Birth Center/Home with a Blood Clotting Disorder?

[tripleblessed]

Hi! I hope I'm posting in the right spot to get responses...but I was wondering if anyone has ever had a homebirth or birth center water birth witha previous c-section AND blood clotting disoder? Although I've found a couple midwives whom it sounds would take me on when the time comes..I'm wondering if this is just too risky?? Anyone? thanks!

[Ilaria]

Subbing!
(I have APS and hoping to have a HB)

[sarahtar]

well, do you have a blood clotting disorder that makes your blood prone to clotting, or one that makes your blood prone to NOT clot?

I have had both. (yay me)

I've had ITP (a disorder that makes my own body attack my platelets, causing low platelet counts) since I was a child, and it causes my blood not to clot properly if my count is low. (Obviously, if the platelet count is normal, then everything works fine. It tended to fluctuate quite a bit.) Fortunately, by the time I was PG with DS, things had stabilized quite a bit and I wasn't really having trouble with low counts very often. As long as my platelet count was normal, I would have been fine to have a homebirth. (We opted for hospital, it's a long story.)

Now I have been diagnosed with MTHFR, which can cause sticky blood that is prone to clotting. HOWEVER, I am not on blood thinners. I am currently PG.

My own midwife, working with a local perinatologist who also sees me somewhat regularly, has said that I absolutely can have a homebirth if that's what I want. The only way she would refuse me as a HB candidate is if I were on blood thinners as I neared my due date. Then she would feel it was too risky.



ETA: I feel quite confident saying that if your problem is too little clotting, a homebirth might not be a good idea.

It stands to reason, then, that being on blood thinners might also risk a person out. I have no idea if that's just my mw's policy or if that's pretty standard, though.

[Ilaria]

I have APS (anti phospholid syndrome), 'sticky blood', according to my rheumatologist.
I have had 4 losses, which they think were caused by APS. I am planning a HB with 2 midwives. I am on heparin and aspirin. I am planning on going off the heparin in the last weeks.

[Xenarthra]

hi Tripleblessed!

I had a waterbirth with APS (too many clots) and it was fantastico! Here is a great thread for you to post on and read: http://http://www.mothering.com/disc...351760&page=25

I think as long as both you and your MW work together and know what to do/expect you should be fine. You deserve to birth in comfort!

[bonbon mama]

Ilaria,

Were your midwives able to prescribe the heparin? Or are you doing co-care with an OB?

I've had two live births since my diagnosis with antiphospholipid syndrome and they were both with heparin and an OB. I'm not currently pregnant but I'd like to start looking into whether I can swing a homebirth and heparin use.

tia

[Ilaria]

Hi!
back in the US, I had 2 MCs, then saw an RE who prescribed the heparin/aspirin/progesterone for the next 2 pregnancies. I stopped the heparin at 20 weeks for them. I had 2 full term, healthy kids, normal delivery, no complications.

Then I moved to the Philippines. I had 2 more MCs and started having weird symptoms (headaches/vision problems and MS-like symptoms, such as neuropathy). When I got pg again, I saw an RE who put me on progesterone, heparin, prednisone, baby aspirin and monthly IVIG. Just a couple of weeks ago (I am 25 weeks along now), I did my second APS test and it came back high (my first was low to moderate), so my rheumatologist thinks I have APS, my RE is not convinced.
I have always wanted to have a HB with my last kid, and my RE is a very high-intervention ob-gyn. So I have been seeing a midwife as well. She doesn't know much about heparin, and I always assumed I'd be off it by now...
I don't feel comfortable talking about a HB with my RE beacuse he doesn't like midwives, Hbs are dangerous and so on...even for the general population...
I guess I don't know what the real dangers are...I asked the drs about birth with APS ina hospital and all they said was that I'd need to stop the hep 12 hrs befor ebirth if I wnated an epidural or needed a c-section...that's really it.
Maybe I am just naive.... :0

[Ilaria]

Originally Posted by sarahtar

It stands to reason, then, that being on blood thinners might also risk a person out. I have no idea if that's just my mw's policy or if that's pretty standard, though.

I asked both my RE and rheumatologist about that. Both said that all you need to do with the heparin is stop taking it 12 hours before birth (i.e. as soon as you start labor). The dangers are 1. if on heparin, the epidural could cause a paralysis 2. an emergency c-section would need general anesthesia.
Heparin should be re-started after delivery...this is all according to my drs.


