I went to the doctor for one of my regular ho-hum, yep you're pregnant, big deal appointments. I enjoy those so much because its only now that the panic level has lowered and I can simply be weighed, measured, and sent on my merry way. Still, I am a little disappointed by my last appointment. The doctor said because I'm on lovenox they don't want me going past my due date and will likely induce me on week 39 or 40.
I don't want to be induced. Induction means meds and I wanted to go as natural as I could without an epidural or pitocin or anything else. Induction means they're forcing my body to go into labor which means they'll likely have to force contractions which means that the pain of forced contractions (which is stronger than natural contractions) will require me to take an epidural.
I need to talk to my MFM doctor to get his take on this but I don't understand why I need to be induced just because I'm on blood thinners. She said by week 39 I will be on heparin which is easily reversible at the hospital but because they would need time to get the heparin out of my system they don't want me rushing in 5 cm dilated, they want time to get that out before I begin labor. I guess this makes sense but I'm still disappointed.
Have any of you had experience with inductions? Any advice?
I don't have any advice since this is my 1st pregnancy, other than ask lots of questions and do as much research as you can. Talking to other women who have been on blood thinners during pregnancy may help to reveal a range of medical practices around delivery.
ReplyDeleteI would ask specifically what the concern is. Is it that there will be placental or fetal issues if you stay on a blood thinner? How long does it take to flush out the heparin from your system? Can you go off of blood thinners at week 39?
Also, FYI - at our birthing class they told us to add 2 weeks to our due dates as the average American mom goes 10 days over her due date.
Good luck hon & here's sending you prayers for no induction!!
Love,
B
Hey there,
ReplyDeleteIt's great to see that everything is going well with the pregnancy. I check in often :)
With my daughter's birth my water broke, but then not much happened. About 6 hours after my water broke the hospital wanted me to come in and they of course immediately started me on pitocin. I eventually did a narcotic to help with the pain and then when the second allowed dose a few hours later didn't work I opted for an epidural as I felt like I wasn't breathing right and needed something to ease the intensity of the contractions. While I wished also for a natural labor, I was most of all grateful that my daughter was healthy and here even though the whole process took about 25 hours from start to finish.
I'm 11 weeks pregnant now and I know that as part of my "plan" I'll be hoping to avoid pitocin this time around. The biggest lesson I've learned through this is that I want to ask more questions, and also remember to be flexible. Pitocin, as much as I hated it, has probably helped with a lot of deliveries by bringing babies here earlier when they needed to be born due to being under stress in the womb,etc. I've also learned that with birth you can only have some element of control. As much as I want to think I'm in charge, I need to realize that the goal is a healthy baby...no matter how he/she gets here. That's helped me a lot.
I know there are inserts that can help to soften your cervix and usually before inductions they have you come in the night before to start with these. Maybe your doctor could try and make sure they start this early and also with a combination of the insert and other "tricks" things could start naturally for you. There's a lot out there to read on how to try and get labor started.
Sorry to ramble so much...it's amazing how birthing thoughts/stories bring back memories and feelings in people :) Keep us updated with what your doctor says about this!
With my daughter, they first broke my water to induce labor and that did the trick so there was no need for anything else. That was 14 years ago, and I understand that isn't common practice anymore. Usually the pitocin is first because once the water is broken, they have 24 hours to get the baby out so as to avoid infection.
ReplyDeleteI can't say whether or not it was more or less painful than it would have been otherwise because it was my only experience. And my hospital didn't do epidurals at that time so it wasn't an option. Lucky for me, I gave birth to her less than 3 hours after they broke my water. Not typical by any stretch though.
Like you, I have no desire to get induced, and no matter the circumstances, I intend to go without meds or epidural(notice I said intend). Definitely get a second opinion.
I'm planning to avoid induction unless I get to 41 weeks. I'm planning on doing hypnobirthing and having nothing at all for pain relief. So I'm totally with you on the plan.
