Vit K for baby w/maternal blood clotting disorders? - Page 2 - Mothering Forums
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#31 of 54 Old 08-18-2005, 09:43 PM
 
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I just want to thank Zeldasmom for her lovely comments on hypothetical situations and appropriateness. It's hard sometimes to see how what seems like "just my opinion" can come across to someone for whom the situation is all too real.
I realize that the comments made were not meant to be "this is how you should feel" but please, please try to see that someone's hypothetical opinion can never carry as much truth as someone's real life journey through the torture of losing a child. Yes, you are entitled to your opinions, but you might be better received sharing them in other hypothetical situations.

And ST, if you do ever come to a consensus on the vit K issue, will you let us know you reached it?
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#32 of 54 Old 08-18-2005, 11:57 PM
 
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ST, I wish I could find the research my OB did for me on the vit K shot. We ended up giving the shot anyway.

To Wendy, I too believe you didn't set out to insult or hurt anyone--but nor did my MIL when she called after my last miscarriage to let me know that our 3 losses was God's way of telling us people who are not married should not have children. She really believed that but just because she believed it didn't make it even remotely close to appropriate. I'm assuming you've never lost a child because if you had I don't think your fingers could have even typed the words you typed. Perhaps your mother doesn't show you the true impact of your baby sister dying for fear of a comment like "Well yeah, but it was better than when older sis died right?
Personally I really think you owe ST and others here an apoligy--just saying you had no intention to hurt someone isn't enough when you've hurt someone in the way you have.

ST, you know I'm thinking about you every single day mama. You'll have him/her in your arms soon and you so deserve it
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#33 of 54 Old 08-19-2005, 01:28 AM
 
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ST, I cannot express the enormous hug I want to give you right now with a silly emoticon.

I am on blood thinners as well, though for an entirely different condition.

IMO, it is so hard to talk about "normal" and such when there is little study and little availible information. I understand too well how difficult it can be to make such decisions when meds and little understood conditions are involved.

It isn't an equal percentage at all for a known condition in the genetics as opposed to a minor risk of another.

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The natural forms of vitamin K that are found in many foods, particularly in vegetables such as collard greens, spinach, broccoli, asparagus, brussels sprouts and salad greens
pm-ing you for more....

Comparing losses...is well...just really not appropiate for this or any forum. Anyone who would do so has little experience in the matter. Let's move on from that please and not discuss it further.

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#34 of 54 Old 08-19-2005, 02:20 PM
 
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babies are born with very low amounts of vitamin k, and although supplementing a mom or having her increase vitamin K foods while breast-feeding will increase the amount of vitamin k a baby gets- it would not be healthy for the mom if she is on blood thinners for a vitamin K related clotting disorder-it would counter act her drugs and would be very unsafe.
---------------------------------------------------------------

a possible case could be made for someone with protein c or s deficiency because vitamin k - could increase production of these proteins but this is speculation on my part no studies that I know of.

here is the USDA address - scroll to the bottom of the page under special interest tables is one for vitamin k- use that link

http://www.nal.usda.gov/fnic/foodcomp/Data/index.html
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#35 of 54 Old 08-19-2005, 03:03 PM
 
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I think as time goes on this is going to be getting more and more study from the scientific community, especially since there is more and more evidence that blood clotting factors increase the risk of pre-eclampsia. I think the effect of blood clotting d/o's in pregnancy is going to become a major focus of research in the near future.
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#36 of 54 Old 08-19-2005, 03:08 PM
 
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Originally Posted by mwherbs
it would not be healthy for the mom if she is on blood thinners for a vitamin K related clotting disorder-it would counter act her drugs and would be very unsafe.
That is true only if mom is on warfarin or another anticoagulant that is a vitamin K antagonist. If the problem is relatively mild, as the Factor II thrombophilia usually is, daily aspirin may be the only blood thinner prescribed. That's what I have been offered. Excess vitamin K wouldn't inhibit aspirin's effectiveness at preventing clotting episodes, because aspirin's mechanism of action doesn't involve vitamin K.

During pregnancy, dietary vitamin K supplementation probably wouldn't pose a problem, but anyone considering it should of course talk to their hematologist first. The oral anticoagulants that act as vit K antagonists aren't given during pregnancy due to risks to fetus, and so most women with a serious problem are on injected heparin during pregnancy. Like aspirin, heparin's mechanism of action doesn't involve vitamin K.
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#37 of 54 Old 08-19-2005, 03:37 PM
 
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Quote:
Originally Posted by gossamer
I think as time goes on this is going to be getting more and more study from the scientific community, especially since there is more and more evidence that blood clotting factors increase the risk of pre-eclampsia. I think the effect of blood clotting d/o's in pregnancy is going to become a major focus of research in the near future.
Gossamer

Hello, this is JUst MY Opinion, HOnestly.

