clexane ladies - birth plan

[Allboxedin]

Hi fellow Heparin users. Had Haemotologist appt on Wednesday and ante natal consultant today. I am currently on 40mg of Claxeane each day.
36 weeks now and the plan is that as soon as I feel any signs of labour to stop it and go in to the labour ward to be assessed. Haemo has told me to try and steer clear of an epidural (mainly because of the lack of movement in legs) but basically if I do need one that I will have had to have stopped the injections in time beforehand.

Question is, what if I needed an emergency section for example- ? or would they give me a general?
I imagine labour should be quicker this time as it's my second, but the good thing is they have told me to go into the ward at the firt sign of labour so I guess I won't be leaving it until the last minute and worrying if it's time etc!

[CombineArvester]

I was told they would not do epidural within 24 hours of last clexane but I don't know why, bleeding into the spine maybe?. No idea what they would do for EMCS though, it's an interesting question, presumably GA more lethal then epidural? Some people do clexane twice a day so what are they meant to do? MW tried to encourage me to move the timing of my injections, as most people go into labour at night, she wanted me to do the injections first thing in the morning to make it as far away as possible from the birth!

I was told I lost hardly any blood despite it being not that long (prob less 24 hours) since last clexane, so it can't have been making my blood that thin! Maybe just a bit more like a normal person's rather than tar.

Make sure someone (haemotologist?) has written you an access all areas style letter saying you have been told to go in when labour starts and X X and X needs to happen before and after the birth. Otherwise you have to wait while they have a big row over whether you should be admitted, what drugs you are allowed, MW fighting with junior doc who has never heard of clexane etc. Oh and take your own clexane for afterwards, otherwise there will be another row waiting for some and the clotting clock will be ticking! I had a lovely letter for the birth but I still had to get it out and point at relavant paras whist waters all over the floor and contracting! They also forgot about the clexane afterwards bit.

Whoops bit of an essay good luck!

[BagofHolly]

They just do it on a spinal block or a GA. I took my clexane too late with my first ELCS and they did a single injection into the spine. It was absolutely fine.

[Allboxedin]

Thnaks combine, I will do that, interesting stuff!
Thanks bag, should be fine then.

[Merinda]

They avoid epidurals with Clexane, because it can cause a haematoma near the spinal column that can lead to paralysis.
If you read the insert from your Clexane box, it is also mentioned there.

[Allboxedin]

Thanks Merinda. Isn't a spinal block the same kid of thing though?

[beginnings]

You sound like a knowledgable bunch so can I jump in here for a bit of advice? I'm 9+5 with my first although this is my third pregnancy. It's ivf and has been successful after we discovered that I'm heterozygous for factor v Leiden. My clinic have told me that I should stay on clexane (40mg daily) and aspirin right up until the end of the pregnancy and I'm yet to see the ante-natal team at my local hospital. Would you advise that I push to be referred to a haemo or do midwives generally know enough? My GP seems to think that I will initially be seen by an obstetrician.....but I don't know that for definite yet. I'm very nervous about going back into the regular system and not knowing what questions to ask to make sure I get the most appropriate care.

[CombineArvester]

You should see a consultant obstetrician, the consultant may then refer you to the haemotologist, sometimes the consultant will be enough.

I have been referred directly to the consultant by the GP and not really seen much of the midwives in my pregnancies. Make sure the GP is referring you to the consultant obstetrician and see what happens then.

[beginnings]

Thanks CombineArvester. The GP says he has referred me to the ante natal service and that, as he's explained my situation, that his presumption is I'll be seen by a consultant. I'll push for it if that's not done immediately. I've got good at being pushy.

[Allboxedin]

I didn't actually get to see the consultant until 16 weeks, but yes you should be under consultant care as ch said. I wouldn't worry too much in the first few weeks but make sure an appointment is lined up.

[beginnings]

Thanks allboxedin, much appreciated.

[pommedechocolat]

I had an epidural with dd whilst on clexane. It was an induction that dragged on a bit but they monitored me and guessed well when baby wax likely to appear.
I was only to miss one dose so took clexane the am before birth. I could therefore have an epidural late that night. Only annoyance was that I had to have clexane straight after birth to be in 24 hours so then epidural had to stay in an extra 6 hours. Be careful to be informed - midwives aren't all that knowledgeable on the details and the docs aren't always around.

[Allboxedin]

Thats ok beginnings, hope it all goes smoothly for you. Are you actually on the clexane yet or would that be after you see the consultant?
Pomme they did ask me if I wanted an induction too, I really don't want to have to stay in though - labour wards are a nightmare!
I would be interested to know when you went into labour, those of you who went in naturally, because I read somewhere that it can be a bit earlier if you have been on Clexane - not sure how true that is though.

Eek - 37 weeks today!

[Allboxedin]

I meant to say beginnings that if they havent put you on Clexane yet and you have factor v then I would push for it sooner than later, I assumed you were already on it. :)

[beginnings]

I am on it allboxedin. I've been on it since the day after egg collection so seven weeks or so. Best of luck to you for the next few weeks!!

[Allboxedin]

oh ok then :) you can join the clexane club!!

[pommedechocolat]

I was induced at 38.5 and it was a struggle. I reckon left to my own devices I'd have gone over 40 (but they'd never let me do that!).

I'm on fragmin this pg so no longer an active member of the clexane club :)

[CombineArvester]

All of mine have gone early (from v early to a lovely late 38 weeks) but I'm not sure if that's down to the clotting condition or the clexane, my waters just break early. SIL went overdue on her clexane pregnancy.

[beginnings]

Thanks allboxedin! So many clubs I've joined over the past few months!! Spoke to the ante-natal team this morning. Apparently they sort out the referral to the consultant at my booking in appt. I'm happy with that although don't understand why they have to wait for that since they've already been told I need to be referred. The inefficiencies in the system never fail to amuse me.....

[Allboxedin]

Is fragmin an American trade mark pomme? you can still stay with us if it is essentially heparin!
Don't talk to me about the system!! Also expect to see a different consultant each and every appointment, I have, the same with midwives.

[pommedechocolat]

Not sure whether it's american but it is just heparin. There's a few others too - I've had Innohep in the past as well.
I would like to stay, it's nice to talk to other injectors.
I have been really lucky with my haematologist and obstetrician although they disagree about the use of low dose aspirin for me (I take it) but it did take a while to find the obstetrician through a sea of her junior doctors! I also had a different midwife every appointment with dd's pg Allboxedin and it really put me off the profession as a whole. I'm starting to warm to them now though.

[CombineArvester]

It is my understanding that fragmin and clexane are both types of low molecular weight heparin. Clexane more likely to be prescribed NHS as it is cheaper. Have had fragmin before, it seemed to sting less!

They probably have to wait until the booking in appointment to get the paperwork right for the funding of the referral, I went straight to the consultant with pg3 but had to get my GP to formally refer in writing to ensure the funding for some reason.

[Allboxedin]

Oh ok CH, I think I had read posts by Americans who generally talked about Fragmin rather than Clexane. No aspirin here, No one has ever told me to take it but again I have heard that some people are prescribed it with APS for example.

[beginnings]

I'm on aspirin as well. I started off taking Clexane on a private prescription but have managed to persuade my GP to fund it as it's probably necessary to keep me pregnant. I've heard lots of stories about lack of continuity of care. That's the bit that really worries me as I'm not a standard case. I guess I'll just have to deal with that as it comes. I got the date for my booking in appointment today, it'll be the day I turn 14 weeks so I might ask, on the basis that my GP has flagged the need, that they make the appointment with the consultant before that so that I don't have to wait too long. I didn't know that about funding CombineArvester so thanks for that.