Can't have the birth I want....

[TwinkleStars15]

So, I was diagnosed with a massive DVT when I was 4+5 and am now on Clexane injections twice a day. I was referred to the ante-natal consultant to discuss birth etc and have been told that a) no home birth (kind of accepted that one, reluctantly) b) no water birth c) no going overdue to induction needed if late (first baby so likely!) d) hospital as soon as labour starts so may be in for a couple of days.

Also, if I've had a Clexane injection within 24 hours I can't have an epidural, and if a c-section is needed I'll have to have a general and be asleep.

Am I justified to be feeling sad about this? I really want a water birth, hoped to stay at home as long as possible, definitely not be asleep when our beautiful girl arrives! Feeling a bit upset

It is rough- DS was breech and couldn't be turned so I ended up with an elective section. My advice would be to let yourself feel sad for a period of time (a day? A week?) then try and find a way forward. I can only think of one person who actually ended up with the exact birth they wanted

I guess lots of people's don't go according to plan, it just sucks to not be able to have your baby the way you want doesn't it? Thanks for the advice, I'll try and think of the positives! I know I'm very lucky X

I think you're absolutely justified. That would make me sad too, I'd be happy with the rest, but a general if you have a section would be tough. To be fast asleep, neither you nor your partner will see your baby born..

Having said that, they must have very good reasons for all the restrictions, and have yours and your baby's best interests at heart. I know it's hard, but as long as you're both well looked after and you have a healthy baby at the end of it, then that's the main thing.

Sending though, as that does sound tough

Hi Twinkle, Sorry to hear. I do understand as that sounds an awful lot like my story except not my first. This pregnancy I was diagnosed with DVT at 13 weeks and on to the injections and adorable stockings ... The first week I was really anxious as it was mentioned I may be induced at 38 weeks. But that seems to have changed and now just hopefully go into spontaneous labor and just stop taking the injection when I feel the beginnings of contractions. I'm hoping TENS and Gas and air will be enough pain relief to get this baby out as I really don't want to be asleep when they are born.

For my last birth I used and thoroughly enjoyed the birthing pool for pain relief (although had to be hauled out before the actual birth as the baby's heart rate couldn't be found) so am mourning the loss of that plan this time around. Sorry, l'm not much help, but wanted to say you aren't alone and you are totally justified to be upset - give it time to sink in and readjust your expectations.

On the positive side, I'm getting a lot more monitoring and baby checks this time which is always reassuring to hear the heartbeat. I also get an extra scan at 34 weeks.

You can absolutely be sad. And then you can remember that those rules have been put in place so both you and baby get to go home happy and healthy.
I've had 2 inductions for medical reasons and both have been fine.
All the best for the rest of your pregnancy.

You are right to feel sad for the birth you had planned but your health has to come first and your healthcare professionals won't want to take risks, especially with a diagnosed DVT.

Perhaps try to see this as the first step into the roller coaster and uncertainty parenthood sometimes brings.

A planned early induction in your case may be a good plan, then you can ensure you come off your Clexane in good time before any epidural requested/needed is sited . Inductions for a first labour often take 48 hours or more (especially if inducing early), so you should have time.

If you need to go to theatre (no increased risk with induction/epidural though there is an increased risk of an instrumental birth), and you have a good working epidural in, this can then be 'topped up', reducing the risk of needing a GA.

Thank you for your lovely replies. I'm going to let myself feel sad for a bit and then give myself a good kick up the backside and get on with things! I'm going to tell this little one every day that she needs to come on time, fingers crossed! DH thinks he'll be getting lots of sex towards the end, men haha.

I don't really understand the rationale for induction so you could easlily so no thanks to that, and if you really wanted the water birth you could argue strongly for that with active management of the third stage (delivery of the placenta). You can sit down with a supervisor of midwives (use them before the NMC gets rid of them!) and discuss your options. Most first labours are very long so you will have time I reckon for an epidural, I have not known one GA done for that reason yet in 12 years.

I understand you feel sad, but ultimately, child birth, is just the way of getting the baby out. I don't think it's the end of the world if you don't get to sit in a tub of water or be at home.

If it needs to be controlled and carefully managed for the baby to arrive safely then so be it. I had a disastrous time and nothing went the way I would have hoped, but all that really matters is the end result being a healthy mother and baby.

Hope everything goes well, try not to let it spoil your pregnancy.

Why can't you have a pool birth? I get if you need to be induced they need to monitor the baby which depending on if they have waterproof ctgs or not may rule it out. But if you labour spontaneously I don't understand the specific reasons why a previous dvt would rule out a pool birth. Can you ask to speak to a supervisor of midwives.....before they're all finished at the end of march.

Could they switch your medication before the CS so you don't need a GA? My biggest fear is being asleep while my baby is born.

And I thought epidural was only contra indicated if cleaned had been given in the last 12 hours not 24 hours?? Maybe different hospitals have different policies but that's the policy where I am.

I think it's completely fair enough to be disappointed. My DD was transverse so I had to be admitted at 38 weeks for observation and then had a CS at 39+4. I had also wanted a natural water birth so 13 nights in hospital and a highly medicalised birth was a huge bummer. I am however thankful for all those things for essentially saving both our lives, and I haven't given it an awful lot of thought since then, too busy!

Good luck and hope it goes smoothly xx

So the reason for being induced on due date is so they can tell me when to stop taking the Clexane, basically my blood is much thinner because of it and if I needed an epidural the blood would seep into my spinal column and could cause paralysis. But how many first time labours are less than 12 hours from start to finish?? I'm thinking, if I start to feel contractions, not to take the Clexane (they've previously told me missing one every now and then isn't the end of the world) so that wouldn't be an issue. If it's a false start I'll just take it then..