When the medical profession simply gives Vitamin K to every single newborn as a matter of routine keeps them FROM doing the research that you are hoping for, gossamer.

As long as doctors operate on autopilot in most of their dealings with people, they will never look at the patient as a unique person.

The OP has a special problem and has a special treatment during a special time in her life. The routine is not going to fit her, so hardly any guidelines are there for here.
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#38 of 54 Old 08-19-2005, 06:01 PM
 
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Hi

Just my 4 eggs here -
I have Protein S Deficiency and had this same q for my haematologist with my second child. (My first was born before diagnosis)

In my gut I felt the same as you that introducing a clotting factor to a child who may already be more prone to clotting seemed unreasonable.

Protein S is a Vitamin K dependent protein so needs vit K to function properly.
Vitamin K is produced in the gut or ingested in foods but does not cross the placenta so newborns have a lower level of Vit K as they have not received any and do not have the necessary gut bacteria to produce it for themselves. Vit K is also 'low' in breast milk so bf babies are thought to be more at risk of haemorrage.
Vitamin_K_and_newborn_babies?
Putting this in context, Protein S is also low in newborns and young children. True PSD can only be accurately diagnosed in young adulthood. Many women have this and other thrombophilias yet we have survived generations and are also able to pass these mutations on to our children.

"Why should a mutation [Factor V Leiden] which is associated with venous thromboembolism (VTE) have spread so successfully? It is first important to note that even in subjects with the mutation fatal pulmonary embolism is more likely to occur after rather than before the individual has reproduced. Nevertheless it is tempting to speculate that the gene could have offered a selective advantage at some point in the past. Our modern way of life may have increased the risk of thrombosis and in the past the risk of fatal bleeding from post- partum haemorrhage or traumatic injury was higher than today."
http://www.jr2.ox.ac.uk/bandolier/ba...s/keeling.html

I report this last in the full knowledge of the pain and sadness that PSD and other thrombophilias can bring; I have DVT and my dad died recently due to a mesenteric vein thrombosis.

What I am getting to is this. The number of children who develop Haemmoragic Disease of the Newborn is very few, but mortality is very high as the body has no way of pre-empting it as many clotting factors are low.
My haemo who I trust and is published and well respected in this field in the UK said that if ds were to develop HDN my PSD would not help him (for the reasons I listed above) but VitK could prevent it so he would recommend accepting the drops.

He had the drops and so did my dd. Since my DVT I have bent my brain reading research on all aspects of PSD and would give the drops to any more children I have.

This pdf shows autosomal dominant inheritance clearly. I will have to wait and see if any of my children have PSD I hope that they don't, but I also count my blessings daily that I have them here with me and they were not taken by this random heartless genetic inheritence.

Hoping you are ok
Rachel
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#39 of 54 Old 08-19-2005, 07:34 PM - Thread Starter
 
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Wow, there are some very interesting thoughts and links posted here.
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ST, if you do ever come to a consensus on the vit K issue, will you let us know you reached it?
Oh I definitely will let you know what I decide. At this point dh and I are leaning towards getting an "optional waiver" from the head of the nursery at the hosp with the option to give the oral drops if there is any bruising or trauma to the baby during birth. (Unfortunately in NYC, when you give birth in a hosp, it's not easy to refuse newborn procedures, so I'll need to have this squared away before hand). But, I am still reading and digesting info so that could change.

shannon, what clotting d/o do you have again?

Quote:
IMO, it is so hard to talk about "normal" and such when there is little study and little availible information. I understand too well how difficult it can be to make such decisions when meds and little understood conditions are involved.
ITA. And it's even harder to make these decisions when you come from a NFL perspective because many people seem to have these knee-jerk reactions of "just do this" or "screw mainstream meds/docs" when so many of us have mainstream meds/docs to thank for our health and the lives of our babies. Literally. It's so complicated when you have to figure out how to toe the line between what the two have to offer you as their best. But I also think that we have the opportunity to teach both sides something- at least that is my hope.

jplain, I'm on a prophalatic dose of lovenox for this pg and six weeks pp and I do eat a good amount of vit k rich veggies. I haven't felt like it wasn't good for me (on an intuitive level) but I def. don't feel comfy consuming megadoses of Vit K. According to what you're saying though, it wouldn't counteract the effects of the lovenox on me?

