To think I can refuse the blood thinners (36 weeks pregnant)

[Icouldseetinsel]

I'm planning a homebirth. This will be my 3rd baby. I'm 36 weeks pregnant. I've been having scans every two weeks to check everything is OK to go ahead with the homebirth. My midwives are saying everything is fine, the consultant I saw the last two times is saying everything is fine to go ahead...
I went in yesterday for a planned scan and saw a different consultant who said everything was fine initially but then rang me a few hours after I'd left and left me a message saying she looked over my notes and now wants me to take blood thinning injections.
She said I have a couple of risk factors with my age and weight...
I am 36 and I am overweight but not obese or anything.
No other doctor or midwife flagged this with me.
I think if I take these blood thinners it then won't be safe to have a homebirth due to risk of PPH blood loss. For me that is a bigger risk than clotting as I've never had any issue with clotting in the past and there's no actual indication I do now either.
AIBU to refuse this prescription?
Does anyone have any personal experience of this situation they could share?
This has made me very stressed because obviously I don't want to put my baby at risk in any way but I think this is a pointless prescription that would mess up my birthing plans for no reason.
I should just add that I am under the perinatal mental health team due to previous post partum psychosis that I had after my first birth and alot of trauma surrounding that birth and the hospital. My psychiatrist and midwives suggested I have a homebirth and all seemed happy with the safety of this. So it's just this one doctor out of nowhere whose done this and she's not really given any solid reason why.

You can have a home birth on thinners. I did.

You can also decline any treatment if you don't want it.

Why not discuss it with a consultant midwife and explore your options and then decide?

@zurala oh that's interesting to hear! Yes I will discuss it further with midwives and doctor. The doctor is ringing me back tomorrow.
Did you have any pushback to your homebirth plans due to the thinners or dud they tell you it was fine from the outset?

Blot clot is the biggest killer of older mothers. You really don't want a stroke. Make sure you are fully informed before turning them down

Why on earth would you reject blood thinners just to have a home birth?

If you had a stroke at home while giving birth you would condemning both yourself and your unborn child.

Take the blood thinners and give your head a wobble.

Also, there is an indication that you might clot so I don't know why your claiming there isn't.

It's a bit odd to prescribe blood thinners now so close to birth. If they are injections do you mean anticoagulants at all?

Blood thinners are often stopped at 36 wk so as to prevent excessive bleeding during birth.

I think you need to be clearer on the advice e from the consultant what the risk assessment is.

Get a second opinion before making your decision, but it's your body, you can refuse any medication you wish.

It doesn't sound like it's a good idea. Do you know your exact height, weight and BMI? The overweight category looks hardly different to normal, so a lot of people are surprised to find they are obese when they only look a little bit chubby.

Without going into details, we had disagreements with doctors about putting an elderly relative onto blood thinners. It turned out the doctors were wrong and they were doing much more harm than good, as we suspected.

So you are right to not go into this without questioning it. Doctors aren't Gods, they are just using their best judgement and following official generic guidance for each condition. They often make the wrong call, but as long as they followed that official guidance they won't get in trouble.

https://womenandbloodclots.org/pregnancy-and-post-childbirth/

you could decide immediately after delivery perhaps?

is there more to your risk factors? This is the rcog risk factor list.

Generally they’re stopped 72 hrs before delivery but obviously if you’re planning a spontaneous birth that’s very hard to estimate. Dd for example is on blood thinning injections for life. If she was pregnant it would not be safe to stop at 36 weeks and potentially have 5 weeks off them. In all likelihood she would have a planned induction

Yeah it is really odd... no one has mentioned this to me at all during any of my care so I don't understand why this doctor has prescribed me this.
She was fine when I actually saw her but later left me a voicemail. I did ring back but she had gone and the person there said the doctor would ring me back tomorrow... so yes I ill be discussing it further.
It's just made me very stressed and annoyed that I've been prescribed this without it being discussed with me or explained
And from what I've read it can increase blood loss during labour so I'd worry about having a homebirth whilst on this.
It is very wierd she's suddenly done this at 36 weeks.. why?

@sockmuncher there's no indication I might clot. Just a statistical risk. I am constantly monitored and am completely healthy.. I have never had any issues with clotting in previous pregnancies and theres no actual evidence I do now either.

Does the Dr mean they would recommend them postnatally? I would clarify as doesn't really make sense to start taking them now at 36 weeks.

I personally wouldn't decline postnatal blood thinners but we had a few maternal deaths from PE's a few years ago, so I'm quite cautious

@PinkPrawns2
It was just a voicemail so i I couldn't ask but I assume they are for now as she said she had prescribed them now..
I'mgoing to ask these questions when she rings tomorrow.
On the face of it it does seem really unnecessary and odd and has shocked me.
She didn't talk about there being any problems when I was actually in the appointment face to face

@slore unless your elderly relative was pregnant you are comparing apples and oranges.

