Blood clotting issues - inevitable cesarian?

[jasmine51]

I have been taking aspirin throughout my pg and also high dose folic acid due to a blood issue that raises the risk of clotting. After delivery I have been told I will need heparin injections initially then aspirin. The consultant mentioned at my 28 wk review that they are likely to recommend a CS as that is a more controlled form of delivery for managing blood issues. I dont get this? Why is it more controlled? Surely making a huge abdominal wound increases the bleeding/clotting risk? Surely the natural hormones involved in a natural labour make it a safer option?
Has anyone else been in this situation and been put under pressure for a CS? What was the outcome?

I've got Factor V Leiden, which means that I have an increased risk of blood clots and took aspirin until around 32 weeks. I also needed Heparin for the first 48 hours after delivery (and had taken it for the intial couple of weeks of my pregnancy as well). My discussions with my consultant around delivery centred around the need to remain as active as possible and as such my birth plan asked for an epidural only to be used if absolutely necessary, not just because I wasn't managing the pain. Booking you in for a C Section seems to fly against this advice, as you will definitely have limited mobility for a period afterwards. I'd definitely challenge this with your consultant.

Thanks tatty I like your advice...I am very aware of being steamrollered into actions that might suit the hospital but are not entirely in the interests of the me and the LO. My advanced age just seems to spook them into making decisions without giving me options and its getting annoying that I have to go away and do my own research and challenge people who I should be depending on....sorry, rant over!

Hi, I have factor v leidens and also pro throbbing g20210a (I think, I may have the numbers a bit wrong!) and am on daily heparin since start of pregnancy until 6 weeks after delivery. This is my second pregnancy but care has been almost the sane other than last time the guidelines were that heparin should be started at 13 weeks but I think I am higher risk than you as I have two clotting problems. What you should get is a referral to the haematologist who really needs to decide what's best for you. Absolutely you should not have a c section unless necessary, natural birth is SO much better. The main thing you need is regular growth scans towards end of pregnancy (mine are booked for 28, 32 and 36 weeks) to make sure the baby is growing properly as one of the biggest risk factors is the placenta clotting and the baby starving. Last pregnancy I was induced at 37 weeks as the scan showed a small baby (although not as small as they thought) and decreased blood flow in the umbilical cord. The haematologist categorically told me that c section as with any major surgery is not a great idea unless necessary. Also not sure if you have been told but you shouldn't take heparin if you are in labour as you won't be allowed an epidural!

Feel free to ask me anything else but can't guarantee i'll know the answer! Happy to help (if I have!)

Thanks for your responses. I have homozygocity MTHFR which is yet another random weird condition but sounds like the outcome is similar to the ones you have mentioned ie clotting risk. I do know there is an issue already with the uterine blood supply so I'm having 2 wkly scans now upped to weekly from 36 wks. I'm also in a high risk PE group due to this condition and at risk of placental adruption due to my age.. which is why I think they have me flagged for a possible CS...however I will absolutely take your advice and question whatever they 'recommend'. The movement during labour makes perfect sense to me and is more in line with what I would really prefer...but bub comes first and I'll do whatever is necessary for a safe birth for both of us. I have emailed St Marys in London this afternoon who originally diagnosed the condition and linked it to my mcs...they seem to know alot about it and should be able to liaise with my consultant here to come up with the best plan.
Thanks for all your help x

my sister had clotting issues in pregnancy and was told c.s more risky and the immobility not a good idea. also epidural was contraindicated too

they did advise a homebirth might not be a good idea in case she did heamorrhage

in the end she had a natural birth in water , with no complications

i would certainly ask for second opinion

Oooo I so want a water birth. If this condition gives me a full justification for having one I'll admit myself now to make sure I'm at the front of the queue!

Hi, I have a blood clotting issue. My consultant did not recommend a c-section. I was told that I would only need injections afterwards if they have to do an emergency c-section.... I am hoping for a natural birth; maybe a water birth. My consultant is supportive. Are you in London? Which hospital are you in? I would try to go get a second opinion from another consultant/hospital... There are lots highly experienced doctors if you are in London (if you want PM me for a reference of a private doctor)...

I too have a clotting disorder, APS, plus a history of PE's in a previous pregnancy. I'm on asprin and clexane. (heparin) I'll stop the asprin at around 37 weeks and stop the clexane at labour, then recommence clexane post birth until 6 weeks post partum. Things are further complicated as I also have a history of large babies and now have gestational diabetes, plus although I am only 26 weeks, for now baby has a preference for being breech.

My haemotologist seems to think a c-section should be a last resort for me (that would be my choice too!) because it adds additional risks that a natural birth won't. On the other hand, if I go into labour unexpectedly I may have just had a dose of clexane, which could potentially cause problems with bleeding at delivery and means I can't have an epidural, so if I needed an emergency c section I would need a general, which is more risky. Prior to the GD I was still hoping for a midwife led birth, possibly labouring in the pool, although didn't want to birth in there.

I can see why they think an elective or managed delivery is potentially less problematic, but in your situation I don't think I'd be agreeing to a c-section. I would certainly get a second opinion.

Have Factor V Leiden and Prothrombin deficiency. Have had 3 pg. All delivered naturally. With first pg was told that I couldn't have an epidural and that they'd do everything they could to help me deliver vaginally as that was by far the safest route for me. And that if I did have to have a section it would be with a GA. Maternity staff hadn't got a clue for first 2 pgs and it was a case of me telling them what was required. With pg3 their "advice" was incorrect and I ignored it! Kept to original advice with all 3 pgs.
On Heparin and Heparin type drugs from DVT until 6 weeks after delivery with pg1, then warfarin for 6? months. Then Heparin type drug from when we chose to ttc until 6 weeks after with pg 2. Then clexane from point I discovered I was pg to 10 days after with pg3.