Is anyone on Lovenox/heparin with a breech/transverse baby?

may2806

Hi ladies, I posted a similar q on the natural birth board because I was hoping to have med-free delivery, but I thought I'd get your opinions on my situation as well. I'm 38 weeks on Sunday and on Heparin (1 ml/2x day) for 2 copies of MTHFR and PAI-1. I was previously on 30 mg of Lovenox. All of this is just prophylactic - never actually had a clot. Here's the thing - my baby is still transverse. OB wants to schedule a c-section for 39 weeks. MFM said he is ok with waiting until 40 weeks. There is a chance that baby could turn during labor, giving me the possibility of a vaginal birth; but if he doesn't turn, I am looking at an emergency c-section, and if the Heparin is not out of my system and they can't reverse it I will have to be put under general anesthesia. OB thinks it's better to have it all planned, but a c-section is not without risks either and I would really prefer to avoid surgery. Part of me just wants to stop the Heparin (the doctors don't all seem convinced that I even needed it in the first place) but I don't know if that's smart. Of course I want to do what's best for me and the baby but I honestly don't know what that is. Has anyone been in a similar situation?

luvboston

I am having a scheduled C section and am changing over to heparin at 34 weeks. However if I go early, the anesthesia team here said that as long as I am on heparin we can wait 12 hours or if its an emergency they have meds to reverse the heparin. I would ask to have an anesthesia consult

DahliaFlower

luvboston said:

I am having a scheduled C section and am changing over to heparin at 34 weeks. However if I go early, the anesthesia team here said that as long as I am on heparin we can wait 12 hours or if its an emergency they have meds to reverse the heparin. I would ask to have an anesthesia consult

This.  I am both also on Lovenox currently, changing to heparin at 36 weeks.  Basically, the only issue with labor epidural or C-section would be if you had just given the heparin.  Heparin has a short duration of action and if it has been 12 hours, nothing needs to be given, you can just have epidural or spinal.  If it's been less than 12 hours, reversal agents would be available.  Agree w/ PP re. talking to an anesthesiologist at your hospital.  

However, if my baby is breech at 36 weeks or so, I would personally plan a C-section date to better coordinate with holding heparin.  It can always be cancelled if your baby gets in position later.  

katenpaul

DahliaFlower and luvboston are right, you should ask and anesthesiologist because they are going to be the ones calling the shots when it comes down to being able to perform an epidural or spinal or if they would have to use general anesthetics. A true emergency c-section is needed if the life/well-being of the mother or baby are in danger... in most cases c-sections that are unplanned fall into two categories, unplanned but needed (ex: failure to progress in dilation) or urgent (ex: baby's heart rate is elevated because mom has a fever/infection and not ready to push). There are fewer cases where it is a true emergency (baby's shoulders get stuck at delivery, prolapsed cord etc.). Where I work the doctors do not allow you to labor if the baby is not head down because it risks the health of both mom and baby, especially if you are already considered a high risk pregnancy. I do not advise you to stop taking the heparin without discussing things in detail with both your OB and MFM doctors... think about how much effort you have put into conceiving this child, is it really worth the risk? I can tell you that the use of general anesthesia is the last resort for all parties involved in your delivery and that your anesthesiologist would only want to use it for a true emergency.

I hope this helps you!