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.

I thought they were given afterwards?

Nope. I have natural birth and have to have them after birth

Had*

I had a PE post-birth despite only one risk factor (medical condition). Next pregnancies, I had heparin throughout, and after birth. I had to have planned inductions and heavily consultant led births.

Personally, I would take any and all medication/medical intervention to prevent another PE, which was one of the scariest things that has ever happened to me.

I had multiple blood clots at 24 - no risk factors at all I was 8 stone 5, not on the pill, no family history- nothing they came out of the blue and landed me in ICU for a week.

Blood clots are one of the biggest killlers post birth (report out this week) - your Dr may have reviewed everything and decided that the risk was higher than thought. You can obviously refuse but I gave birth to both my kids on blood thinners - having only stopped the injection one day before the planned birth - no issues with bleeding and more importantly no clots!

@takealettermsjones I agree, I was petrified! I don’t know why you would risk it!

I am about as pregnant as you and on blood thinners due to a heart problem discovered in pregnancy.

I was utterly terrified of a blood clot. I am another one who is amazed you are questioning it... I took every they told me too as I was frankly terrified I'd die at around the 24 weeks mark.

One key thing it sounds like you don't know (which I didn't know) The thinners are short acting.

Their effective life is very short so you can be protected from stroke Risk without it impacting levels of bleeding during birth.

I'll stop mine 24 hrs before my ELCS and my consultants expect an non eventful section (don't we always though!)

@GreatGateauxsby

I'm questioning it because it was a shock with absolutely no explanation and what I read suggested it might increase risk of bleeding which would make a homebirth unsafe...
I feel I have more risk of heavy bleeding than I do from a blot clot
Commenters have now said this may not be the case but I think it's a reasonable thing to question.

Hi op, I was on anticoagulants in pregnancy and my consultant said I could have a home birth if I wanted to.

@Mwnci123

That's good to know thanks

Nor did I. Third baby, not hugely overweight (lost weight during pregnancy actually so even less overweight than I started!) No history of blood clots. Had baby all went well, went home and boom. Collapsed and was blue lighted to hospital where they discovered I had multiple clots in both lungs.

So just because you've no history doesn't mean it won't happen to you. I'd definitely query it and maybe get a second opinion if you're still unsure but I wouldn't ignore the advice.

This with bells on. ( im an HCP so observe exactly what @LunaTheCat is referring to)

Well I cant ignore what she said because she has prescribed me this with absolutely no input or discussion with me.
I work for the NHS myself and my husband is a nurse practitioner and he would never do this to someone. Leave them a voicemail saying they'd been prescribed some random drug with no warning or details as to why. Of course I've questioned it. No one ever mentioned it to me before and as I said I've had alot of appointments where they could have.. im having scans every two weeks, I've seen other doctors.. im now over 36 weeks. Its just really odd and very stressful.
I am hopefully going to have a proper discussion with her about it and get more information tomorrow but im not best pleased to be honest. I could do without this level of anxiety. If there's some convincing solid reason for me to be on them then fair enough. But im sorry you shouldn't just prescribe people things without actually talking to them about it and going through the reasoning and the pros and cons.
Having a home birth is very important to me but I dont want to put myself at risk by taking something that could make it dangerous.. but I dont know because all I have is Google because no doctor has actually been through this with me. So I could have got it wrong...its looking like from the comments on here that what Google tells me about anticoagulants and homebirth is not correct.... but im certainly not just going to accept it without question. They shoukd have actually consulted me before prescribing me something.

@zeibesaffron which report is this please as I’d like to read it. Edited to say, I think it mus5 be the MBRRaCE report which I have already read. It was actually published last month but just seems to have hit the news last week…..thought maybe something else had been published 😀

I’m glad you survived, my Dd also had a clot in her early 20s with no risk factors at all. Was only last year and I’m still traumatised by how close we came to losing her. She’s on thinners for life now. Everyone keeps saying how unusual she is to have it happen at her age. I do wonder if it’s Covid related.

@Icouldseetinsel You are right to question it, if I were you I’d have that rcog list infront of me during the conversation and ask her which of the risks she thinks you meet.

I was on heparin throughout my third full-term pregnancy due to clotting factors found during recurrent mc investigations (the pattern of my mcs leaves me unconvinced the clotting factors were responsible but it still seemed sensible to take the heparin). They weren't stopped before birth - I was induced at 40 + 10 (may have not taken one the day before going in, possibly). I had a very precipitous birth. Went home after 4 hours and had no bleeding problems despite the speed of the birth and having had a PPH after my first birth.

Haemorrhagic strokes where there is a bleed rather than a clot have a far higher fatality rate.

It's a balance of risks.

I know someone who nearly died in labor from a stroke - her DS nearly died too. Recovery has been slow

She's young, this was her 3rd pregnancy and was completely healthy (maybe a little overweight? - but that's it).

If you're worried, get a second opinion from a different doctor, but I'd suggest not blindly ignoring the advice

I spoke to another doctor this morning who rang me. Apparently I'm fine to go ahead with a homebirth even on the blood thinners. He also said they'd been prescribed not due to my initial weight but due to how rapidly I'd put on weight during the pregnancy. I have to stop taking them if I think I'm going into labour (?)
He did say it'sunusual that I've been prescribed them at this late date but he said that's probably because my weight wasn't a risk factor before but now is due to how rapidly I gained weight.
I'm to go into the hospital next week to talk further about it and be shown how to inject them etc.
So I'm feeling a bit calmer now I've been given more info. And I've been assured it won't make my homebirth dangerous.
Thanks to everyone who commented

Thank you for letting us know… and very best wishes.

An update on this. I went in to be shown how to do them and basically got very conflicting advice from two doctors and a midwife and now I'm unsure what to do again.
One doctor was quite chill about them and said it shouldn't stop me giving birth at home.. however the consultant midwife told me were I to go on the injections I should not try for a homebirth due to the risk of a big bleed.
Again both queried why I had been put on this so near to my due date.
Now I'm quite anxious again.. they couldn't tell me which the bigger risk was. The potential blood loss during labour caused by the injections or the potential blood clots if I don't take the injections.

I think what you’ve got to consider now is whether your wish for a home birth is more important to you than both of those risks.

What is the incidence of death from haemorrhagic stroke in pregnant/peripartum women prescribed prophylactic LMWH? How does it compare to the risk from thromboembolic disease?

@Littlegoth well this is the thing.. the midwife from the community team did point out that they've only recently started weighing people at the end of their pregnancy as well as booking in.. so last year I would never have even had this problem putting to me as my weight at booking in was not a risk It's just all very stressful because obviously there's the risk I develop psychosis again from the hospital interventions.. if I decide to go into hospital... so whatever I do there is some risk of something bad happening.

I'm leaning towards only starting these injections after th as I think taking them to eliminate a potential risk increases a real risk so its not worth it. As opposed to after the birth where they address a risk but do not create a risk.

Itjust reminds me of the cascade of medical intervention I had in hospital with my first where they started out doing things due to statistical risk that ended up causing more problems for me and leading them to have to do more things..

Idon't want to go down that slide again..

I'm sorry I don't know what my phone did with that post there!!