Coumadin, clotting disorders and contraception — oh my!

I saw my hematologist last week and he reminded me of something that I can’t believe I’d forgotten about: that the whole Coumadin issue is going to be on the table again as soon as the baby’s born.

For those of you who missed the fun last time (some highlights here and here), just a few weeks after I came to agree with Catholic teaching on birth control I developed a blood clot whose treatment requires a medicine that is completely incompatible with getting pregnant — if you conceive while you’re on it it is very likely that the child would have severe birth defects, if it lived at all. It’s so urgent to prevent pregnancy while on this drug that many doctors counsel women to consider tubal ligation before they start on it. Not what you want to deal with when you’ve been trying to live by Church teaching for all of two weeks.

Anyhoo…it turns out that the clot was caused by a clotting disorder called Factor II (similar to the more common Factor V) which I miraculously inherited from both parents. The odds of that are about one in a zillion. It makes me wonder if my parents are telling me the real story behind how they met (“the truth is, Jen, we were at a family reunion…”). Especially that I have both copies of this gene, any kind of high estrogen state is risky and requires preventative blood thinners, hence the shots in the stomach every day during pregnancy.

What I had forgotten all about, however, is that breastfeeding also puts me in the risk category, and the shots I take now, while safe for pregnancy, are not safe for breastfeeding. Coumadin (also called Warfarin) is what I should take for while I’m breastfeeding…but Coumadin is incompatible with becoming pregnant.

So, I’m back to that dilemma where my options are:

  1. Breastfeed, take Coumadin, disregard Church teaching and use contraception;
  2. Breastfeed, take Coumadin, practice NFP very carefully;
  3. Don’t breastfeed, in which case I wouldn’t need Coumadin;
  4. Breastfeed, take Coumadin, and practice abstinence until weaning (which would probably mean weaning fairly early);
  5. Breastfeed, don’t take Coumadin, and accept the risk of a another DVT or pulmonary embolism (which are really dangerous, often fatal, and generally something you want to avoid);
  6. Pray that there’s some alternative I haven’t thought of!

After a lot of prayer and consideration, the first two are out.

I really would never consider the first option. Not only has Catholic teaching on birth control gone from something I accepted on a purely intellectual level to become a personal, heartfelt belief, but there’s also the very compelling point that was originally pointed out to me by commentors here on this site: no form of contraception is 100% effective. You can’t count on anything but abstinence to completely avoid pregnancy — and at least with NFP it’s likely that you’d be aware of a pregnancy sooner and therefore could discontinue the medication immediately and mitigate the damage. So it’s not like using contraception is the perfect, worry-free answer while taking an FDA Category X drug.

And after a lot of prayer and thinking I decided that option #2 is just not worth the risk. Even if I practiced NFP conservatively and the risk were small, the prospect of conceiving a child who would be severely harmed by a drug I was taking that I knew full well caused birth defects is just not something I can have on the table. It’s not worth taking even a slight chance.

That leaves me with options 3-6, and a lot to think about. Frankly, I’m really holding out hope for #6. icon smile Coumadin, clotting disorders and contraception — oh my!

So why am I writing a post about all this?

First of all, my commentors are always so full of good advice that I thought it would be interesting to hear what others have to say.

But the main reason I write this post is just to get it out there in case my story is helpful to anyone else. I’ve intentionally written it in a Google-friendly way and welcome emails from anyone else who faces a similar dilemma, even if you’re reading this months or years after I originally wrote it. Back when I first faced this issue one of the most difficult parts of it was the lack of support and resources that were compatible with Catholic teaching.

So anyway, I have a lot to think about in these coming weeks. Although, with my new philosophy on worrying, I’m probably not going to think about it all that much. I’m going to pray for guidance and just see how I feel about it after the baby arrives, and trust that God will clearly lead me down the right path. Everything that happened last time only brought me closer to God and deepened my faith, so I believe that the only thing I really have to do is prayerfully seek God’s will, and trust.

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Enter the Conversation...

