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You've all got me thinking now with all this talk of spinals and c sections!

I have not been anti-coagulated during my previous 3 pregnancies as at that time I had not had any episodes (weird way to describe the horribleness of a DVT or PE don't you think? :( )

Anyhow now that I am thinking of going for a fourth so that my darling girlie isn't lonely when she gets older I am worrying about how I might deliver a baby after an anti-coagulated pregnancy.

I am now at higher risk than before because I had a non-pregnancy related DVT last summer and when I spoke to my haemo last he said I would need to be on Fragmin for another pregnancy but why would I want another baby anyway. Wasn't three enough? Grr at that - is it his business?

I am weighing up the risks in my mind but one thing that bothers me which I haven't spoken to him about is the actual delivery. I had spontaneous onset labours with the other three but ended up on a Syntometrine drip with the last one as she was in an odd position and they wanted to force her down into my pelvis. The little tinker had her head up on my hip and not in my pelvis even after my waters had broken so there was a risk of a cord prolapse. The contractions I had on the drip were horrible compared to my other two drug free labours and I dread going through that again if I had to be induced.

This probably sounds odd but after delivering two babes easily with the minimum of fuss I was really shocked and it took me a while to get over it. Epidural and C section are my worst nightmare and although I would do it if it was the only way to deliver my baby safely, I don't want to begin a pregnancy knowing that that will be how the baby is born.

If you've got this far...

Have any of you gone into labour spontaneously or am I in cloud cuckoo land hoping that it could be possible?

I'm glad to see everyone is keeping well; I find myself worrying about you all

Rachel

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Hello there, I was in a sort of similar situation in that I was debating whether to have another one given all the potential issues and I went in and had a chat with my haemo about it for reassurance before I made the decision (fortunately he was reassuring and didn't offer any pearls of wisdom like yours did!).

The chats I've had this time about the birth basically come down to ... they seem to not want you going into spontaneous labour because they don't want it to happen right after you just had a shot of Fragmin (or whatever Heparin you're on). They want to plan it so that you can be off the injections for 24 hours in advance, otherwise you have too high a risk of bleeding and rupture. For this reason they talk about planning to get the baby out at 38 wks which is usually before the chance of spontaneous labour is there.

So I would say chances are they'll probably discuss induction with you I'm afraid! Unless they consider your risk not too great in that they're happy for you to come off the Fragmin and chance it natural? Might be worth asking.

I have to have another c-section, boo hiss, but I'm so happy to be pregnant again I will take whatever they offer me.. and I also find myself worrying alot less about the birth than potential future 'episodes' during the pregnancy and afterwards... so I'm not focussing TOO much on the whole epidural/spinal/c-section thing right now (this may change later!)

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I am 12 weeks now but I have had two miscarriages and that is when they found my PSD. I have to laugh :( at your questions because I too, did lots of reading and asked lots of questions of my high risk doctor about spinals and being on lovenox. I was not sure that I would try again if I would not be able to have a spinal of some kind. They doctor laughed and said, that is why they alway induce at the doctors schedule, not mine. I had my first son 2 weeks early so my high risk doctor is going to check the baby's lungs about 34 weeks and then decide when to induce me. That way, they can take me off the lovenox/heparin 24/48 hours before they induce.

I really don't think I could do it without something. But, maybe it would build more character to have the baby naturally!!

I would ask your doctor. They will let you know in detail the full "plan".

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  • 1 year later...

Please help me! My doctors want to induce me at 38 weeks also but my worst fear is c-section. I've been doing my research on induction and c-section and have found that the risks of induction is c-section because if your uterus overworks itself without stopping it deprives the baby of oxygen, therefore putting it into distress, wich will most likley lead to a emergency cesarean. Also I read that mothers undergoing induction almost doubles the risk of cesarean.

The research I did on risks of cesarean isn't pretty either... they include post-birth complications such as: infection, hemorrage, thrombosis, and pumonary embolism. Somebody please tell me why doctors would put a person who is already at risk of forming blood clots, and hemorraging through something that could potentially cause this same problem!?!?! :D

I should note that I'm 25 weeks pregnant, on 40mg/day lovenox, moving up to 60mg/day at 28 weeks, then at 36 weeks going to two shots a day of something that doesn't stay in your system as long.

Please help to support my objections or help to ease my fears....are these fears even legidamate, or am I just an emotional pregnant lady? :D

Juwels.

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I am continuing to take the Fragmin and will be going into labor spontaneously and natural without painkillers, unless I go over 40 weeks and then I might have to be induced or even c-section(if baby is breech). I will not be opting for the epidural. I will opt for full narcotics I for some reason I have to have a c-section and am going to tough it out and do it naturally if I have an induction. My doctor says there is no problem if I have some Fragmin in my system when I go into labor. I will be getting a shot the next day anyways and from 6-8 weeks afterwards. Fragmin is the best to be on imo because it allows you to go into labor on your own! No need to worry about being over anti-coagaulated. <_< I praise Fragmin to the heavens!

