Anyone work with a mom on bloodthinners?

[Belia]

Hi-

I was diagnosed with an "extensive" blood clot in my right leg when I was approx 8 weeks along. (I have hyperemesis gravad-whatever, so they think it was caused by my increased clotting due to being pg, as well as thicker blood due to dehydration. I have no history of blood clots anywhere in my family.)

Anyway, I was in the hospital on a heparin drip for approx 4 days, and now I have to self-inject Lovenox twice a day for the duration of my pg. The OB, MW, and reg doctor all said that was my only option.

Do any of you have any experience with this in terms of when I go into labor???? I remember the OB saying that I would just skip the injections as soon as I go into labor, and the medicine would be out of my system by the time I deliver. But at my last appt with the hematologist, she said I would have to be admitted to the hospital for a week before my due date to be back on the heparin drip and basically sit there and wait to go into labor.

Ummmm...... NO WAY do I want that. Talk about the express lane to the intervention superhighway.

I have my second appt with the hematologist this week. I want to know what my options are in case she says something again.

[memiles]

I had a client on blood thinners for a different condition. The plan was to take her off the meds a week before her due date. Of course, her bp went way up and she needed an induction (sigh), so for her they kept her in the hospital for 24 hours, treating the bp while the blood thinners left her system. She ended up with a surgical birth but didn't have any bleeding issues.

Probably not very helpful for your case!

[Charmie981]

You might consider asking this on the thread in Health and Healing called "women with blood clotting disorders." The ladies there have a wealth of experience from the pregnant woman side of things.

[Girlprof]

Definitely come over to Health and Healing for a wealth of information. I've never heard of anyone waiting around in the hospital for a week. Common practice in the US is to go off the blood thinners and then be induced. But that doesn't mean all care providers do this and I'm pretty sure that is not common practice elsewhere.

In my own case, my midwives and OBs agreed not to induce. I was just supposed to stop the shots when I went into labor. I don't think it's that big a deal to give birth while on the blood thinners. But you can't have an epidural until the drugs have cleared your system.

I ended up being induced after all due to high blood pressure but besides the labor augmented with pitocin had a completely natural birth. You will need to have a lot of discussions with your care providers to get on the same page about all this but it can be done. Good luck.

Sarah

[doctorjen]

Have you had a clotting disorder work up? Most folks with uncomplicated leg clots take meds for 3-9 mos, so you may well be at the end of your treatment by the time the baby is born.

I have done 2 things for folks on blood thinners depending on their condition and their wishes. Either stop the blood thinner and induce in 12-24 hours, or just wait for labor to start and hold the blood thinner then. The only thing with lovenox is that you cannot have epidural anesthesia with lovenox on board - there is then a risk of bleeding the epidural space when can cause paralysis. For many of my clients who are not planning an epidural this is no big deal, but it does mean that if a surgical birth were needed on lovenox, it would have to be general anesthesia.

I just had a lovely birth for a mama with a clotting disorder and multiple previous losses. Due to some other issues (IUGR especially) we ended up with an earlier induction at 38 weeks. She stopped the lovenox the night before her induction. Everything went great, and she had no significant bleeding during or after labor, and her little dd did great, too.

[Belia]

Thanks for the insights, everybody... I did not know you could not have an epidural while on Lovenox. In a perfect world I would NOT want to plan on an epi, but.... everything that's gone wrong so far has really shaken my confidence. Plus, I don't know if I could handle pitocin without an epi.

Hmmm.... I've never explored the Health and Healing forum... I'll check it out. Thanks.