When you are pregnant your body increases clotting and makes your blood more sticky. It ramps up towards the end of pregnancy. It’s to stop you bleeding to death in labour but it means that women are at their highest risk of blood clots at the end of and for several weeks after pregnancy. If you have extra risk factors then you are at increased risk of a clot, stroke or heart attack. It’s not just you at risk either, it’s your unborn baby depending on if a clot does form and where it forms. This is why you’ve been advised to take them now at 36 weeks - you are at the highest risk now and for the next 16 weeks or so.

Yes you can of course refuse the thinners, but why would you if you’ve been advised to take them?

I have a clotting issue so I take thinners in pregnancy and for a while after. Someone I went to primary school with died from a clot 3 weeks after having a baby. Another local lady also sadly died due to a clot. Both in their 20s, not overweight, no history of clots. It can happen to anyone.

The blood thinners last about 12 hours. You can’t have an epidural in this time but I’m not sure if you can have one with a home birth anyway. I had 2 elcs deliveries at 37 weeks (due to the increased clot risk after this with my sticky blood and the extra pregnancy clotting factors). I was older than you for both and also overweight. I lost 400ml on the first and less on the second.

Have a discussion. Risks are risks, it’s not a guarantee anything bad will happen, and it’s a relatively small risk - but if it did you want to be sure you’ve given it full consideration.

All the best whatever you decide x

It would only be indicated in pregnancy with 3 risk factors, are you sure she doesn't mean for the postnatal period?

Commencing heparin won't affect your plans to birth at home.

It is your decision regardless, I recommend reading Sara Wickhams information on heparin (Google her).

Good luck with your decision and I hope you have an amazing home birth.

Obviously. I don't know why you bothered to say any of that.

The point was that doctors can make the wrong call, so seek a second opinion.

Thanks guys. Obviously I will be discussing it in more depth with the doctor. It's just been a big shock out of nowhere and hasn't been explained to me. No one has mentioned it to me before.
Hopefully I can still have a homebirth. This is something I'll discuss with the doctor.. I just found it alarming when I googled it as there were some people saying that heparin may increase your chance of excess blood loss during labour so would mean you shouldn't give birth at home. I'm glad to hear this might not be the case.
For me the risk of blood loss seems a higher one than the risk of clotting...
Obviously I don't have much info on this and need more.
I just wish they had actually discussed this in my appointment or made me another appointment instead of casually saying she had prescribed me this in a voicemail.
Obviously I am quite anxious and this has caused me alot of stress.

Disclosure, I am a doctor so that affects what I say.
It sounded like the second doctor who suggested thinners gave it some thought - you went away and she thought about it some more - that is a sign of somebody wanting to do their best for you - professionally those “ after the patient has gone” thoughts are usually significant. I wouldn’t ignore what she said… maybe another opinion.
I am so so sorry that you have been through a post parturition psychosis … that is always horrendous. Best wishes for your delivery and for a healthy baby and healthy Mama whatever you decide.

Have you had a look at the RCOG risk factor table posted above?

I can see you have two risk factors (age and BMI) but normally you need 3 to be prescribed anticoagulants. Are you a smoker or have varicose veins perhaps?

I was on anticoagulant injections for my first pregnancy I was 38 years of age and had a history of clotting issues having had a DVT after a long haul flight 10 years prior. Injections were stopped 72 hrs prior to induction, I experienced a PPH and required blood transfusion, two "bags" is what I was told not sure of volume and My recovery was slow. My significant risk factor was known and I took the anticoagulant for my second pregnancy at 42 years with no issues but based on age alone I'm not sure I would have.

@IDontDrinkTea

No I don't smoke and i don't have varicose veins.
my ankles are swollen but I showed them to the consultant last time and he said it was normal for this stage of pregnancy and there was no sign of blood clotting or anything to be worried about

It does seem odd I only thought blood thinners were needed for c section? Or at least I had blood thinner injections when I had my c section.

You can decline the medication for whatever reason you like. It may be worth seeing another consultant and asking their opinion. I had lots of extra scans and consultant appointments in pregnancy and never saw the same consultant more than once. So got lots of opinions on what to do.

With My last home birth, I was 37 so was offered the blood thinners. I’m otherwise perfectly healthy. I never even saw a consultant. They were given to me by the midwives. It was fine. Really no big deal. Better than having a blood clot or worrying about needing to drag myself to hospital for any reason after a lovely easy birth.

@mindutopia
That's really good to hear. So there was no question that you couldn't have a home birth due to being on thinners?