The reason for not being allowed a water birth is a strange one - basically the midwife is at risk of being sued if something goes wrong, but the only thing they said could go wrong is too much bleeding and having to get out - but surely that could happen outside of water too?! Apparently finding a midwife willing to do it is the problem.

I've been referred to a supervising midwife - are they being cut soon??

Yes, supervisors finish at end of march.

Midwives can't decline to look after a woman. You can make informed choices. The hospital can decline to let you use their pool, but they could not stop you having a pool,birth at home so most would be sensible and compromise on a hospital pool birth. A midwife looking after a more high risk woman is protected as long as risks are pointed out to you and this is documented.

Any woman can bleed in the pool and they will practice emergency pool evacuations for this reason. And yes, you could bleed on dry land. The pool doesn't make you more likely to bleed....I guess they're worried there could be a delay to treat you due to having to get you out.

How about a compromise of labouring in water but getting out for pushing?

It's ok to be disappointed, but you may never have got the birth you wanted.
My birth plan for DD1 was to have a water birth in a midwife led unit. I ended up induced due to pre-eclampsia. Birth plan with DD2 was to get us both through it alive by any means necessary!
The ultimate goal has to be a safe delivery. Try to go into it with no other expectations.
You could ask if there's an alternative to clexane you could change to in order to keep options for epidural.

Have the birth you need to give you the child you want. We all dream of a perfect birth, sadly it doesn't always happen that way. Do what you have to to ensure the healthy arrival of your beautiful baby. That sounds harsh, I don't mean it too, sorry.

I would have liked a water birth at 42 weeks. Instead I developed complications requiring an EMCS under GA with about half an hour's notice. ultimately though I wanted a birth that my baby and I survived and I got it. Birth is just a means to an end. Feel a bit disappointed and then get over it.

I can definitely understand why you're disappointed and really feel for you. In your position I think I would be asking for an ELCS as surely then you could stop taking the Clexane 24 hours before it is planned? I understand that it is not how you planned to give birth but it mitigates the risk that you would need a general anaesthetic if you needed an EMCS in labour. I would be refusing induction as there is an elevated chance of needing a) an EMCS (general anaesthetic) or b) assisted delivery (either general anaesthetic or being expected to deal with potential episiotomy / forceps / resultant stitching with only local anaesthetic).

Again, realise that this isn't how you envisioned giving birth but it would greatly reduce the risk of not being awake when your lovely baby is born. I had an ELCS and it was a lovely, peaceful experience. Good luck with it all.

I'd second that if I was in your shoes I'd ask for an elective c-section. That way (unless you go into labour super early) you should be guaranteed to be awake.

I was told I'd have to be induced on my due date due to issues with the placenta. My waters broke at 39+5, I was the induced as no contractions. Monitored at all times. Failed to progress and showed signs of infection so ended up with an emcs. We both had to stay in for a bit for some Iv antibiotics but the c-section itself was very calm and I recovered well. If I I have a second dc I will have an elcs!

Just something to think about but given the issues you've had I think it would be a possibility. Good luck!

If it gives another perspective, I wanted a natural, vaginal birth with no pain relief and to stay at home as long as I could. I got what I wanted because I had a horrible, terrifying fast labour, was 10cm dilated and screaming in pain when we arrived at the hospital, too late for any pain relief anyway, lost a lot of blood and tore badly. I was very traumatised afterwards. So yes, I got what I thought I wanted, but the reality was nothing like I imagined and I would have given my right arm for an epidural when it actually came to it.

I guess my point is that even when you do get what you want, it might not go the way you hope it will, of course you are allowed to mourn the birth you thought you were going to have, but in reality very very few people get the experience that they think they are going to have. Of my NCT group, none of us got the birth we expected, in your case it's just that you know in advance and therefore have more time to think about it. Give yourself that time but then try to move on from it, focus on the baby you will have and how little the birth really matters in the end.

Thank you all for your replies, it's really helped and much appreciated. You've given me lots to think about and some good questions to ask next time I see the consultant, thank you. What really matters is that this little one comes into the world safely and her mummy is healthy x

Possum it's 12 hours for the preventative dose of clexane, 24 hours for treatment dose.

OP, sorry that this has happened to you. But as someone else has said, be glad that we have treatment for this now - DVT/PE used to be a big killer of pregnant/peri-partum women, but that's massively reduced in the last few years. I would say that the majority of women, particularly first timers, do not get the "ideal" birth that the antenatal classes sell you - spontaneous labour, stay at home as long as possible, get in the pool in hospital and pop the baby out with a bit of gas and air - I don't think it happened for ANY of my NCT class!

When I was a student, I remember one pregnant mum on my mother and baby placement. she wanted an all natural birth, get in the pool, home the next day. She ended up being in labour for days, walking up and down the hot, sweaty ward complaining at the midwives... I think she ended up with the CS. My mentor told me that in reality, a birth place should just say "for mum and baby to be healthy".

I went 10 days overdue on Fragmin injections (induced in the end as absolutely nothing was doing - they might have been OK leaving me another day or two but I ran out of patience. Should add that I hadn't had a DVT - was on them for genetic clotting issues and history of recurrent mc). I'm not sure why going overdue per se is a problem, tbh, unless the aim is for you not to go into spontaneous labour if at all possible, in which case surely they should be inducing at 38-ish weeks? I ended up having a (very) precipitate birth and didn't bleed excessively - I lost more blood in my cascade-of-intervention first birth, at which point the clotting issues weren'T known, hence no Fragmin.