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We are going to be TTC in a few months. I have been PSD and had a DVT 10 years ago, I have recently been to see my haematologist about TTC and she has said that I need to ring her as soon as I get a postive test and I can be booked in for a scan and start the LMWH injections. They will then monitor me closely at the hospital having frequent scans and appts.

My question is will I also have a local community midwife like 'normal' pregnancies or will my care just be hospital based? I live in the UK, can anyone tell me their experience?

Also when do people start the injections? I thought it was once you'd had a scan at 6/7 weeks and the pregnancy was 'viable' but my haematologist has already given me a prescription and I have some at home already?

I am really not looking forward to injecting daily, I have them when I fly long haul and I'm such a wimp I can't do it myself, hubby has to inject me in the departure lounge (god knows what people think we're doing) but I suppose I'll have to learn to do them myself sooner or later. :lol:

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Hi Angela,

I am in Australia, so I'm unsure how it works in the UK. Hopefully someone with experience there will be able to give you some advice about how the system works.

I have had 8 full term babies before my PSD was discovered. So it is possible to go through an entire pregnancy without blood thinners. I'm just telling you my story, not that I recommend you don't use the drugs, as I do believe they help enormously. I just don't want you to stress if your dr says to wait before you start the injections.

I am 15 weeks with #11 and as soon as I suspected I started doing the injections as I lost 2 in a row last year and had a clot as well. My dr agreed that I had done the right thing this time and is keeping me on them until after bub arrives.

I think drs take each patient as they come and each situation as it comes.

Wishing you all the best in your TTC journey.

Cheers,

Kathy

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  • 3 weeks later...

Hi Angela

How exciting!

I still saw my community midwifery team as well as having consultant appointments during both of my 'high risk' pregnancies.

I think that they used to wait for a scan but in practice it can be quite hard to get to see a consultant for a long appointment to sort everything out at short notice, so it is easier for you to inject from a positive test then see them when they can fit you in.

With my last pregnancy I had about 5 visits to the hospital in all but all the other appointments were at home with my midwives as I had booked a home birth. Not having to get to the clinic is another advantage of planning a home birth! During the hospital appointments they did all the same midwifery checks, urine dip, blood pressure, etc but a couple of blood draws for liver function tests as well. They also talked about how birth woudl be managed in terms of when to stop injecting and what they woudl do to stop bleeding post partum and that kind of thing. Quite often the midwives would put questions in my notes for the OBs team and the obs team woudl reply or ask questions themselves through the notes too. The pages got quite packed with all the to-ing and fro-ing.

I only had one scan which was a doppler scan to see the blood flow through the cord and the placenta. I think that might have been at 24 week or so. I didn't have the ordinary 20 week scan because we didn't want to have it.

Up front they make it sound as if things will be very medically-orientated but in fact once you are injecting there is less concern and you can go for weeks without seeing anyone at all just like a normal pregnant mummy.

As for injecting, doing it yourself is better, honestly. Bite the bullet and do it! In case you can't find them elsewhere, here are my injecting tips for beginner. Once you have the hang of it you will be able to inject yourself in other people's bathrooms at birthday parties! Ask your GP surgery for a big sharps bin and also a smaller 'travel' size one too.

Lie down and bend your knees so your feet are flat against your comfortable bed.

Make sure the bubble is at the plunger end of the syringe not near the

needle end. Hold the syringe like a pencil with your thumb and middle

finger with your first finger on the plunger. The bevelled edge of the

needle should be face up.

Pinch a good inch of skin somewhere low on your belly - you'll lose sight of this part of your belly after a

while so its good to use it while you can.

At this point you might want to remind yourself to take a few breaths and relax.

Poke your skin a bit with the needle. If it hurts a lot poke another place

until you find a bit that doesn't feel too stingy. There are some

places where the nerves seem to be more 'alert' than others - honestly.

Once you have found a good place tilt the needle to a 45 degree angle and

push the needle in as far as it will go. Now hold very still and press

the plunger with your first finger as slowly as you can. Once you have

pushed in all the liquid and you have only bubble left pull the needle

out and let go of your skin. And keep remembering to breathe!

Some doctors will tell you to remove the bubble but you can direct them this paragraph

"Subcutaneous Injection Technique: Patients should be lying down and Lovenox

Injection administered by deep SC injection. To avoid the loss of drug

when using the 30 and 40 mg prefilled syringes, do not expel the air

bubble from the syringe before the injection. Administration should be

alternated between the left and right anterolateral and left and right

posterolateral abdominal wall. The whole length of the needle should be

introduced into a skin fold held between the thumb and forefinger; the

skin fold should be held throughout the injection. To minimize

bruising, do not rub the injection site after completion of the

injection."

which can be found at Sanofi Aventis prescribing info

http://products.sanofi-aventis.us/lovenox/lovenox.html#Dosage%20and%20Administration'>http://products.sanofi-aventis.us/lovenox/lovenox.html#Dosage%20and%20Administration

http://products.sanofi-aventis.us/lovenox/lovenox.html

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Thanks to your both for your replies :)

I am quite excited but also quite daunted at the prospect of TTC and not just because of the PSD, just in general!