Quote:
As long as doctors operate on autopilot in most of their dealings with people, they will never look at the patient as a unique person.
I think this is so true, which makes me so very very thankful that I've managed to find a team of providers that is working with me as an individual. I have a homebirth midwife who's doing a planned hospital birth with me (after we discovered my d/o when I was 15 weeks along) and a perinatologist who is a strong supporter of homebirth midwives (and caught 4 of his 5 children himself at home) and who has lots of experience working with women with clotting disorders. Bizarre to find one person who has years of experience with low-risk healthy pregnancies and births and another who constantly sees the many things that can go wrong in pregnancy and they work together as a team and are able to still see women as individuals.

Rachel, thanks for your thoughts and info and I'm sorry for the loss of your dad.

To all of you who've offered support to me (and you probably don't realize it but your words also offered support to the other mamas of dead children who've read this thread and been upset by those comments) thank you.

I think there's a real need to educate people about the loss of a child and I've tried to do my part with the people in my real life and my circle and through connecting with other mamas of angels. Nonetheless, it does hurt like a mo-fo when I happen across people that have no idea the way that my son's life and death has affected me as a woman, a mother, a wife; how it's affected the lives of my friends and family members who mourn with me very deeply, still; the life of my godson who could barely touch me this pg for fear that his little brother or sister would die like Nazir did; how my career and school plans have been derailed/sidetracked, relationships gained and lost, spirituality questioned, changed, all these things and more that have been thrown into another dimension and someone, not knowing one ounce of these things through personal experience could actually have the audacity to tell me (or any woman) that "it could've been worse". I've been told this crap IRL before and my response was not nearly as polite as it was here. So thank you for understanding and for expressing yourselves here.



Would anyone have an interest in doing a thread in FYT for women with clotting disorders to discuss issues related to NFL/AP and our lives/health/treatments/research/children? Just curious cuz I know there seem to be a few of us floating around here.
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#40 of 54 Old 08-19-2005, 10:58 PM
 
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I was on Lovenox injections during pregnancy after what appeared to be a clot in the placenta led to more testing which revealed a clotting factor. I discontinued the lovenox at 38 weeks, increase perinatologist monitoring to twice weekly and delivered at home. However, took the vit K after a pregnancy on blood thinners after a long and difficult labor. I didn't invest the research in it at all though, just went with my sense at the time. Therefore, I'd be really interested to continue hearing what information you find, as I'll likely be dealing with similar issues in a future pregnancy.

(On a funnier note with the Lovenox injections - they'd leave bruises on either side of my stomach that led the birth center midwives I started with screen me for domestic violence on every visit, much to the chagrin of my in attendance husband, heh. And people say caregivers never ask about those things )
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#41 of 54 Old 08-20-2005, 12:29 AM
 
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ST, I love you. Thanks for so beautifully posting your point. I'm sorry you ever had to experience this, and I pray everyday for your beautiful baby 'Paris'

Mamato Ruby Violet joy.gif(6 with autism) and someone 1sttri.gif who should make him/herself known sometime in the next month.

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#42 of 54 Old 08-20-2005, 03:09 AM
 
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"In the blood coagulation cascade, prothrombin is cleaved by factor Xa to form thrombin, an active serine protease (Narayanan, 1999). This proteolytic reaction occurs on the phospholipid surfaces of platelets and requires calcium. Thrombin is responsible for inducing platelet aggregation and activating several other mediators in the coagulation cascade. It converts fibrinogen to fibrin, which then polymerizes to form a clot around platelet aggregates. Thrombin also converts factor XIII to factor XIIIa, an enzyme that cross-links and stabilizes fibrin polymers. The prothrombotic effects of thrombin are ultimately suppressed by the binding of thrombin to thrombomodulin on endothelial cell surfaces to form a complex that activates protein C. Protein C then degrades factors Va and VIIIa to inhibit the coagulation cascade."

aspirin reduces platelet aggregation so directly or indirectly it has to do with vitamin K related clotting factors (prothombin is factor II) so I do not understand how increasing vitamin k would not result in a change in the effectiveness of treatment. I am not trying to be difficult here I will have to find a friendly hemotologist to talk to sort this out more- on to do some more research--
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#43 of 54 Old 08-20-2005, 09:19 AM
 
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Originally Posted by mwherbs
aspirin reduces platelet aggregation so directly or indirectly it has to do with vitamin K related clotting factors (prothombin is factor II) so I do not understand how increasing vitamin k would not result in a change in the effectiveness of treatment. I am not trying to be difficult here I will have to find a friendly hemotologist to talk to sort this out more- on to do some more research--
I'm having a hard time thinking of how to explain without resorting to biochemical pathway talk. Vitamin K acts 'upstream' of platelets. Aspirin acts on platelets, but that action is downstream of vitamin K. If you act directly on something downstream, upstream interventions may or may not be able to interfere with the end result.

