Childbirth and blood thinning injections

[Wmoejg]

Hi all,
I've had a bit of a rubbish pregnancy thus far with my health (it's been a bit complicated due to what doctors believe to be long term effects of covid on my heart causing regular palpitations and tachycardia). As a result of my existing health concerns, I was planning on having either an elective c section or a epidural.
Anyway, last week I unfortunately fell ill and it turned out I had a small pulmonary embolism (a blood clot on the lung) this was really small and luckily very treatable with blood thinning injections twice daily. Unfortunately this has meant both of my preferred birth options are more complicated, as being on blood thinners can increase bleeding (which is a risk with a c section) and I'm unsure why it's a risk with the spinal or epidural.
So what this long post is really asking is:
if you've been on blood thinners, what were your birth options? Did you have any complications? Were you able to have the birth you wanted?

It’s a risk with a spinal or epidural as the needle is inserted “blind” into your back. It is possible to hit a blood vessel in the limited epidural space.
Normally this would soon stop bleeding with your platelets and clotting factors forming a firm fibrin clot. But if you are on anticoagulants, the bleeding continues, forming an expanding mass called an epidural haematoma, which can compress your spinal cord and cause paralysis if not rapidly evacuated surgically.

@Babdoc that sounds scary, but makes total sense. Thank you for your explanation!

I was on blood thinners with my youngest. Was allowed a natural birth but had to be carefully monitored. Didn't work and I had a huge (like 6L) haemorrhage. Woke up in ICU confused when the last thing I remembered was a few hours before being presented with a baby. Birth debrief basically was that they fucked up and I should never have been allowed to labour naturally and should have had an scheduled C section. Please make sure you question everything and are completely sure of your decision. Good luck and enjoy every minute with your lovely little newborn.

I was on blood thinning injections for both pregnancies. You can still have a planned c section...you just take the last injection the night before. I was advised I couldn't go into Labour naturally due to the increased risk of blood loss due to the thinners so would have had to be induced before my due date of I had wanted to do a vaginal birth

I was on them twice a day for my whole pregnancy, stopped once my waters broke and ended up with an epidural and CS couple of days later. Didn’t cause any problems, it was a complicated CS and I lost about 600ml which I don’t think is a lot. Definitely worth discussing with your team, write a list of questions as you think of them. Best of luck.

The issues relate to the time of the last dose and what the drug/dose is. For an elective section/induction you know when things are likely to start so can plan the last dose accordingly and cut the risk of operative bleeding right back to normal. It’s more complicated in emergencies/natural labour because both are less predictable. Usually the advice would be to stop blood thinners at the first hint that labour’s starting & hopefully by the time things got cracking properly it’d have worn off (timing depends on the drug/dose). If there’s been long enough then an epidural/spinal should possible (with the risks being as pp described about bleeding in a confined space if there hasn’t been long enough off the blood thinner). For an emergency section of the blood thinners are still active then the only anaesthetic option would be a GA. On top of that things like the size of the PE/whether it’s having any effects need to be considered when they’re advising you about vaginal del/section.

As well as seeing your obstetrician it may be worth asking about an anaesthetic clinic appointment so they can explain it all in more detail and advise you about the relative pros & cons of the anaesthetic/pain relief options. HTH

I was on clexane injections for 6 weeks before my elective section.

All fine, just monitored closely for bleeding.
Had a spinal block not an epidural.
Lochia wasn't too bad. Bled for 3 weeks. Nothing to compare it too but it didn't seem too bad.

Came off them 6 weeks later, periods back to normal after 2/3 months.

I just bruised more easily.