C Section Jabs

[cgwx]

Hey - keep it short and sweet just want to hear others opinions.

I have been given 6 weeks worth of Jabs after being told originally it was 10 days. When I queried why they said the point score for risk factor was over 3 and so it was recommended I do 6 weeks worth of Jabs. Don’t really know what my risk factors were, BMI I’d imagine was one of them. Pregnancy was fine right up until the week before I had my baby, then high BP started. I also have Iron Deficiency Anaemia. Not sure they may have added to it?.

Anyway needles don’t bother me, but my husband is petrified of them so its been a case of doing it myself. I have done 2 weeks worth now. But have to be honest, hating them. Its getting to the point now where they are starting to get me down.

I wanted to know if anyone has just stopped taking them after doing them for so long? I spoke to 2 different midwives and they basically said there were no alternatives. For reference I was up and moving around by day 2 and have been doing my normal things for over a week and a half. C section scar is pretty much healed on the outside. Been discharged from Midwives aswell. So not sure really now whether its necessary? I can’t even find any research about it really other than its to prevent DVT.

Thanks - C

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/

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.

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

thanks everyone! I really appreciate the messages.

I looked into the research that was linked and actually reading that the 43% between 2020 and 2022 that they stated is the percentage combined with COVID 19 and heart disease and not just Blood Clots. So it be interesting to see what the percentage of the 43% is only down to Blood Clots. I also saw White women are less at risk, 12 in 100,000. I read aswell that 63% of the deaths of those 43% were classed as obese; so more than half the deaths of the 43% were obese women. So the risks are like what was said, really small.

I don't really know what to do to be completely honest. I don't see myself seeing it through to 6 weeks. I was taking Aspirin in pregnancy aswell to prevent preeclampsia, and I know that also helps thin the blood. I feel like if I discuss this with my midwife though she'll just advise me to keep taking them because thats what they have been told to do due to policies etc. I also think aswell it doesn't immune you from having them even when taking the jabs so thats another thing that puts me off. Its a small risk even when your classed as higher risk, and do the injections for longer and yet it doesn't completely prevent it from happening. I just worry for my mental healths sake now that its spoiling time with my baby and getting me down because I'm fedup of doing them.

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!

I had to take them for 6 weeks after my first section (and only for a week after my second) and it was such a pain but I really didn’t want to die of some horrendous haemorrhage so I followed medical advice.

I know someone who didn’t take them (wasn’t offered) and died from a clot. Low risk, too. I also know a lovely lady who had a stroke 3 weeks after she had a baby.

During pregnancy your blood gets thicker. Your platelets stick together and have a party. Meanwhile the coagulation system works double time to thicken your blood. It’s a biological reaction so you don’t bleed to death in labour. This effect doesn’t switch off overnight when baby arrives though, which is why women are at their highest risk of strokes, DVT and clots (and elevated risk for heart attacks as many of these are caused by clots) in the last weeks of pregnancy and for several weeks after. Your risk is increased because you had a C section. Moving around a bit won’t mitigate this much, otherwise they wouldn’t prescribe these injections, you would just get told to go for a walk

Up to you. In black and white, you risk dying and leaving your newborn without a mum. If you are ok with that then stop taking them.

Or crack on and get them done. It’s not nice but it’s a few weeks. Your aspirin will be well out of your system by now. If you don’t take it every day (and doubt you are post partum unless FF as you shouldn’t take it when breastfeeding). Aspirin is fully out of your system within 10 days, and for each of those 10 days loses about 10% efficiency per day.

Disclaimer- had to have them from positive pregnancy test and for 12 weeks after each pregnancy. Never thought about asking someone else to do them for me because unless you have a fear of needles, which you said you don’t, it’s not really an issue and they are easy enough to do yourself.

I had to do them from 28 weeks to 6 weeks pp. Hated them!

Pregnancy before I was 3 years younger so only had to do them for 10 days pp which did seem quite arbitrary.

I also hated having the injections after my c-section. I’m not frightened of needles, but it was sore and miserable doing it every day.

I was dreading them so much when I was having my second, I bought some numbing cream (I think it was called emla cream?) from the pharmacy. I put it on about 10 minutes before the injection. It didn’t work perfectly every time, but it certainly made it easier!

Also make sure your bevel faces up. Hurts less.

@cgwxi had to do 6 weeks after both babies (and had some during pregnancy too). I totally understand what you mean. I started to really dread them..it hung over me. So I switched to doing them in the morning instead of last thing at night. It just meant it was “over with” and also that I did them when I was least exhausted.

i also found one thigh less painful.

best of luck whatever you decide x

My best friend developed a clot post partum. Luckily she is ok but got admitted to hospital (without her baby) and had to stay for 2 weeks. 12 years later she has to wear a surgical stocking every day still.
I would keep doing the injections.

@Holdonforsummer if you have low platelets do you still have to take these? I know they can lower platelets so is there any reason they don’t test for this 3 weeks out of the 6 for someone like OP?