In this case, if you give aspirin, the platelets are inherently less sticky. Adding more vitamin K to the system, even if that results in higher concentration of vit K dependent clotting factors, shouldn't make the platelets more sticky. The platelet stickiness is independent of the clotting factors. That stickiness is a property of the platelet itself.

The difference between aspirin, heparin, and the oral anticoagulants is that the oral drugs directly impact vitamin K activity. Adding extra vitamin K to the system would interfere with that type of treatment.

Someone on aspirin or heparin is unlikely to be deficient in vitamin K, unless they're also on oral anticoagulants. So far (and this is the key question!) I haven't found any evidence that adding extra vitamin K will make a person with non-limiting (normal) levels of vitamin K clot faster. (It is however, true that someone seriously deficient in vit K will clot better if vit K is administered.)

As an aside, very high doses of aspirin do directly interfere with the vit K dependent clotting pathway, although I'm not sure exactly which step is affected. I'm pretty sure it is moot though, because as a rule, high dosages of aspirin aren't given for clot prophylaxis.
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#44 of 54 Old 08-20-2005, 10:22 AM
 
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It is however, true that someone seriously deficient in vit K will clot better if vit K is administered.
This is exactly the reasoning behind babies being offered VitK drops; because they are deficient in Vit K.

WRT to aspirin, warfarin and Low Molecular Weight Heparins (LMWHs), Warfarin acts on the liver and the production of Vit K so is affected by diet as J says. All warfarin patients are advised to either maintain a steady intake of Vit K or keep it to a minimum. This is to facilitate regulation of the necessary dosage of warfarin, which is notorioulsy difficult at the best of times without having broccoli soup every day one week and not the next!

This article explains it well.

A short list of Vit K in food is here

If you are taking warfarin and any vitamin supplements look for one without Vit K - pregnancy multivitamins often don't have it.

LMWH works differently by binding to antithrombin III and inhibiting clotting that way.
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#45 of 54 Old 08-20-2005, 10:32 AM
 
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Quote:
Originally Posted by orangefoot
This is exactly the reasoning behind babies being offered VitK drops; because they are deficient in Vit K.
Nature provides for babies to be born deficient in vitamin K because Nature never intended for them to be poked, pulled, prodded, pinched, pricked, and processed the way the hospital routines treat newborns.

Newborns are treated gingerly and carefully by their mothers instinctively in more natural settings.

Vitamin K is made in the gut and processed by the liver when their digestive system gets going. The clotting factor is in gear, usually, by the end of the first week.
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#46 of 54 Old 08-20-2005, 10:46 AM
 
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Originally Posted by orangefoot
This is exactly the reasoning behind babies being offered VitK drops; because they are deficient in Vit K.
But if all babies are deficient in vitamin K, then the fact is that none of them are deficient, right? They're just normal.

However, there is a subset of newborns who are truly vitamin K deficient. For whatever reasons, these newborns have used up their limited supply of vitamin K, and don't have enough left to continue producing clotting factors at a reasonable rate. The vitamin K they had will regenerate itself, but that takes some time. So in the meantime, supplemental vitamin K may prevent serious bleeds.

Since one can't tell by looking which babies are truly low in vitamin K (compared to other newborns), it is routinely given to all. But that is very different from saying that newborns are deficient in vitamin K.
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#47 of 54 Old 08-20-2005, 11:01 AM
 
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I like the idea of a forum to discuss clotting disorders.
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#48 of 54 Old 08-20-2005, 11:34 AM
 
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I said that was the reasoning, I didn't say I agreed with it! I should have said the medical reasoning.

A lack (compared to adult levels) is always perceived as a problem, which it can be, but in these circumstances it is not necessarily so.

Children have low PSD naturally as do pregnant women (hence false positive PSD diasgnosis during pregnancy) This must be because during pregnancy we need protection from bleeding, as do small children; how many bumps and scrapes do they have when they are little?

However, current OB practice does involve a lot of messing around and possible trauma so it is entirely possible that more cases of HDN have been reported and instead of reducing interventions, Vit K 'deficiency' has been scapegoated.

Anyone diagnosed with a thrombophilia is very unlikely to be advised to give birth at home so there is a 'risk' of less thoughtful treatment. It is only people who are willing to fight OBs, registrars and doctors who are able to make decisions regarding their labour and birth. The vast majority of people follow their doctor's advice without questioning it.