57 Responses to “Coumadin, clotting disorders and contraception — oh my!”
  1. Rebecca says:

    Have you talked with your priest? I’d be curious what counsel you would receive.

  2. Erica says:

    (Long-time lurker, first time commentor)

    In addition to talking to your priest, have you considered talking to an NFP teacher or someone at the Couple to Couple League? I’m guessing that someone at the CCL headquarters has helped another couple deal with this.

  3. Anonymous says:

    It seems like #3 would have to be the best option (or maybe #6 but I can’t help there). I realize it would be a difficult decision, but it’s the least risky. One might argue that the bonding that occurs during breastfeeding can’t be replaced, but the love of a Christian mother is stronger than any natural bond. Nutritionally, there are baby formulas that are as good for (or better for) your baby as breast milk.

    In the end, it comes down to a sacrifice, but then, sometimes that’s what being Christian is all about.

    Just my 2 cents.

  4. Peony Moss says:

    #6 (prayer) of course :) And since you have decided not to go with option #2, #4 (BF/ abstinence until weaning) seems like the most prudent decision. Even a few weeks of bf’ing is a few weeks of bf’ing’s extra benefits.

    I would also contact the La Leche League and see if they can help you. There is a book called Medication and Mother’s Milk that has very detailed, up-to-date info.

    Praying for you.

  5. mrsdarwin says:

    Well, you’re supposed to abstain for a few weeks after the baby is born anyway, so #4 will work for the first few weeks. Personally, after that I’d go with #3. I’d consider the clotting issue a pretty serious medical condition, and it seems like going to formula and skipping the coumadin would put the least stress on your family life.

    Though, don’t forget that as soon as you go to bottle feeding you’re supposed to assume that you’re in phase 2 and abstain until your cycle returns. Catch-22 there… But if you wean thoroughly, it will probably return fairly soon.

    I’d do #6 as well.

  6. Peter says:

    This is a tough one. I will add you to my prayers.

    I will pray especially for your husband. God bless him.

  7. Sarah says:

    Jen,

    I’d have to go back and find my stats, but I believe that a baby receives something like 50% of the benefit of breastfeeding in the first six weeks. This being the case, if I were you, I’d just breastfeed for the amount of time I would normally abstain from sex (and then maybe add on a couple more weeks just so I could breastfeed a little longer). What does your Hubby think?

  8. alicia says:

    Breastfeeding amenorrhea (ecological breastfeeding) can be as effective at preventing ovulation as oral contraceptives. BUT – it does require fairly continuous access to the breast and the return of fertility is variable. I would counsel to take a REALLY COMPREHENSIVE nfp course from a teacher experienced in critically important need to avoid pregnancy. As much as I love the CCL folks, not all teachers are created equal, and many moms find that breastfeeding is an area where they need one on one teaching such as is done in Creighton Model NFP. You could also email the folks at Marquette who have a program using the ovulation predictor kits to help with confusing fertility signs such as during breastfeeding and menopause.
    email me privately if you want some names and contact info.

  9. Mary Nappi says:

    I agree with breastfeed as long as you would normally abstain and then switch to the bottle. I only breastfeed for the first two weeks, and then developed horrible post partum depression, had to be put on strong meds, and therefore had to switch the baby to a bottle. She and I have a strong wonderful bond, she has been amazingly healthy, and she is advanced for her age (she took her first steps and said her first word at 9 months). Of course, praying is important too …

  10. Anonymous says:

    Jen,

    I assume you have interrogated your doctor as to whether there is any other medicine you could possibly take. Ask him what would he recommend if you developed an allergy to Coumadin.

    If there’s another medication that isn’t the first choice of treatment for this clotting disorder (because of a greater risk of side effects, or whatever) … it might be worth trying it out so that you might be able to breastfeed your baby longer. (Weighing the reason why it wasn’t the first choice, of course.)

    Also, what’s in the shots you’re getting now? Generally, medications injected during pregnancy are going to reach the baby in far greater concentrations than that same medication excreted in breastmilk. Have you looked up this drug in “Medications and Mothers’ Milk”? This is an excellent book that every nursing mother should get her hands on, if at all possible.

