Blood Thinners & Induction

[fatandfettered]

I had a blood clot in my groin in my first pregnancy 10 years ago.

This pregnancy my consultant put me on blood thinning injections and booked me in for an induction @ 39 weeks, so that I would stop the injections 24hrs before so as to reduce the risk of bleeding during an epidural or ecms.
The consultant made it very clear to me at my (one and only) appointment with her that the blood thinners are extremely important, that there may be no symptoms of a clot and I could basically suddenly drop dead if one got to my lungs etc.

I was admitted to be induced on Friday.
My bishops score was 5 but not dilated at all. Pessary went in, initially had strong regular cramps which then died down to nothing. Saturday at 12.45pm they examined me and applied the gel as I had only dilated to 1cm. Again, I initially had regular painful cramps which then went away after an hour or so.

By Saturday evening I was a bit and asked the midwife on shift if the consultant had put a time limit on the process for me seeing as it was apparently so important that I take blood thinning injections, and they were withholding them until baby was born? She spoke to a doctor who told her that "there's not a lot we can do", very vague.
I was a little concerned also because every midwife that came on shift would ask me why I was being induced as part of making small talk. It seemed there was no different protocol for my inducement than someone who was simply over term for example.

I was told at about 6.30 that I could go to delivery ward to have my waters broken but would have to wait for a space. At 4.30am still waiting this morning with two nights of no sleep and massive childcare issues at home I discharged myself from the induction and came home. The doctor who signed off my discharge was not concerned about me having the baby any time soon or that I was going home. He said I could have my injections again so have given myself a dose now.

A midwife from delivery ward rang at 8am asking me to come in to have my waters broken but I explained what had happened and that I mentally/physically was so tired and miserable I am refusing and would prefer to wait to go into labour naturally.

I have also had a massive fallout with my mum who made my time on the induction ward really stressful by making it quite clear she was stressed at the prospect of having to do the school runs if I was still in hospital in the week. She is close to my two children but has always been really moody and has just come off her antidepressants and is now irritable beyond control! I am not going to be able to make any alternative childcare arrangements til middle of this week so also explained that to the midwife.

Anyway, I suppose what I'm asking is if anyone has any experience or answers regarding the blood thinner/risk of clot issue during an induction. The attitude from all the staff was very much, you're not at any great risk being off the thinners for days on end during induction , whereas the consultant had really drilled into me if I didn't inject daily I could just drop dead from a pulmonary embolism.

....so I'm just a little concerned/confused that they haven't got any balance in place for inductions where the patient needs to be taken off blood thinners to avoid the risk of bleeding in childbirth, but is also at massive risk of a clot every day she is not on the blood thinners?

I was really naive in thinking they wouldn't let my induction go on for days in the way that they do other patients, because of this blood clot risk.

I am now exhausted and emotional and wish I'd never consented to the induction.

At least I have my children back now and will hopefully get a good nights sleep.

Are you able to speak to your original consultant for advice?

@mynameisMrG I'm not sure 🤔 I was surprised she hadn't put a plan in place for me, there seems to be very little communication between the consultant and the other staff...I only met her once a few months ago never to hear from her again!

The midwife who called today said they would prefer to have me back in because they have given me the chemicals to start labour, but that she also understands I'm sleep deprived and stressed/my childcare plan have collapsed and said it would be difficult for me to go in and start labour already feeling so crap.

I do have to go in tomorrow to be monitored on the ctg for 20 minutes but not very hopeful for answers. Every midwife I asked could not answer as to why it was ok to let someone with a clot risk be withheld blood thinners for such a long time - inductions can go on for days and days?!

Speak to PALS.
There will be a written protocol on the labour ward regarding this. The senior midwife should produce it and review your care plan.

