Blood clotting disorders ? - Mothering Forums

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#1 of 6 Old 05-28-2008, 03:01 PM - Thread Starter
 
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My OB consulted with two independant Peri's on my case. Both Peri's recommended substantial bloodwork to look for underlying conditions that manifest during PG. I had the bloodwork done earlier this month and the results came in- I tested positive for a form of Lupus and anticardiolipin AS (auto immune blood clotting conditions).
There is an assumed connection between these results and DD's early arrival. Treatment is available for the blood clotting issue, and my current OB is able to take care of us. The treatment is daily lovenox injections from + HPT to at least 6 weeks PP. I would get on heprin before delivery in hopes of lessing complications for delivery. These meds make delivery very complicated. Method of delivery is still a bit fuzzy- and needs to be a very controlled situation.
It looks like the chance of a low intervention PG are slim. The OB's recommendation is to see a Peri now for a pre-con. consult and confirm treatment plans.
What are some other options for care providers? Our area is not very NCB friendly and many midwifes can not take PVABC clients. (DD was a true urgent section due to Severe Pre-e/ Hellp).
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#2 of 6 Old 05-30-2008, 12:58 AM
 
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You might want to come on over to the health and healing thread. There are a lot of us over there in similar situations.

I was diagnosed w/a blood clotting disorder and I was on lovenox for my last pregnancy. My understanding is that you can not have an epidural with the lovenox. Because many care providers assume you will want an epidural, they want to have you stop the lovenox and then be induced. But, if you don't want an epidural, you probably have other options.

In my case, I ended up being induced because of high blood pressure, but other than the pitocin, I didn't have any meds. If you want to have a low/no intervention birth while taking lovenox, hunt around for a care provider who is ready to do that. They do exist, but they can be hard to find and you will need to clarify a lot of stuff from the beginning. Good luck!

Sarah
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#3 of 6 Old 06-01-2008, 12:40 AM - Thread Starter
 
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Thanks!
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#4 of 6 Old 06-02-2008, 12:43 PM
 
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Barging here - I just had my third vbac (fifth child), while on anticoagulants, with no epidural or other meds. I posted my story on the vbac board. The usual standard of care is induction, but with the vbac issue I could not be induced. As luck would have it, I tend to have preterm labor issues anyway, so going late is not a problem for me. I delivered at 38 weeks this time, going into labor on my own. I switched from lovenox to heparin at 36 weeks (lovenox dose was 40 mg 2x per day; heparin dose was 10,000 units 2x per day), but ended up not getting the epidural because I went into labor suddenly, not long after my heparin shot. (It was I who wanted the epidural. My docs mildly preferred that I had an epidural in place but were not adamant about it.)

My OBs had said that the heparin presented no bleeding problems with regard to delivery, whether vaginally or by section, except that epidural is contraindicated when there's not enough time after the last shot because the risks are so great. I was also on low dose aspirin and fish oil. Indeed, I had no bleeding problems. After a few more days of lovenox, I'm now on oral coumadin for the rest of the postpartum period (both lovenox and coumadin are safe for breastfeeding).

I had my first child while on no anticoagulants (that was before I knew about my clotting issues) and there were growth restriction issues and she also has had subsequent significant developmental delays and sensory processing disorder. If only I could go back in time.

Incidentally, I loved the care I got at my peri's office. They monitored my blood levels of lovenox monthly for dose adjustment. I also had monthly ultrasounds to check growth. Myself, and some of my friends, have been on the wrong side of small odds too many times, so I welcome that kind of care. None of that prevented me from having a med-free birth in the hospital. The OB didn't even tell me when to push; she just let it happen. Maybe I was really lucky with my OB, or with my labor or both, I don't know.

With needing a vbac, I don't see how they can really induce you anyway, at least not with medicine (there are some who will use pit to induce with a vbac, but my docs would not). The most my docs would be willing to do to move things along was to do a membrane stripping if there was a favorable cervix (they wouldn't even recommend nipple stimulation). Check the vbac board for old posts discussing inducing vbacs.

Good luck!!
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#5 of 6 Old 06-02-2008, 01:26 PM
 
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I'd start interviewing providers. Yes, in your case the standard of care would be a repeat section, but I'm sure you can find someone who would be willing to do a trial of labor. It will take some searching, though.

I started out this pregnancy on lovenox, before consulting with a hematologist and two separate perinatologists who all agree that lovenox was overkill in my particular situation. I did manage to find a doctor who was willing to skip the stop and induce protocol. The reason for switching to heparin later in pregnancy is actually because the heparin has a shorter half-life than the lovenox and is more likely to be out of your system by the time baby is born. And really, the concern is not pp bleeding or anything, but the fact that you can't have an epidural unless you have been off of the blood thinners for X amount of time.

So yes, it will be more interventive than you're accustomed to, but it doesn't have to be as interventive as the standard of care is, if that helps . Check out that thread in health and healing. It's called "Women with Blood Clotting Disorders" and was really helpful to me.

Charlotte, midwife to some awesome women, wife to Jason, and no longer a mama to all boys S reading.gif('01), A nut.gif ('03) S lol.gif ('08) and L love.gif ('10).
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#6 of 6 Old 06-02-2008, 06:26 PM - Thread Starter
 
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thanks everyone!!!!
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