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Factor V Leiden/Clotting Disorder & Epidural
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. Thanks in advance! |
#2
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Factor V Leiden/Clotting Disorder & Epidural
I cannot make a decision. Does anyone else out there have similar
experience? I would love to know what you did. so what would they do if you were to need an emergency c-section, would they put you out with a general anaesthetic? If so I think I would want to have one in place, because I wouldn't want to be knocked out to give birth unless it was vital. I've heard of it being possible to put the epidural in, but not put any drugs in it, you might consider that as an option? You may also get a good idea what you are wanting after labour has started, if you are managing things, but are told you are only 1cm dilated you might feel very differently to if you were told you were 7cm. Or, things might start very violently, such that you can't cope at all right from the start. What seems to be normal is for people to cope at the start and then the point at which they are begging for an epidural is when it is already too late as it is transition. Also, if you end up being induced for any reason, you may want to consider it then, as there is a much higher chance of it being long, or particularly painful, or ending in a c-section. Personally I've had 2 births with epidurals, the first was an induction in which I tried to go naturally, but reacted so violently to the drugs that I was hyperstimulated and was getting quadruple peaked contractions, that was enough for me to say I would never have that drug without an epidural already being placed, the 2nd time was planned due to other issues, but had it not been planned I suspect that with the violent onset that I experienced I would either have had one, or had the baby before there was time. I know this is not direct experience, but I hope it might help, there is also a web page somewhere (which I unfortunately cannot locate just now) with a really good summary of the pros and cons, it might help you to decide if you would actually be thankful for having the option taken away from you. The other thing I thought of was what will the whole birth situation be like, will they insist on continuous monitoring or anything? basically any interventions hinder your ability to manage, will the heparin injection be via IV, or IM, will they insist you have a line placed already, all these kind of things can influence whether you think you can do it. Anne |
#3
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Factor V Leiden/Clotting Disorder & Epidural
Anne Rogers wrote:
I cannot make a decision. Does anyone else out there have similar experience? I would love to know what you did. so what would they do if you were to need an emergency c-section, would they put you out with a general anaesthetic? If so I think I would want to have one in place, because I wouldn't want to be knocked out to give birth unless it was vital. I've heard of it being possible to put the epidural in, but not put any drugs in it, you might consider that as an option? Apparently, general anesthetic is recommended in cases where the heparin injection isn't far enough in the past. What I can't seem to find any information on is whether it's a good idea to have heparin *after* the epidural. Everything I can find (that's recent) talks either about prophylactic antepartum heparin which should be stopped during labor with at least 12 hours before an epidural and then resumed 12 hours or so after delivery, *or* no prophylactic heparin and starting postpartum therapeutic heparin after delivery. I can't find anything that says to *start* heparin *during* delivery. From what I can tell, the safest birth for someone with FVL is a very low intervention birth--no anesthesia, remain mobile, reduce likelihood of c-section, etc. But given that sometimes interventions are needed, I'm not sure why someone would *start* heparin during labor? Maybe someone who knows more can enlighten me. Oh, here's another practice guideline: http://www.attract.wales.nhs.uk/ques...estion_id=1601 Best wishes, Ericka |
#4
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Factor V Leiden/Clotting Disorder & Epidural
Hi. I administered myself injection of heparin for three months before the
delivery. I had the same problema with epidural. You can have epidural only after 8 hours (at least) after the last injection of heparin. This is usally possible. I ended up with a elective c-section and I just stop the heparin the day before. For Anne. If you need an emergency c-section and you take heparin, they made general aenestesia. -- Valentina (from Florence, Italy) |
#5
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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 |
#6
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Factor V Leiden/Clotting Disorder & Epidural
I don't have the disorder you've got; however, I have a severe
intolerance to most stronger pain meds (narcotics, like opiates) and all general anesthesias I've ever encountered. One dose will have me so violently ill for days, even weeks, that I'm in the hospital for dehydration. Although I always wanted a natural birth, the fear of such a reaction to an epidural, since no doc could tell me whether the epidural would have the same effect, made me feel like it wasn't an option no matter what. I managed just fine to have a normal birth in a hospital -- and, mind you, it was a *very* pro-epidural and intervention hospital. Yes, it hurt. Yes, my double and triple peaking contractions made me wonder whether I'd make it. But I think that's the interesting thing about birth -- you get through it because you have to. And looking back, it wasn't that bad. Have a little faith in yourself. I know nothing can guarantee you an intervention-free birth, but I bet you'll surprise yourself if you've got the right attitude once you're in there. -Carlye DD 9-29-04 "Butterball" EDD 6-2-06 |
#7
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Factor V Leiden/Clotting Disorder & Epidural
carlye wrote:
[snip] But I think that's the interesting thing about birth -- you get through it because you have to. And looking back, it wasn't that bad. [grin] That's what I've always thought - once you're there, you're gonna get through it, cuz you don't have a lot of choice... And don't forget - one of the side effects of the labor hormones is short-term memory loss! [grin] -- Cheri Stryker Mom to DS1 - 6 yrs old preg w/ DS2 - due in Feb |
#8
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Factor V Leiden/Clotting Disorder & Epidural
[grin] That's what I've always thought - once you're there, you're gonna get through it, cuz you don't have a lot of choice... there is always the option of killing yourself, seriously I had a horrendous emotional reaction shortly after the onset of labour with my 2nd, had I been left along, the third floor window would have ben very good option, so in that case, I wouldn't have got through it! Anne |
#9
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Factor V Leiden/Clotting Disorder & Epidural
Anne Rogers wrote:
[grin] That's what I've always thought - once you're there, you're gonna get through it, cuz you don't have a lot of choice... there is always the option of killing yourself, seriously I had a horrendous emotional reaction shortly after the onset of labour with my 2nd, had I been left along, the third floor window would have ben very good option, so in that case, I wouldn't have got through it! Anne Yikes! My sympathies! I always tell people that I figure I just have to be brave about painful procedures - I've got tattoos on both arms and I paid good money for those. It was actually the throwing up that got to me.... -- Cheri Stryker Mom to DS1 - 6 yrs old preg w/ DS2 - due in Feb |
#10
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Factor V Leiden/Clotting Disorder & Epidural
Are you heterozygous or homozygous for Factor V? Have you ever had a
blood clot? If you are heterozygous with no history of clots, it is controversial whether you need anticoagulation. There is also a difference whether you need full anticoagulation or just coagulation prophylaxis. The latter, with lower doses of heparin, is not always considered a contraindication to epidural anasthesia. Often times, we discontinue heparin during labor anyway (then restart it after the baby is born). Regular heparin has a short half-life and can be timed so it wears off in time for an epidural. There are a lot of factors and decision points in your care that seem to be glossed over here. I wonder if either your provider is not totally aware of all these complexities, or whether he/she has done a poor job of explaining them to you. In either case, I think you might benefit from a consultation with a perinatologist. If you are going to be on heparin therapy, it would also be good to have an anasthesia consult before the time of labor so that the plans and questions are addressed ahead of time. You don't want any "surprises" at the last minute, and you certainly don't want your option of an epidural closed off because of a miscommunication or misunderstanding. |
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