The two issues seem antithetical but both are a possibility given the coagulation cascade taking place in the body s/p birthing. I do not know of any anticoagulated mamas who delivered in a homebirth setting, however.

Also, I just want to throw in there re: girlprof's note on heparin being 'reversible' - Lovenox is a type of heparin; it is technically a "low molecular weight" heparin, and as such, has different pharmacokinetic properties than standard heparin. However, it is still also "reversible".

There is lots of information available out there re: FVL mamas on Lovenox during pregnancy and a lot to learn so that your friend can make good decisions. I thought it was the end of the world when I was prescribed Lovenox (and it would have been, if I hadn't had health insurance; it's a few grand a month), but I had awesome, wonderful, amazing, no-intervention births that I loved and am very proud of. It can be done in a hospital setting.

Good luck to you and your friend. I hope she has a great pregnancy and birth.

[homebirthing]

As far as I know, women who are on Lovenox switch at the very end of pregnancy as Lovenox is a 24 hour med while Heparin is only 12 hours, so you have to take two shots a day. You should not have used Lovenox before you go into labor.

As for homebirth, I would think that with the amount of monitoring she and the baby will need, she would be risked out. She is considered high risk, and should be in a hospital as far as what I would think. That doesn't mean that she can't have a vaginal birth though.

[Paige, CPM]

http://www.fvleiden.org/publications/midwife.html

a very good presentation on the subject

[Girlprof]

Emily, I'm very interested to hear that Lovenox might also be reversible. I know it's a kind of heparin, but I've been told a non-reversible kind. So you stayed on Lovenox until the end? I would find that preferable, but I don't know if my medical folks will go for it. I am SO happy to hear about your awesome, wonderful, amazing, non-intervention births with Lovenox pregnancies! That is exactly what I'm hoping for. Honestly, I don't think I can convey how much it means to me to hear that everything went so well for you. I also thought the Lovenox was the end of the world when I had to go on it, but so far, so good.

Sarah

[hopefulfaith]

Protamine sulfate is the reversal agent for standard heparin (UFH = unfractionated heparin) and Lovenox (LMWH = low molecular weight heparin).

It is technically *more* effective against UFH than against LMWH as a small amount of anticoagulation activity will remain in Lovenox patients even after administration of protamine sulfate; that could be where the argument is coming from that 'Lovenox isn't reversible' - however, it's not enough not to not recommend the agent in the event you need to reverse the anticoagulation.

I think there is also a tribe here for FVL/APS mamas - I learned a great deal from them during my pregnancies - might be worth a search.

[EKilgore]

safe homebirth with FVL

I have/am homozygous for FVL and had a successful homebirth, as did my mom, though she didn't even know she had the disorder in the '70's.

Most of what PP's have said I agree with. Dr. told me that heparin gets out of your system much faster than lovanox.

I was on heparin from around 12 weeks until about 4 weeks postpartum. I saw an OB who prescribed the meds, but even he said that having FVL did not make me high risk. My MW was very comfortable with attending my HB.

I had a 40 hr labor, so as soon as it started I stopped shots. I then resumed them about 10 hrs after birth.

My sis (also homo for FVL) also had a long labor and a homebirth, and my mom and the midwilfe suggested she give herself a shot, though it was about 12 hrs before baby was born, but she did hemorrage a bit.

I had no excessive bleeding whatsoever.

I will reiterate again that she is not high risk!!! There is more of an increased risk of clotting postpartum. I found out I have FVL after a maternal aunt had a deep vein clot about a week postpartum, then the whole family got checked out.

It's so true that surgery puts a woman at much higher risk of clotting- so c/s is definitely not the answer.

[ghuaghua]

I stumbled on this thread and it has given me SOOO much hope! While I haven't been diagnosed with any clotting disorders YET, I will be finding out pretty soon if I have any. (I've had a postpartum blood clot with my daughter, and am currently 30 weeks pregnant and have a clot in my calf) My plan this entire pregnancy has been to have a home water birth, and once I was put on lovenox I figured this might be out of the question. My midwives told me they have no problem dealing with blood thinners, but a few people I have talked to have tried to scare me into delivering in a hospital. ANYWAY, Its wonderful and encouraging to hear that its still a possibility.

[Breastfeeding Insomniac]

I have Factor V Leiden, I had already had 3 children before I knew I had it, all vaginal deliveries. Baby #4 was also an NSVD but I took a baby asprin daily during pregnancy.