The less appts I have at the hospital the better as the one where the haematologist is based is 45 minutes away, mind you it does mean I get a paid half-day off work ;)

My haematologist did seem to suggest I would have quite a few scans though. I guess I'll just see what happens :D

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Hi Angela

I'm 29wks and also UK based. We discovered PSD in the family after my sister had a PE following emergency ceasarian. I've had a clot in my leg that was 1cm away from the deep veins which the haematologist here doesn't class as DVT but the obstetrician does! Basically it meant I had to be quite forceful to get hold of the clexane but sounds like that isn't a problem for you as you have it already. What will make a big difference is your free prescription card though - i only get 20 injections at a time so it would have cost me a fortune otherwise!

I had a scan at 8wks for viability then started injecting at 10wks. I'm also being given extra growth scans 'just in case' at 26wks, 30wks and 36wks which is good, but apart from that they seem very relaxed about the whole thing which i'm pleased about. I'm lucky that my hospital is only 5mins drive away so the extra appointments aren't a hassle. I've got an appointment there tomorrow and was planning on asking them if they consider me 'high risk' or not - as only 'low risk' mothers are allowed to use the more homely birthing suites. I'm hoping they'll consider me low risk and have been encouraged by some of the women on here saying they've been allowed home promptly after birth! I'll inject for a further 6wks post-partum. Injecting is absolutely fine and, following orangefoot's instructions, don't hurt or bruise. I am really running out of inches to pinch though as my tummy gets bigger!

Sally

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Thanks for your reply Sally.

No, I don't have a problem with getting the injections, a while ago I went to my GP about getting them for long haul flying and I also mentioned pregnancy to her and she didn't seem to think I would have any need for flying or pregnancy :rolleyes: , but I was told 10 years ago when I had my DVT that I'd need heparin throughout pregnancy. Luckily the haematologist I saw recently agrees. I live in Wales so prescriptions are free anyway :P:D

I have a load of questions that I should have asked the haematologist at the time but I forgot!

If you're classed as high risk does this rule out water births?

I will definitely be following orangefoots instructions come injection time - I recently flew long haul and I told myself that I was going to do the injections myself to prepare myself for when I have to do it everyday, but I bottled it and Hubby had to do it again :unsure::lol:

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free prescriptions in Wales? Didn't know that - lucky you!

Yes I think the birthing suites with the pools are only available to low-risk mums in our area. Having said that you could have a pool at home that you could use in the early stages regardless? Also re waterbirth I didn't want to 'plan' one as the hospital only has the two pools and it is strictly first-come-first-served, so you could be disappointed. I'm not sure if some hospitals have more pools than others. I just didn't want to set my heart on it and then be sad if they were in use. As it happens my friend has just offered me her pool which she used in the early stages for her first - bonus! Apparently they're not too expensive. A happy compromise.

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My second son was born in water and couldn't keep away from it as a toddler! I think you can argue that you want a homely birth room so that you can have a better labour with less stress regardless of your 'risk'. I was classed as high risk and under a specialist high risk team in Oxford but they still agreed to a home birth. I ended up in hospital with a tricky brow presenting babe and no progress after 36 hours with broken waters but I still got a nice comfy room with birthing ball, aromatherapy vapours, bean bags, windows and loads of space!

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that's encouraging - yep they DO class me as high risk :angry: which means in theory no access to the nicer rooms and also means constant monitoring. I'm going to resist that though... I think I need to speak to the midwife and explain my feelings and push for what I can get. The silly thing about refusing me the nicer room and insisting on the monitoring is that I'm likely to delay going in for as long as possible - and surely if they consider me high risk they'd want me there! I would definitely consider a home birth but don't mind wavering on that if they will waver on their requirements....

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Have you met the OB yet and asked them exactly which parts of the labour they consider to be high risk? This is what it came down to in my labour: the labour itself wasn't considered high risk but everything from the moment the babe was out and after the cord was cut (the third stage) was considered high risk. They wanted to prevent unreasonable blood loss and that would mean quick clamping, chemical assistance to detach the placenta and more chemical assistance to shrink the uterus and therefore shrink the site where the placenta had been attached. OBs will tell you that the scariest labours they have seen are the ones where there is unstoppable post-partum bleeding and this colours their judgement when dealing with pregnant women injecting anti-coagulants.

It was explained to me that they can advise you all they like but as a patient you don't have to accept their advice and recommendations. They do however have to do what they can to support you. This is what Patient Choice is about. They can be 'active' during the third stage of labour and administer any drugs necessary in any room in the hospital if they have them ready as soon as you walk through the door and if more help is needed you are in the right place and can be treated urgently if required.

The thing to do is keep talking to them and make sure they write down their concerns and their solutions to these concerns whilst taking into account your wishes.

Oh and in between do enjoy being pregnant and try not to worry too much! :P

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so you had to have an assisted third stage? One of the things I was quite keen on was allowing the cord to keep pulsating until it was ready and only clamp/cut after that. I suppose I find the attitude of the haematologist at odds with the obstetrictian but am seeing him in a couple of weeks so will quiz him too! Will have good chats with them all at my next appointments - thanks for the advice!

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