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Factor V Leiden/Clotting Disorder & Epidural



 
 
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  #1  
Old January 10th 06, 04:12 PM posted to misc.kids.pregnancy
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Default 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  
Old January 10th 06, 05:00 PM posted to misc.kids.pregnancy
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Default 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  
Old January 10th 06, 05:58 PM posted to misc.kids.pregnancy
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Default 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)


  #4  
Old January 10th 06, 08:05 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
  #5  
Old January 10th 06, 08:24 PM posted to misc.kids.pregnancy
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Default 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
  #6  
Old January 11th 06, 02:41 PM posted to misc.kids.pregnancy
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Default 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  
Old January 11th 06, 04:39 PM posted to misc.kids.pregnancy
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Default 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  
Old January 11th 06, 05:27 PM posted to misc.kids.pregnancy
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Default 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.

  #9  
Old January 11th 06, 07:24 PM posted to misc.kids.pregnancy
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Default 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


  #10  
Old January 11th 06, 10:27 PM posted to misc.kids.pregnancy
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Default Factor V Leiden/Clotting Disorder & Epidural


I was taking heparin throughout my second pregnancy from 6 weeks right up to
the birth and then for 3 days afterwards. The type of low molecular weight
heparin I took was called Fragmin (dalteparin sodium) at a dose of 2500IU /
0.2ml per day - which is considered a low amount.

I had an elective c/s and so had a good chat with the anaesthetist the day
before the op. They told me that with heparin they wouldn't have allowed me
to have an epidural inserted within 24 hours of the last dose of heparin. I
was shocked at this because if I had gone into labour naturally I would have
wanted an epidural as plan B if the pain got too bad (I had had an epidural
with sproglet #1 when I wasn't taking heparin). So my last dose of fragmin
was about 40 hours before the op.

The anaesthetist also said that the epidural catheter shouldn't be taken OUT
within 12 hours of a dose heparin. Apparently it increases the chances of
bleeding into epidural space, which is bad. So I made sure that I had my 1st
post partum heparin shot after the catheter was removed.

Hope this helps !

Peg
DS1 2002
DS2 2005

"Rafael" wrote in message
oups.com...
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!





 




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