    Those are the two steps that I would take first. (Searching for a #6 …)

    Blessings to you and all your babies,

    T. Frances

  11. James H says:

    BY the way here is another interesting yet pretty bad ethical and moral quandry over using birth control this Catholic blogger is having to think about

    http://et-tu.blogspot.com/2007/08/coumadin-clotting-disorders-and.html

    Not to ass too that post you are writing on this subject :) but boy do I feel for that lady.

  12. James H says:

    oops I was asking a blogger some thoughts on your situation so to assit you. She is a devout Catholic blogger that is a doctor. Didnt mean to post it here. Too many tabs open.

    Disregard the above

  13. Emily (Laundry and Lullabies) says:

    Jen, does the Church make ANY exceptions for medical need? Because this really seems to be a situation where contraception makes the most sense. It is the only option that isn’t hurting someone.

    Also, I’d STRONGLY advise against using NFP while breastfeeding. It doesn’t work. (Not even Creighton or Marquette, which I was using.) My husband and I really put our marriage through a rough five months in the attempt (mostly abstinent), and I got pregnant anyway after five months, EXACTLY how quickly I got pregnant after my first son when we weren’t using anything at all.

    Just FYI.

  14. Matthew S says:

    Just a thought:
    1) ecological breastfeed for the first 6 months and have a pregnancy rate of 1% with no fertility awareness. You could utilize patch rules and make daily mucus observations after week 8 post-partum.

    2) upon return of fertility, practice nfp under the conditions of (using a sympto-thermal method to confirm ovulation) having relations only during phase 3 and adding 1 day to the most conservative phase 3 interpretation.

    Under the Mercy,
    Matthew S

  15. Anonymous says:

    If it were me, I would breastfeed and abstain for as long as possible (even if it’s only 6 weeks), and then stop breastfeeding

  16. Michelle says:

    While #6 would be nice, you have to make practical plans.

    I think you can rule out #5. You can not risk your own life to breastfeed your child. Yes, risk your life to bring your child out of the womb safely (for example, if you had cancer), but not simply to feed your child when there are other ways to accomplish that.

    I am very pro-breastfeeding (having breastfed 5 children), but I do not think that breastfeeding is a moral thing. Yes, it’s the best thing for you and your child, in most circumstances. Obviously, your circumstances are not normal.

    Basically, it boils down to this: your relationship with your child or your relationship with your husband.

    You can have a wonderful relationship with your child whether you breastfeed or bottlefeed.

    Abstinence for a long period of time is not a recommended way to have a wonderful relationship with your husband.

    Every “body” is different. I did not regain fertility while exclusively breastfeeding my children for over 6 months after their birth. But I know a lactation consultant (who ought to know what she’s doing) who regained her fertility within one month of giving birth. That would be a rare case, though.

    I would breastfeed until my fertility returned, but I am experienced in knowing the signs. If you are concerned about recognizing the return of your fertility, seek the council of good NFP instructors. If you still fear missing the signs (you know your body best), then you and your husband need to decide how long you think abstaining is right.

    I don’t know about the “50% of the benefits of breasfeeding are given in the first 6 weeks” thing. Sounds to me like words designed to comfort moms returning to work.

  17. Christine the Soccer Mom says:

    Jen,

    I’m glad someone mentioned that the “no fertility for six months” is an estimate. I have a good friend who has a history of difficulty getting pregnant who was found to be six weeks pregnant before her baby was six months old. (Healthy baby boy, by the way.)

    As far as not breastfeeding, I have to say that it is completely possible to bond over formula. Seriously. I did it pretty well with my two because I had such a REALLY hard time. And Michelle is right: breastfeeding is not a moral issue. You are not required to do so, especially if it’s putting your life and your marriage at risk. (Abstaining for so long could make things very rocky!)

    Anyway, as the mother of two beautiful, intelligent, happy girls who were not breastfed (except for three excruciating days with Big Girl when I wasn’t sure she was getting anything at all), I can say that the bottle of formula is not dangerous to your child or to your soul. ;)

    I’ll keep you in my prayers even after bambino #3 is here.

