Just a quick note to say that everything is fine, but it’s been a slightly more exciting several days than I might have hoped!
Last Thursday when I hit 36 weeks, the plan was to switch from the once-a-day Lovenox injections I’ve been giving myself throughout this pregnancy to twice-a-day Heparin injections. This is pretty standard — Lovenox is great because it has a long half-life and the side effects are less common and more predictable than with Heparin, but as you get closer to labor the shorter half-life of Heparin becomes more attractive because if you go into labor it leaves your system faster. This is a good thing for two reasons: (1) you shouldn’t have an epidural when there’s still a bunch of blood thinner in your system, because it can cause rare but severe complications that mess with your spine (scary!), and (2) if you give birth (or need a c-section) when you have too much anticoagulant in your blood you’re at risk for hemorrhage. To give you an idea of the timing involved, you have to wait 12-24 hours after your last Lovenox dose for an epidural (depending on who you ask), but only 6-8 hours after your last Heparin dose for an epidural.
I’ve had no side effects at all from the Lovenox in this pregnancy, so I wasn’t even a little bit worried about the switch to Heparin. After all, they’re very similar drugs (Lovenox is actually a type of heparin — what they call a “low molecular weight heparin”). At first, things seemed fine. I thought it was kind of cool to learn how to draw up the medication into the syringe and everything — new life skill! (The Lovenox syringes are pre-filled.)
Then I started to notice red patches around the injection sites. And they were getting bigger. By the end of my second day on Heparin, I had a two large red streaks, each about six inches across, that spread across the two injection sites on each side of my belly. Of course, it was Friday night by the time I got freaked out enough to realize that I should do something about it. After all, I’ve had little bits of bruising and weirdness at injection sites before — but those always faded with time instead of getting worse. If anything, the area around the first day’s injection was larger and more red than the second day’s.
I didn’t feel like my throat was closing up or anything, so I waited until Saturday morning to call the doctor. She told me to stop taking the Heparin, switch back to the Lovenox for the weekend, and come in on Monday to talk about what to do.
Today the doctor explained that there were two possibilities they were concerned with: one was that I was having an allergic reaction to something in the Heparin (it may or may not be the medication itself; apparently there are various preservatives and byproducts of exactly how the particular brand of medication is manufactured that can cause reactions). This was actually the less scary possibility. The scarier possibility is that I could have caught the earlier stages of something called Heparin-Induced Thrombocytopenia (HIT). Luckily, there’s an easy test for this, so they drew some blood to check my platelets, which came back normal. Allergy it is! The doctor assured me that having an allergic reaction to the medication wouldn’t hurt the baby, so that’s a relief.
So, now they’re recommending that I stay on Lovenox for the remainder of the pregnancy. I’ll just have to be very vigilant about early labor signs — I’m supposed to call when I feel any sort of regular contractions, so they can help me decide whether or not to stop taking the Lovenox. In theory, this should all be fine, since most women have very long labors with a first baby — even though I gave birth once before in the second trimester, I only dilated 3-4 cm, so they don’t think this will make my current labor any easier/faster (rats!). I’m a little bit nervous about it, especially on the off chance that I wind up needing an emergency c-section because of some complication. I’d really like to not bleed to death, thanks! And if I need a c-section, I’d rather be awake for it, which I can’t be if I can’t get an epidural (I’d really rather not miss my child’s birth because I’m under general anesthesia if I can avoid it). I’ve read that there’s a way to reverse the effects of Heparin if necessary, but not Lovenox. I think I will try to ask more about this when I call tomorrow to ask them to refill my Lovenox prescription (I also have a non-stress test and visit with my regular OB tomorrow, but they might not know the answers). The doctor also gave me the option to try taking one more Heparin injection tomorrow to see if the red streakiness persists, assuring me that it wouldn’t hurt the baby and was very unlikely to have serious side effects for me. I may do that, although she didn’t sound very hopeful that the reaction would miraculously have stopped, and she sounded pretty sure that I should just stay on the Lovenox for the rest of the pregnancy.
As pregnancy issues and complications go, I’ve been really lucky in this pregnancy, so I can’t complain that something is finally not going quite right. After all, you win some lotteries and lose some lotteries, and I’ve been winning all the important ones in this pregnancy, so having this one minor hiccup should not be a big deal. That said, I think all pregnant women get anxious about how labor and delivery might go, and this is just one more thing that might make it more complicated for me. I’m not too freaked out about the prospect of not being able to get an epidural when I want one — I’ve been on the fence about epidurals anyway, and even if it’s hard, women have been surviving labor without epidurals for most of human history. What I’m more freaked out about is the possibility of hemorrhage if things move too quickly or if an emergency c-section becomes necessary and I need general anesthesia. I think these are all relatively low risks, but I’d like to know more about exactly how likely these various scenarios are. Mostly, it’s just one more set of unknowns to worry about as labor approaches. Well, we’ll see how things go, and I’ll ask some more questions at my appointment tomorrow. Here’s hoping I have a nice, long, not-too-painful, uncomplicated labor and don’t wind up needing to worry about any of this! (Ha!!!)