I was on blood thinners and was also induced due to being on them. It’s all a blur as I was similarly exhausted from being in for days and having to tell everyone my plan because it hadn’t been documented. But I am pretty sure I continued on injections every day during the inducing. I think the plan was that once I started on active labour, the injections would stop and then re-start as soon as possible after. Ultimately, the induction failed. So they stopped the injections, I had a c section, and then started again the next day. When you are in tomorrow, I would try and either speak to your consultant or someone in haematology. I know how stressful it all is so you have my sympathy.

@endofthelinefinally I have tried to call them a few times this afternoon but no answer.

I was on blood thinners and was also induced due to being on them. It’s all a blur as I was similarly exhausted from being in for days and having to tell everyone my plan because it hadn’t been documented. But I am pretty sure I continued on injections every day during the inducing. I think the plan was that once I started on active labour, the injections would stop and then re-start as soon as possible after. Ultimately, the induction failed. So they stopped the injections, I had a c section, and then started again the next day. When you are in tomorrow, I would try and either speak to your consultant or someone in haematology. I know how stressful it all is so you have my sympathy.

It's so frustrating when the staff have no idea why you're there and having to explain repeatedly isn't it?! Can I ask how your induction failed?
No one at any point has mentioned a c section to me as an option. I was all ready to tell the doctor who signed my self discharge that if they wanted the baby out in a controlled setting then give me a c section, but he wasn't bothered at all just let me go home. I really don't understand why I was there in the first place anymore everyone was so casual.

I would try and speak to the consultant when I'm in tomorrow but I don't see much point as I had to wait 2.5 hours in the waiting room for my one and only scheduled appointment with her two months ago? I will also have my children with me. Feeling very "what's the point" about most of it.

I failed to progress. After at least 2 or 3 pessaries, I hadn’t dilated at all. Due to the thinners, they told me they needed to control the labour, so a failed induction meant c section. Second time around, they seemed to suggest that wasn’t the protocol and they might let me go naturally. But in the end, it was decided that a planned c section was the best bet.

Oh and they needed to deliver my baby due to concerns around the placenta, hence why they didn’t let me keep trying for induction indefinitely.

@BarbarAnna I presumed that the same
Protocol as your first would be followed for my induction too. I don't understand their logic or lack thereof.

I had my second child 7 years ago in a different hospital and although I was on the blood thinners they didn't induce me, just told me not to inject once natural labour started. I guess it's pretty random depending on which hospital you go to.

I have to take bloody thinners due to a previous clot also. Had to last pregnancy also from 28 weeks to 6 weeks postnatally.

I think your consultant was out of
Order telling you that you could just drop dead! So could anyone. Typically you would definitely have symptoms if you had a blood clot on lung and it can be treated.

If you have also been taking blood thinners for weeks, missing a few injections should not make a difference as you blood will be very thinned out already.
I would ask to speak to another midwife or consultant and ask for some reassurance as being told you could drop dead by a medical professional is totally unprofessional and not something any pregnant woman should be hearing.

Just to add I have to stop taking my injections the day before I have c section and did last time and was told this is because as blood so thin there is risk of bleeding too much in surgery, I’m assuming your told same for induction for same sort of reasons so by that Logic your blood is going to be very thin for a while hence they want you to stop it right before labour so I really wouldn’t worry but again you need to speak to someone to put your mind at rest. Good luck and hope baby is here soon xx

Heparin (low molecular weight, if that’s what you’re taking) is not a blood thinner (Aspirin is) it changes the blood’s ability to clot. So, from that perspective, there usually isn’t any harm caused if you miss just a few days provided you don’t have factor leiden or another serious clotting disorder that causes blood clots (as opposed to just causing your blood to be unable to break them down). This is what I was told by several consultants, my midwife, and my pharmacist after she called the drug company. I take heparin and Aspirin due to a clotting disorder and my advice was also the same as yours - that if I am being induced or go into labour I should miss the injection from that day. Basically when on Heparin the risk of bleeding out during labour is nearly always higher than the risk of dvt if you don’t have a serious clotting disorder.