By the time I was eight months pregnant with M, my stomach was one ginormous bruise stretching from side to side. With number two, at 7 1/2 months, there’s no bruising as yet, but if there was I would grit teeth and smile – those bruises keep my babies alive.
Unlike most women who have to suffer countless pregnancy/fertility difficulties before being diagnosed, I’ve known about the complications with my blood for many years so thankfully was informed about what to do to minimise risk before M was even conceived. The complications – Factor V Leiden and MTHFR – on their own carry significant difficulties for expectant mothers and child; together doctors act as you’re a time bomb just waiting to go off. Factor V Leiden is a blood clotting disorder, meaning during pregnancy your risk of miscarriage, placental failure, pre-eclampsia, DVT is increased. MTHFR is a genetic mutation which also increases likeliness of blood clotting but also inhibits the body’s absorption of folic acid, more specifically B vitamins, so vital for the baby during pregnancy. The combination of the two blood mutations increases the risk of pregnancy complications, hemorrhage during labour, placental clotting with subsequent malnutrition of the baby and worse case, stillbirth.
When you read all of that, it’s scary to say the least. With M, our fears were increased when we tried to find a doctor to take me seriously in a country where people are, in the main, oblivious to the make-up of their body. We saw three doctors, in three hospitals, who each said I couldn’t possibly know I had these conditions because I hadn’t been pregnant before and who refused to prescribe me medications – in particular soluble folic acid which would be easier absorbed by my body and is vital to the baby in the initial 12 weeks of pregnancy. By the time we met with our current OB who not only believed me but also seemed gened up on the implications, I just burst into tears. She prescribed folic acid, heavy-duty iron tablets and a daily dose of Clexane – the blood thinning injection I would take daily for the duration of the pregnancy – and did all this while waiting for the state required (nobody said this, and flat-out refused to run my genetics for us) genetic blood work needed for her to prescribe this to me. M’s pregnancy progressed uncomplicated and I can’t help thinking this doctors hand as well as Allah’s had a hand in ensuring that. This pregnancy, when we realised I was pregnant at 3weeks and a day, when the scan didn’t show anything and blood work only a trace, she re-wrote those prescriptions and has done ever since.
The care I’ve received during pregnancy has been fantastic, and I’m so thankful to be receiving maternity care here as opposed to the UK where check-ups are so limited. I see the doctor every month – from here in 3 weeks dropping to two, then to every four days from 37weeks – have received two in-depth ultrasounds (think 20minutes counting veins, literally) to monitor the health of the placenta and ensure Bump himself has no clots going unseen, and have the OBs personal cell phone on speed dial which she will answer any time of the day. Alhamduillah, if there was a better place for me to birth children, I haven’t heard of one yet.
And better still, this doctor we somehow found in a haystack, is willing to let me try VBAC – almost unheard of in MTHFR mothers. The reason VBACs are scarce is the same reason I would likely have been offered a scheduled c-section with M under anyone elses care here: the blood thinner (Clexane) while working through the pregnancy to prevent undue clotting, can trigger hemorrhage during labour as it overrides the body’s ability to clot instinctively. Pregnant women who have been administering blood thinners are often advised to induce labour at 38 weeks, or schedule a section to allow them to stop taking the thinners and reduce risks during birth. My doctor was happy for me to stop taking Clexane from the moment labour started, and monitored me daily for the final two weeks, an hour at a time, to screen contractions I wasn’t feeling, to determine the prime time to stop. My last injection was administered two days before M was born and it can only be concluded that the massive blood clot I lost just before the emergency c-section and M’s birth had been waiting to build and had simply been kept at bay; likewise the lack of platelets in his cord blood when we sent it for stem cell harvesting. We were lucky. Alhamduillah.
So this time? Bump’s birth? We don’t know. We have no idea how it’s going to pan out, nor what our safest option really is. Little research has been conducted on the subject so we’re grasping in the dark really, trusting our gut – well, our doctors gut really – and she herself is trusting little more than that too because MTHFR isn’t all that common in practise. I really don’t want to be induced again. I really, really don’t want another c-section. At the same time, if either of those is necessary once my baby’s been in gestation 40 weeks, either would be innumerably preferable to premature labour/birth, the other risk from Factor V Leiden/MTHFR.
If anyone else has experienced pregnancy with either of these conditions, or has any advice re. VBAC, I’d love to hear it.