Some women like me, know before they ever get pregnant they will have to be on anticoagulation (blood thinning) therapy, like Lovenox injections during pregnancy. Others have never heard of it and can be scared when they think about having to give themselves injections every day. Lovenox can be prescribed for a variety of reasons. For me, it was a history of a DVT, deep vein thrombosis (blood clot) in my leg. My DVT was a postoperative complication of my spinal fusion surgery, but once you have had a clot, you are at risk to have another. So for me, that meant 546 injections in my stomach over 39 weeks to get my baby here as safely as possible. Factor V Leiden thrombophilia in pregnancy and history of some pregnancy losses or fertility treatments are also reasons a woman might be put on anticoagulation like Lovenox. Pregnancy increases a woman’s risk of blood clots and they can be detrimental if they travel to her heart, her brain, the baby’s placenta or the umbilical cord. Although it can be intimidating, if your obstetrician or midwife prescribes Lovenox or anticoagulation therapy, it is because the risk of a clot outweighs the risk of the medication in your pregnancy.
Lovenox is usually injected by the woman, twice daily under the skin of her abdomen. As you can imagine, this gets a little tricky as her belly grows, but the needle cannot reach the baby and it gets easier with practice. Because it is a blood thinner, bruising at the injection site is common, so switching sides every other time is helpful to some women. There can also be a little bit of pain or a quick sting at the site, so some doctors recommend numbing the area with ice beforehand or using a cold spray. You might need to inject the medicine quicker or slower, based on what is the most comfortable for you.
Being on Lovenox injections during pregnancy can mean a few adjustments for labor plans and the birth of your baby. Usually women on Lovenox (low-molecular-weight heparin) are switched to Heparin (unfractionated heparin), a blood thinner with a shorter half-life, to prepare for labor. It is recommended that spinal anesthesia or epidurals not be used until a certain amount of hours have passed since the last dose of anticoagulation medication, to avoid spinal bleeding. Since, the time needed to wait is shorter on Heparin, women are usually switched to Heparin at around 36 weeks in pregnancy. All anticoagulation is stopped in labor in anticipation of delivery and can be resumed after delivery or 12-24 hours after an epidural is removed. Women who are on Lovenox injections during pregnancy, are usually kept on them for 6-8 weeks postpartum to avoid postpartum clotting or DVT.
There are so many sacrifices you make for your baby during pregnancy, and for some women that looks like a belly covered in tiny bruises and an extra dose of self-care after each stick. If you’re wading through syringes and blood thinners to keep you and your baby safe, know that it will all be worth it so soon.