As someone with platelets around 100 this has always been on my mind when people mention these jabs

I only had to do 10 days but if 6 weeks was advised I would absolutely have done this. I really can't get my head around even the suggestion that you might stop stop them sooner because you don't like doing them. There are some valid reasons someone might need to stop, say unstoppable bleeding, or horrific side effects, but just disliking the process, surely it isn't worth the risk of death.
I found it easier to do in the dark, FYI. I would get the needle ready on my skin, turn off light, then inject.

I think OP you just have to weigh it up.

Do you really think that if you stopped, you’d be at risk of a DVT? Do you have a history/family history? Are you still relatively immobile? Are you obese? Hydrated?

To be honest I’d be turning round to my husband and telling him to pull his finger out and start helping, but that’s just me!

I don’t think anyone will be able to advise you otherwise OP. Your obese with a BMI is over 30 (as you said it it was due to BMI and criteria is over 30), had/has hypertension (? Start of pre eclampsia) and a C section (where you are unable to move your lower body due to an epidural) You are the ideal candidate for a DVT.
I also agree with @Greybeardyregarding figures. Having a DVT may lead to PEs and you will be on life long blood thinners, high risk of stroke (having a high BP during pregnancy also shows you have an increased risk of high blood pressure in the future also which increases risk of stroke).
Im afraid that this will affect your health both mentally and physically if you develop a DVT/PE. It may not lead to death but life long conditions.
Pp have gave good suggestions such as Emla cream or changing the time of injection. (You should do this gradually).
If you’re happy to take that risk it is up to you, guidelines aren’t just there for nothing.
I have seen many post op patients who haven’t taken their blood thinners or wore their compression stockings develop DVT’s PEs and living with those consequences.

@StillChangingForTheBetterI wouldn’t want my husband to inject me 🤣 I injected for 12 weeks for IVF and he would have freaked out haha x

Yes but when it’s OP’s position where it’s starting to impact her mental health, and she doesn’t want to take them anymore, he should be stepping up to help her

@StillChangingForTheBetterher husband is petrified of needles…… definitely don’t want someone who’s petrified injecting you.

Sounds dramatic to me. I find adults are rarely “petrified” of things like needles. He’s just avoiding stepping up.

Keep going…! I had 10 days worth and got a clot at 2 weeks. Regardless of whether it would have killed me, the pain from the clot was absolutely dreadful! I was begging for the anticoagulant injections so that the pain in my leg would stop. In A&E with a newborn. I got a further 3 months of daily injections.
I get it, I hated doing them after the pain from the clot went away. Maybe have a little reward afterwards like a biscuit and/or a coffee. This is how I got through them!
Congratulations on your baby 🥰

Thanks everyone!

I have found a way of doing them without them stinging so much, just the last little bit at the end of the bile stings. I use an ice block and place it there for 5 mins prior to doing it, do the Jab and then reapply ice block and just sit there for 5. Its just the mental capacity of them I think now and starting to get me down.

I was actually told not to wear my compression socks anymore by my midwife because i was mobile and not even remotely immobile. I was doing all my normal stuff (apart from driving) and looking after 2 other children. So i had no choice really i had to get up and move around. I did lots of periods of rest in the beginning just because i didnt want to cause any complications. But i’ve been back to my normal mobile self for the last week.

Regarding Aspirin and Blood Pressure. Aspirin i’m no longer taking, I wasn’t told to take them after pregnancy. Blood Pressure i’m actually on tablets and have been since I was admitted to have my baby. Been told to see GP in a few weeks to try and wean me off them. So who knows we’ll see.

Regarding my Husband - he isnt trying to get out of going them for me, he really is petrified of them to the point it makes him ill and feel all funny. Adults do have phobias that can be severe. Blood is mine, if i see any bit of blood i will be going faint and hot and ashen. Id be useless in an emergency of it was anything to do with blood.

thanks for all your messages and help xx

I find this thread fascinating as I had two sections, one in 2003, one in 2005. I was never given anticoagulants, just a few shots of painkillers while in the hospital. I remember they put on compression stockings but once removed for my first shower that was it.
As for the shots, I see that the needles are longer (now, they didn’t used to be) but as a type 1 diabetic if it’s a matter of life or death you get used to it.

I find this thread fascinating as I had two sections, one in 2003, one in 2005. I was never given anticoagulants, just a few shots of painkillers while in the hospital. I remember they put on compression stockings but once removed for my first shower that was it.
As for the shots, I see that the needles are longer (now, they didn’t used to be) but as a type 1 diabetic if it’s a matter of life or death you get used to it.

I’ve been injecting myself with heparin since December, daily without fail …baby due imminently!
I have a blood clotting disorder.
I don’t understand why anyone would not take it seriously and just suck it up. Blood clots are dangerous and you’re at risk postpartum
sorry but a small scratch and a few bruises is worth it to ensure your life isn’t at risk