I think a forum for clotting might be useful because the boards which currently offer support are very mainstream. I cannot believe how many times I have read people advocating that induction, epidural and caesarians are better/safer than a spontaneous labour, and that warfarin is not safe when breastfeeding.
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#49 of 54 Old 08-20-2005, 01:04 PM
 
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Sorry, I lost track of this thread. ST, to answer your question, I have APS and Lupus Anti Coagulant. I did have a DVT and PE after knee surgery about 7 yrs ago. I also have rheumatoid arthritis so the autoimmune factor is in play there too.

I agree that a tribe for mamas with clotting disorders would be very helpful, I have to admit, when I was pregnant this time I had a heck of a time finding other moms here who had been through what I was going through. I had the support of my OB, who was awsome, but she admitted she was winging it a bit. Unfortunately the peri and the RE I had seen wanted to "try another pregnancy without treatment" He didn't care that dh and I had both decided we could only try one more time. We couldn't go through yet another loss--so this was our last kick at the can so to speak. I told my OB that I wanted to try everything that could help as long as the risks were not worse than loosing a baby. She agreed especially since my mother had severe pre-eclampsia, she felt that not treating for the clotting disorders left far too much chance of another failure. It would have been so nice to be able to get in touch with others here regarding the clotting issues. I belong to a yahoo group, but much of it is so mainstream.
To whoever mentioned about being screened for domestic abuse...:LOL, me too, it was worse too because I was so sick in the beginning that until they finally placed a pick line I'd had IV's in multiple spots on both arms--so my arms were bruised up as well. Poor dh, the looks he'd get if we went out to eat or something :LOL
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#50 of 54 Old 08-20-2005, 01:52 PM
 
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Quote:
Originally Posted by jplain

In this case, if you give aspirin, the platelets are inherently less sticky. Adding more vitamin K to the system, even if that results in higher concentration of vit K dependent clotting factors, shouldn't make the platelets more sticky. The platelet stickiness is independent of the clotting factors. That stickiness is a property of the platelet itself.
-----
As an aside, very high doses of aspirin do directly interfere with the vit K dependent clotting pathway, although I'm not sure exactly which step is affected. I'm pretty sure it is moot though, because as a rule, high dosages of aspirin aren't given for clot prophylaxis.
Thank You jplain,
these 2 bits make it clear for me because I thought I remembered that aspirin could block vitamin K .


The study of vitamin K and the other functions in the body beyond clotting factors has grown in the last 10 years most of the research is related to aging. But the research also created a better way to quantify the amount of vitamin K in foods.In the US dietary intake is often not even at RDA levels. Even at levels that are sufficient to maintain normal blood coagulation may be sub-optimal for bone and artery health, and habitual low dietary intakes of vitamin K may have an adverse effect on bones and cardio vascular health. if you have healthy intestinal flora the production of vitamin K is low. also from more recent studies it was found that in hydrogenated oil there is a form of vitamin k called dihydrophylloquinone it is not well absorbed and seems to produce clotting factors but does not help with the other functions of phylloquinone no protection to bones or keeping the arteries free from calcification, dihydro goes where natural vitamin k goes in the body but is not converted to MK-4 like natural phylloquione does.
Breast milk readily delivers an increasing amount if mom increases her intake- since many nutrients are tightly regulated in breastmilk I think that there must be a reason that the body is delivering higher amounts in response to mom's diet.
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#51 of 54 Old 08-23-2005, 09:04 PM
 
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I would be very interested in a forum for women with clotting disorders. Just starting to gather info on this and lord is it overwhelming. I don't know if I have this problem or not, but after 2 losses my ob/gyn had damn well better test for this. If not, outta my way because I'll find someone who will. :

Lisa

Lisa , married to Dan, mama to IVF miracle Natalie 5/20/09 :
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#52 of 54 Old 09-24-2005, 06:35 PM - Thread Starter
 
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I just wanted to let you all know that I had my baby boy last Saturday- Sept 17th at 3:43 am and we are both healthy and happy. He was 6 lb 11 oz and is just a joy to behold.

I was induced at 37w2d because my bloodwork started looking not so great and we all agreed (my dh and I, my midwife and my perinatologist) that it would be better to induce rather than "wait and see" what happened.

After much discussion with the head of the nicu at the hosp and 2 hematologists, we decided to go ahead with the vit k shot and baby boy is doing well.
Thanks for all of your thoughts, info, suggestions and well wishes!
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#53 of 54 Old 09-25-2005, 10:42 AM
 
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Congratulations and welcome to your little one!
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#54 of 54 Old 10-05-2005, 10:51 AM - Thread Starter
 
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thank you orangefoot!

i finally started this thread in fyt:
clotting disorder thread
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