ReplyDeleteI think it's nuts to say you'd be induced because you're on lovenox. I'd expect them to switch you to regular heparin twice daily shots maybe around 35 weeks. It depends a little on what your dose is how they'd proceed after that. If you're just on clot-preventing 5000U every 12 hours, supposedly you're fine to have regional anesthesia if you need it without any further ado. If they want to be sure, they can also check the PTT to see if it's abnormal from the heparin, and if it is, they could use protamine to reverse the heparin instantaneously. That's what we do for patients having vascular or cardiac surgery who get huge whopping doses of heparin IV during their operations.
From the ASRA Guidelines (in case you're interested in reading medical mumbo-jumbo): http://www.asra.com/consensus-statements/2.html "During subcutaneous (mini-dose) prophylaxis there is no contraindication to the use of neuraxial techniques. The risk of neuraxial bleeding may be reduced by delay of the heparin injection until after the block, and may be increased in debilitated patients after prolonged therapy. Since heparin-induced thrombocytopenia may occur during heparin administration, patients receiving heparin for greater than four days should have a platelet count assessed prior to neuraxial block and catheter removal. "
Even at prophylactic doses of fragmin, according to them you're fine for an epidural if you're 12 hours out from the last dose.
Patients where I work also routinely get shots of heparin or fragmin at the start of bigger operations to prevent blood clots, and the surgeons never worry about operating and losing more blood then.
I'd definitely see what other docs say about this. If their concern is bleeding at delivery, I've never heard them worry about that when I trained. You can have a woman on a high-dose heparin infusion to treat a pulmonary embolus, and if it's shut off for about 4 hours, you can basically expect her blood to clot just fine when she delivers.
If their concern is whether you can get an epidural if you decide you want one, ask for an anesthesia consult well ahead of time to come up with a plan.
And heck, with a first baby, it's unlikely that you'll come in in mad labour and pop the kid out 2 hours later anyhow. By the time it arrives, the heparin should be gone!
Maybe your MFM or OB should talk with a hematologist or pharamcist to clarify these things - it all sounds a little weird to me!
(But as always, take what a random person like me says with a grain of salt, and go with what your doctors say after some educated discussions!)
http://www.blackwellpublishing.com/medicine/bmj/nnf5/pdfs/uk_guidelines/ENOXAPARIN-thromboprophylaxis_in_pregnancy_guideline.pdf (Interesting guideline from the UK - they seem to continue prophylaxis through labour, or if they think you're at risk for bleeding, convert to regular heparin before induction or labour is likely to occur)
My first question is -- why do they not want you to go past your due date on lovenox? If I were you, I would do lots of research on this.
ReplyDeleteI was not induced with my son, but it was still a horrible and disappointing birthing experience (ending with a C-section after 24+ hours of labor and 3 hours of pushing). I commend you for wanting to be as natural as possible, and as someone with many regrets myself, I *urge* you to gather your own information, read medical journal articles, etc. before agreeing to be induced. I would avoid it if at all possible.
I was dead-set against induction.But when my water broke and I wasn't having any contractions whatsoever, I had no choice but to get pitocin because of the risk of infection.
ReplyDeleteI was in labor 20 hours with no epidural. Not once did I think I wanted it. Not once was I tempted. (But then had to have a C-section and got a spinal, so there went that.) If you have it in your head from the get-go that you don't NEED the drugs, you WON'T need them.
Does it hurt? Yes. Will the pain kill you? No. And, even though I didn't have the experience of non-pitocin-induced contractions to compare the pain to, I really didn't think they were that bad. I clenched tennis balls in each hand, closed my eyes, and rode the waves of pain. Painful, but bearable.
The emotional pain of losing a child is FAR FAR worse than the physical pain of any contraction.
Most docs in our area dont induce until you hit 42 weeks unless the baby is very large or there are problems. Have you gotten a second opinion?
ReplyDeleteHave you checked into the Bradley Method to help with natural birth? We used them and I loved our classes.
Thanks for your input and advice. I think I am feeling a lot more confident now to do more research and push for no induction if the research shows there is no need. Sometimes I get so scared, there is that guilt factor like what if me saying no to this will be a life/death situation i'm not aware of and then I'll be haunted b the guilt. I hate that fear is a tactic to get me to induce when its likely not a necessary measure. I will talk to my MFM on the 23rd and let him know how strongly I feel and see if he can convince my OB. Regardless, i think she has to do what I say right? Like, they can't MAKE me get induced right?
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