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Hi Juwels

You are not an over emotional pregnant lady! I totally agree that suggesting that someone who is already at risk of clotting has a spinal puncture and an abdominal operation is Obstetric induced madness. <_<

Doctors know that induction can cause problems which is why they insist on fluid drips and Constant Foetal Monitoring during the labour. Having experienced the effect of an oxytocin drip in my last labour I can say that it causes contractions which are most unlike those I experienced in my previous 2 labours.

The overstimulation of the uterus is more painful as well as more risky. This opens the door to the 'cascade of interventions' you have read about which can move through epidural - failure to progress - foetal distress - to caesarian.

A baby born at 38 weeks is premature and at more risk of breathing difficulties. A frend who is having an elective caesarioan due to pelvic and scar tissue issues has been told that her OB will NOT deliver the baby at 38 weeks because it involves more risk for an under-ready baby.

I think the reason that many OBs suggest induction at 38 weeks is because they do not understand the function of LMWH and its 'life' once injected and because it means that they know more or less when your baby will be born - which is easier for them in terms of having surgeons ready to do the caesarian during daylight hours. They are also concerned that you may want an epidural and that would be contra-indicated if you have recently injected.

There is no reason why you cannot begin labour spontaneously as Hyacinth has described and be treated as per the UK Obstetric Green Top guidelines.

The woman should be advised that once she is established in labour or thinks that she is in labour, she should not inject any further heparin. She should be reassessed on admission to hospital and further doses should be prescribed by medical staff.

http://www.rcog.org.uk/index.asp?PageID=533

Ultimately, if the baby is OK, you are well and you arenot already in labour (!) you are under no obligation to attend the induction appointment. (a midwife told me this) The hospital has duty to treat you whenever and however you arrive there. They must help you birth your baby as you wish, not 'deliver' the baby at their convenience.

This has got long, sorry. Do talk to them and say you don't want an induction for the reasons you have stated. Ask them what they will do when you go into labour on your own. Get you haematologist on side; mine was happy to write to the OBs and put his perspective on it. You are at a much lower risk with a 'normal' labour.

They have already prepared to change your meds to a shorter half life so they are half way there already :) Keep negotiating until you are happy.

Best wishes

Rachel

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Thank you for your replies, I have an appt. with my ob on the 29th.

Now my ? is...is fragmin the same as lovenox? I'm on lovenox wich is a lmwh, but do I need to be taking a different injection in order to go into spontaneouse labor?

I am assuming the reasoning is so the pateint will not hemmorage during or after labor? <_<

Thanks agian!

:)

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Hi,

I am new to the board. I am so glad that there is a community of folks out there with this same issue with PSD - especially dealing with pregancy. I was diagnosed with PSD about 2 years ago but it was suspected in my family long before that - my Dad died at age 48 with a PE and my uncles and grandfather on his side all had DVT at various points in their lives. I am the one lucky girl in my generation to have the condition, but it is latent - meaning I haven't had a blood clot to date.

I am 43 and this is my first pregnancy out of 4 that I have known that I had PSD. Of the 4 pregnancies, 1 ended in miscarriage last year - but they are pretty sure it was a blighted ovum as opposed to PSD related. The other two where normal pregs with no issues - which my perinatoligist (sp?) says was pure blind luck since my PS levels are almost bottomed out at 11 (!) with this preg and probably were with the other two. Always nice to know after the fact that me or the baby could have died!!! Thank the Lord everything turned out Ok in spite of the ignorance of the condition at the time.

I am at 13 weeks with this preg and on 40mg Lovenox daily, which has the honor of being the most expensive medication I have EVER taken - $800 a month!!!! Thank heavens for decent insurance - I never thought I would kiss my HMO card. <_<

My OB has already gone through some of my options for delivery - meaning they will pull me off the Lovenox and onto Heprin at 36 weeks (I have historically delivered early with my others, so she wants to be safe). I did ask what would happen if I went into early labor with Lovenox in my system and as many of you have already confirmed, they will not do an epidural because of the risk of spinal bleeding. So, I asked what are my options then...her response was either natural child birth - if everything is going Ok with the baby or if I need a C-section, she said that they would probably do a general with heavy doses of a localized "blood thickener" to counteract the Lovenox.

The other thing that is working in my favor is that I should probably have an incredibly short labor...I was only 6 hours with my first - 3 with my second. If I follow the pattern, and this labor is less than 2 hours, there will be very little time for me or the baby to get into distress. But it's interesting that I haven't heard anyone else mentioning about general being an option...are you hearing otherwise from your docs?

Thanks, ladies - hang in there!

