C Section Jabs

I think you've got confused with some of the numbers.

43 (16%) of the 275 women who died in that time period died as a result of blood clots. That may not seem like a big number when you consider how many have babies, but it is that low because of thromboprophylaxis preventing a whole bunch more women developing blood clots (and it doesn't take into account the women who develop non-fatal blood clots, which come with other problems even if they don't cause death). In population terms it may not seem like a huge number, but to 43 families that lost a mother it will have been devastating. It is perhaps a bit of a confusing coincidence that 43% (117/275) of the women who passed away had either a PE, Covid or heart disease and it looks like that's where you've got the numbers in a muddle. Death is of course at the very extreme end of the outcomes and most people don't die, but having a DVT or non-fatal PE can also cause some long lasting problems too.

re. obesity, the infographic shows that 177 of the 275 women who died had obesity, so that's 64%. The infographic doesn't say how many of the women with obesity died of a PE but the green top guide does say a bit more on that (early 2000s data). There is evidence in other documents that obesity in pregnancy does increase the risk of VTE, and that's why it's in the risk assessment tool.

pregnancy induced high blood pressure and pre-eclampsia both increase the risk, having a c-section increases the risk (more so if it was unplanned). A whole bunch of other things that may not be that obvious affect the risk. Also worth remembering that the changes that make pregnancy a higher risk period for developing clots even without any other risk factors take several weeks to return to normal.

The only people who can advise you about which risk factors you have are the people involved in your care so you're really going to have to get back in touch with them. They may also be able to suggest ways to make the injection less stressful for you. The risks may seem small to you, but the impact (even the non-fatal outcomes) are pretty big if someone does develop a clot and, while no one can make you take a medicine you don't want, you really need to make sure if you do make that decision it's based on the right numbers and risk factors as they apply to you. The policies are there to try and improve patient outcomes, not to improve the midwife's wellbeing!

The risk scoring system is linked to in PP’s attachment. That greentop guide is quite old now but if you look at the latest MBRRACE report (hopefully linked) you’ll see why venous thromboembolism prevention is taken so seriously.

www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2024/MBRRACE-UK_Maternal_Report_2024%20_Lay_Summary_V1.0.pdf

I had 6 weeks’ worth after each of my three children so I completely understand they’re a pain (literally), but I would keep going if at all possible. I was also very mobile and healing well, and also did them myself. My husband did a few after the first baby, but I found it hurt less if I did them myself, in the thighs.

I’m a midwife. DVTs are one of the leading causes of death in pregnant and postnatal women. Obviously the risk is still small but in the last few years, it has become policy to risk assess every woman for the risk of DVT in pregnancy and in the postnatal period. Some women will be advised to have 7-10 days of anticoagulants and higher risk women will be advised to have 6 weeks after birth. Having a caesarean section is a risk factor in itself. Age, BMI and various medical disorders are all risk factors. No one can force you to keep injecting these but make sure you understand the (small) risk of not doing so. Also make sure you know the signs and symptoms of a DVT just in case. This is a good place to read about it all so you can make an informed decision: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/reducing-the-risk-of-venous-thrombosis-in-pregnancy-and-after-birth/