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Old January 10th 06, 09:05 PM posted to misc.kids.pregnancy
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Default Factor V Leiden/Clotting Disorder & Epidural

Rafael wrote:
Hi,

I have a blood clotting disorder called Factor V Leiden and I'm 35
weeks pregnant. I've been told that, as a precaution, I ought to have
a Heparin injection prior to delivery and then will need to continue to
inject myself for 6 weeks after our baby is born. I have no problem
with this in itself but I have also been told that I should give plenty
of thought (more so than someone without Factor V Leiden) as to whether
or not I will want an epidural. This is because if I'm going to want an
epidural, I must have it administered before my Heparin injection can
be given to me.

Initially, I wanted to avoid an epidural if I possibly could but was
relaxed in the knowledge that I could change my mind if I wanted to.
Now though, I know that once I've had the Heparin injection, I can't
change my mind at all and an epidural will be out of the question.

I cannot make a decision. Does anyone else out there have similar
experience? I would love to know what you did.


Hmmm...I have no experience with your medical
condition, but I suppose I had something parallel in that
having decided on a homebirth, I was definitely choosing
to go without an epidural. I *could* have changed my mind,
but it would have meant a major change in plans and transport
to the hospital during labor.
My belief is that in the vast majority of cases,
if you A) really want to go without an epidural and B) plan
to create an environment that is supportive of unmedicated
birth, the odds are very much in your favor that you can
be successful. Part B), however, is very important. Most
hospital births are terribly unsupportive of unmedicated
labor. So, it would be important to find a caregiver who
was experienced with supporting unmedicated labors and
who will help you manage your labor in such a way that
you're likely to be fine without an epidural.
Having a doula (professional labor support)
reduces epidural rates substantially. Staying mobile
during labor helps a lot (no continuous monitoring,
no spending labor lying down in bed hooked up to
all sorts of things). Eating and drinking helps
(staying hydrated is quite important with FVL).
Having a doula or support person who is knowledgable
about different techniques to try helps. You may
have a bit of an uphill struggle getting an environment
that is really supportive lined up because the FVL
puts you in the high risk category and they may want
to manage your labor with lots of interventions.
However, when you really look at the pros and cons of
those interventions, it may weigh out that it is more
important for you to be able to manage labor pain and
go without the epidural (and other interventions that
might also pose special risks because of the FVL) than
it is to have some of those interventions.

I did a little snooping around online regarding
FVL, and I am a little confused. The ACOG practice guideline
doesn't seem to line up with your information that you
should have heparin during labor, but not while pregnant.
They seem to think you'd be on it postpartum, and maybe
antepartum (but ideally to be stopped prior to labor),
depending on various factors affecting the severity of
your condition? They seem to indicate that if it's been
24 hours since your last heparin injection, the epidural
is likely fine (and that it's likely fine if you've been
taking unfractionated low-dose heparin and your APTT is
normal). Here's the practice guideline:
http://tinyurl.com/d6kue

Anyway, I wouldn't freak out at the notion of
not having an epidural, or assume that it's impossible
or crazy (no matter what your friends say ;-) ), but
I do think it's wise to understand that how your labor
is managed can have a great deal to do with how much
pain your experience (and thus how much you desire
pain medication). Avoiding an epidural is much more
than Just Say No. You need a proactive plan for
coping with an unmedicated labor, and you need
caregivers and staff who aren't going to sabotage
that for you. I can honestly say that I never
wished for an epidural in any of my three labors
(and the first one was 45 hours of active labor),
but I had a great team and a great environment
that was very supportive and knowledgable, and I
think that made a big difference. I could easily
imagine being in a different environment with
different caregivers and begging for an epidural
with the very same labors.

Best wishes,
Ericka