Cynthia Crowder - Atlanta, GA USA

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Hi there

I'll wade in on the Fragmin/Lovenox thing - only because I actually asked my hemotologist what the difference was between the two. He said that effectively they perform the same but he has had lower instances of reactions and side effects from Lovenox. Plus Lovenox is injected once daily as opposed to twice daily with Fragmin. But ya know...the next doctor might say the exact opposite based on THEIR experience. As long as they both work....

Ta ta

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I only take Fragmin once a day. It all depends on how much you weigh. I was told that if I didn't want as much medicine in my body at one time, then we would look into seperating the medicine. Half in the morning and half at night, but the dose would be the same, but since my injections come pre-filled that would have been quite impossible. Hehe.

I guess all doctors have different opinions on these things. <_<

What side effects?

I have heard worse things from the Lovenox end, more women miscarrying and such.

I found this link that describes Fragmin fairly well.

http://www.indyapharma.com/Dalteparin-detail.htm

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Hi, There:

Doctor said that Fragmin, in his experience, caused more issues with back/joint pain, nosebleeds and allergic-reaction type things like hives. He hadn't seen that many issues with Lovenox except for bruising at the injection site. Of course, he didn't mention anything about miscarriages being higher with one than the other - which gives me a pause. But then again, my perinatologist was in complete agreement with the Lovenox - said that's what he would proscribe. Since he was recommended for his experience with PSD babies, I have to assume he has some knowledge of the risk factors involved but I'll ask on my next visit just to be sure. Thanks for the heads up.

I just started my injections about a week ago and personally my main complaint is that I feel *strange* after the injection - can't put words to it, I just feel weird...but it passes. And I get the little bruise. But otherwise, seems OK. But, of course, I just started so heaven knows what I'll be dealing with in 6 months, eh?

Ta TA

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Most of the women that I have talked to who take Lovenox are not on it because of PSD, so maybe that has something to do with why they have miscarriages and it has nothing to do with the Lovenox itself. It is so hard to know really. You just have to try everything. <_<

I felt weird the first few weeks of taking Fragmin as well and had terrible heart and chest pains that were like angina. (I do have a mitral valve reguritation). They would come between an hour to 3 hours after taking the medicine. They finally went away after one serious episode of what I thought was a heart attack during the night and then the next day I had a bubble effect take place in my chest. Afterwards, no more pain. Smooth sailing from there on out. I do not know if there was some sort of clot in that area or not, since I had suffered from pain there for many years, but the medicine did seem to help one way or another.

I do not even worry about bruises anymore. They either come or they don't. I just do not have the patience to worry about them. Only problem with them is that it makes it harder to find a safe area to stick, and they are few and far between when your pregnant(stretch marks, big veins,etc). Not fun!

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Thanks for the response, Hyacinth (what a pretty name by the way). Makes me feel better that I'm not crazy about the weird feeling after the shot. I have found that icing the site before and after the shot seems to help with the bruising - makes it a little bitty bruise instead of a big one. And the upside (if there is one) is that I use the little bitty bruise like a little marker to tell me where I have shot before. Of course, this weekend, I was trying to activate the safety system on the syringe and it popped out of my hand, flipped backwards (I had it pointing towards the counter) and managed to hit the edge of my foot needle-first. It was right where my little toe joint sticks out and I think it must have nicked the bone, because I ended up with a HUGE bruise there and it HURT like the dickens. OUCH! Needless to say, I will hold on to the stupid thing tighter from now on. <_<

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Ouch! I do not have any safety system on my syringes.

Yes, a good thing with the bruises is that you know where you have stuck yourself before. :)

I stubbed my little pinky toe yesterday on a chair. I barely hit the chair, but the pain was terrible and my toe swelled up and got bruised. Regularly I do not think that would have happened. Heparin must make our toes more sensitive.

I hope yours was not so bad that you cannot walk. Toe injuries are one of the worst things I can imagine.

I am sick to death of syringes. I want my baby to come asap so that I will have a big fatty area to inject into again. <_<

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Sure we can. You can do it Orangefoot!

I have a kinda weird question for anyone that has gone through a pregnacy while on blood thinners.

I noticed that my skin is stretching almost to its limit lately and there are two areas that seem to be starting to form "sores". Is it normal for that to happen?

I am going to show them to my doctor on Thursday, but wondered if this happened to other women's stomachs. If so how do they treat them?

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  • 3 weeks later...

Hey ladies, Sorry it took so long to update you on my induction worries my computer has been down! I finally worked up the nerve to get pushy with my ob and told him I wasn't willing to be induced for no reason other than convenience and he was like, oh well you don't have to it's always up to the mother wether she will go spontaniously or not. He said even if it was medically necessary the decision was stil mine and mine alone!!! Yeah! I told him of course I would be induced if my baby or I were in danger but just because is not acceptable. Thanks for the advice ladies and hope your toes feel better!

Julie. :)

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