(Sarah, I 'know' you from your business I have bought stuff from you for my business in the Philippines. )

[sarahtar]

Oh, Hi, Ilaria! I didn't make the connection there!

I think my mw might be somewhat conservative on her guidelines for taking on patients. She doesn't have insurance, and I'm sure that's part of it.

So, the prednisone and IVIG...what do they do for you? I'm just curious, and it's really none of my business, but I took prednisone pretty much every time my platelet count dropped when I was having a lot of trouble with the ITP. When the prednisone stopped working, they switched me to IVIG. But that was for LOW platelets, the complete opposite of "sticky" blood. It's just fascinating to me that they use that also for sticky blood.

[Xenarthra]

When I was prescribed Heparin for sticky blood the doc said that Heparin can cause your platelet counts to drop and that I would have to have careful monitoring through blood tests to watch for it. So maybe it is a precaution to prevent that? I am sort of speculating here....

[bonbon mama]

I stopped the heparin just as soon as I thought I was in labor. Both times, I gave birth just under 12 hours from the last injection (aka before the next scheduled injection. I started up again soon after the birth and continued for 6 weeks postpartum. I was doing a low, prophylactic dose as suggested for APLS/Hughes.

I agree with Ilaria on the epidural and c-section concerns.

I had my platelets and antibodies checked once or twice during the pregnancy and watched how I felt.

I think the IVIG helps mitigate the immune response that is causing the sticky blood while the heparin keeps the blood looser and less likely to make clots.

[Ilaria]

Originally Posted by sarahtar

So, the prednisone and IVIG...what do they do for you?

Honestly? I don't remember exactly. They are part of his protocol for 'habitual aborters' and his IVF patients, he gave me a vague 'protect from inflamation/infection' spiel and I went with it. At that time, I thought I had Lyme, and REALLY wanted this baby to stick!

I am on ONE heparin shot a day...BUT i actually do it every day and half...I know maybe I am crazy, but with my other 2 I stopped at 20 weeks and I am 25 weeks along now...So I am not sure it really has an effect since it wears off after 12 hrs anyway....

What are the real dangers of giving birth (anywhere) with APS? All I got from the drs is the heparin thing, nothing else.

I had 2 births not knowing I had APS and both were fine (dd was almost an UC as i got to teh hospital as she was crowning and was born 7 mins later). Now that I have a diagnosis, what has changed? Do my APS symptoms make it worse/scarier? WDYT?

[sarahtar]

I don't know about APS specifically, but I think the dangers with the clotting disorders are generally limited to pregnancy, and there's nothing particularly concerning about birth itself.

I don't know enough about how heparin works, or how IVIG works, or prednisone for that matter. It stands to reason that if heparin gives you low platelet counts, the prednisone/ivig might mitigate that. hm. interesting.

[Ilaria]

Originally Posted by sarahtar

I don't know about APS specifically, but I think the dangers with the clotting disorders are generally limited to pregnancy, and there's nothing particularly concerning about birth itself.

See, that's what I thought. What would they do at a hospital during the birth that can't be done at home? I realize I might be prone to clotting afterwards or excessive bleeding when back on heparin, but I am not sure anything would be different for the birth!
I have looked online everywhere and can't find any labor/birth dangers with APS. However, I have found many midwives/HB websites who say that women with blood clotting disorders should not have a HB, but no reason given.

I bought some compression socks today to wear for my super long flights (15 hours+) and during labor/delivery just in case.

[berkeleyp]

It depends on what clotting disorder you have. I would go talk to a maternal fetal medicine specialist and also talk to some midwives. I talked to a MFM specialist and also my CNM did some research for me and determined that I am a fine candidate for homebirth and don't need to medicate for the disorder but it depends on your circumstances. I have never had a clot. My only risk factor and the reason I know about the disorder is that I had a stillbirth but the facts of the stillbirth suggest it was not clotting related. If you have a history of clotting, I think that is different. I would definitely talk to some "experts" and don't just trust what you read and hear on the internet.

[Ilaria]

What disorder do you have, berkeleyp?

[anudi01]

No c-sec, but I'm Factor V leiden heterozygous

I just had a UC with my 3rd. I transferred when I wasn't comfy w/ the amount of blood I saw. The transfer was a good choice. Next time, I would still HB, but I would have an attendant who had access to pit.

[Ilaria]

Were you on any meds fr the birth?

[anudi01]

no meds

no heparin, no aspirin, nothing. If I was homozygous, I'd re-evaluatr that.

[berkeleyp]

What disorder do you have, berkeleyp?

Factor V leiden heterozygous