Homebirth with a clotting disorder

[Ilaria]

Do you (midwives) take on women with a clotting disorder (i.e. anti-phospholipid syndrome) for a homebirth? If not, why not?

[jengacnm]

A woman with antiphospholid antibody syndrome isn't a candidate for midwife care, let alone home birth. Their rates of miscarraige, stillbirth, severe and early preeclampsia, fetal growth restriction, and thrombosis-blood clots-are alarmingly high. They require frequent and early fetal survellaince; ie, ultrasounds and non stress tests.

Here are some factoids from eMedicine:

"APS increases the risk for maternal and fetal morbidity and fetal mortality in pregnancy. The rate of fetal loss may exceed 90% in untreated patients who have APS. Therapy (including aspirin and heparin) can reduce the rate of fetal loss to 25%, as described by Cowchock et al."

Here's the link:

http://www.emedicine.com/med/topic3258.htm

[Ilaria]

Thanks for your reply. I do know of all the risks in pregnancy, but can't find anything online about the risks during birth. I might have APS and was planning a homebirth.
I have had 2 normal, healthy births at 40 weeks, for my second, I labored at home for 15 hrs (just me and dh) then went to the hospital as she was crowning and she was born. I was on heparin and aspirin until week 20 for both.

I have never had a blood clot and I am being followed by my RE and a rheumatologist. Baby is doing well. I have had 12 ultrasounds and all is good, baby has been measuring 4 days ahead from the beginning. I am 26 weeks.
I guess I don't know what the real dangers of BIRTH are...I asked the drs about birth with APS and all they said was that I'd need to stop the hep 12 hrs before birth if I wanted an epidural or needed a c-section...that's really it. No other dangers were brought up.
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. Maybe I am missing something.

[AzariaJordan]

Protocols and ideas of out of hospital safety vary from person to person, state to state, and country to country.
I just attended a first time mum with APS at home and would do it again with no concerns depending on individual circumstances. PM me if you want

[hippiemommaof4]

Originally Posted by Ilaria

Do you (midwives) take on women with a clotting disorder (i.e. anti-phospholipid syndrome) for a homebirth? If not, why not?

I have a clotting disorder too prothromben gene mutation which is a risk of blood clotting too much or abnormally....with that said I didnt find out until my 4th pregnancy and I had 3 and then 4 successful healthy normal pregnancies. we're military and our clinic has midwives so I plan on seeing one next time we have a baby no matter what they always have on call docs in ob ward anyway so if a midwife isnt on staff you get an OB delivery anyway @@. I'm on blood thinner shots my entire pregnancy so I have to deliver in a hospital but mine has a birthing tub, is very pro BFing and pretty crunchy luckily!

[Ilaria]

[Jane]

In my state, no they can't take someone with known APS. However, there are many times when something like APS is diagnosed after several successful homebirths and you're pretty sure they had it for at least one previous pregnancy.

I don't know of anyone that switched back to low risk care after reaching term and stopping anti-coagulent therapy. Women at risk of pre-term labor do that reasonably often, sometimes with cerclage and lots of prenatal monitoring. It seems possible with a clotting disorder but I haven't heard of it.

[Ilaria]

Originally Posted by Apricot

you're pretty sure they had it for at least one previous pregnancy.

You are born with it.

If I do indeed have it (not yet sure), I had it for my other 2 normal, healthy, no complication pregnancies. (one born at 40w and the next at 40w3d), no PPH, no blood clots.

[Jane]

I thought it was an immune thing? That you develop it, like Lupus?
Now I gotta google it...

[Ilaria]

I was told it is congenital, but I might be wrong!

[Jane]

I do think I remembered right after googling it - it's an immune system dysfunction. You can inherit a tendency to develop issues (just like you inherit allergic tendencies, not specific allergies).

I hope you don't have it.

I would like to suggest there is value in not knowing. To make the general issue personal to me, I throw a positive ANA titer. I demanded this test from my doctor when I became ill. I was afraid I had lupus. I do not have lupus (well, as far as anyone can categorically state that). But now I have to deal with a positive ANA titer on my records. I do not qualify for life insurance at regular rates, because of that. And the test did not change the treatment options and has had a huge personal cost.

Many people choose to do baby-aspirin therapy to reduce miscarrage risks without a known problem. Please take some time to determine if not following up on this has risks for your health. If it doesn't (ie, you'll do the same treatment whether positive or negative), consider the ignorance option.

[~Mamaterra~]

I have a Protein S deficiency (my blood clots too much) and am on Heparin 5000ug twice a day. At 28 weeks, I will go up to 7000ug twice daily and I plan to birth this baby UC at home...

FWIW, I was just diagnosed with this in January after 4 m/c last year and three healthy full term babies before that.

[Ilaria]

Originally Posted by Apricot

Many people choose to do baby-aspirin therapy to reduce miscarrage risks without a known problem. Please take some time to determine if not following up on this has risks for your health. If it doesn't (ie, you'll do the same treatment whether positive or negative), consider the ignorance option.

That is wise...I now wish I hadn't started down this investigative path... I had 2 MCs and was put on Heparin and Aspirin for the next pregnancy (after a zillion tests that found nothing), had 2 healthy kids (mentioned above, no complications whatsoever, unassisted labor at home until 10 mins before birth!). Then 2 more MCs, then weird symptoms (MS-like) started, so I wanted to know what was wrong with me...got pg (surprise!) again and it is going well (I am 27 weeks now). I have had a zillion blood tests, 13 ultrasounds, urine tests, one NST, an amnio. I am on heparin, aspirin, prednisone and monthly IVIG. I am not opposed to med. interventions to keep me pregnant and to monitor baby's and placenta's progress, but I don't want to go to the hospital to for the birth. It's my last one.

[Ilaria]

Originally Posted by ~Mamaterra~

I have a Protein S deficiency (my blood clots too much) and am on Heparin 5000ug twice a day. At 28 weeks, I will go up to 7000ug twice daily and I plan to birth this baby UC at home...

FWIW, I was just diagnosed with this in January after 4 m/c last year and three healthy full term babies before that.

That is encouraging. Will you go off te hep when labor starts?

[Jane]

Originally Posted by Ilaria

I am not opposed to med. interventions to keep me pregnant and to monitor baby's and placenta's progress, but I don't want to go to the hospital to for the birth. It's my last one.

You've encapsulated my thoughts pretty well there. I'm sorry you're already knee deep in testing.

[~Mamaterra~]

Originally Posted by Ilaria

That is encouraging. Will you go off te hep when labor starts?

As a fellow PAL member, you will understand when I say, I haven't crossed that bridge yet because I just want to make it out of the first trimester.

[Ilaria]

I understand! I have just lately started thinking this baby might really make it!!