  18. Dymphna says:

    Don’t breastfeed. It’s not a crime. I and just about everyone born in the late 60s were bottle babies and lo and behold we survived. A baby really doesn’t care where the milk comes from as long as it keeps on coming.

  19. Sarahndipity says:

    If I were you I would probably go with #3, or maybe breastfeed for as long as you’re supposed to abstain anyway and then switch to formula.

    I’m a huge fan of breastfeeding and I breastfed my daughter for over 2 years, but even I think the breastfeeding advocates go a bit far sometimes. I think mothers should breastfeed in most situations, but I think this situation counts as sufficiently serious reason not to breastfeed. I agree with Mrs. Darwin that #3 would probably be the least stressful.

    But of course, only you know what’s best for your family and your marriage. I would pray about it and pray with your husband about it. Good luck, I’ll be praying for you!

  20. Anonymous says:

    could you take baby aspirin, and they could do the clotting time tests? it could very well be enough, and then there’s no conundrum. ;-)

  21. Elena says:

    I wonder if #4 would be that difficult anway Jen. Remember how tired everyone is with a new baby in the house? I seem to recall that for a period of months after birth if either my husband or myself have to choose between sleep or sex, sleep was going to win – hands down!

    Then after everyone is healed and settled into a new routine, you could start the NFP again.

    Good job thinking this through. It is wonderful to see you work through these problems logically and with reason.

  22. Anonymous says:

    I am a die-hard breastfeeder, and I know how the little ones hate to be weaned before they are ready.

    That said, #3 seemed to be the no-brainer in this situation.

    Baby may not be happy, but at least there is no medical side effects to lots of cuddling!

    Whimsy

  23. Renee says:

    I would bottlefeed or practice abstinence until weaning. With my second I was breastfeeding only twice or three times a day, because I went straight back to work, I was always showing signs of potential fertility for about four months after birth. We abstained.

  24. Anonymous says:

    and it is interesting how contraception has attained a god-like status as the answer to all problems.

    whimsy

  25. Anonymous says:

    Option 1 — a personal choice, which is fine.

    Option 2 — foolish, risky and unnecessary.

    Option 3 — sensible.

    Option 4 — sensible.

    Option 5 — what, are you on crack…?? Why would you needlessly risk your life? To get a gold star from the “lactivist” crowd? For crying out loud, breastfeeding is merely one factor in overall good health, and by the time you get to be my age and see all these kids grown up, you’ll realize there are as many dumbass, overweight, unhealthy breastfed kids as there are bottle-fed ones. In spite of what the boobnazi crowd will tell you, breastmilk is not a magical formual that guarantees perfect kids, and I’ve got the dumbass, overweight, unhealthy nephews and nieces to prove it. Breastfed for YEARS, each one, and turned out as dull as ditchwater, plotzy, pimply and pudgy, and their mother was a walking La Leche League nightmare. God certainly does have a sense of humor.

    Option 6 — pie in the sky thinking, and a waste of time.

    That leaves options 3 & 4, both of which are sensible, rational, and doable. Which of these will work best for you is really between your husband and yourself. You know yourselves better than anyone, so how long abstaining will be a good option without putting undue stress on yourselves is something only you can decide.

    So, it’s not so many real options as you think. It’s just two fairly similar options, both of which don’t seem all that difficult to stick to.

  26. Anonymous says:

    A lot of this commentary assumes you can switch back to your injections after you wean. It’s my understanding that these are prescribed for pregnant women only, and I think you’d have trouble explaining to the insurance company why they should pay for them indefinitely. “So I can have unprotected intercourse” is going to sound pretty weak. I am not sure that’s an option for you, so early weaning or not breastfeeding is probably not going to be helpful. It sounds like your only choice is to abstain until your cycles regulate, and then be very careful.

    What you might want to investigate more thoroughly is at what stage of pregnancy coumadin affects the fetus. It may be safe for you to take coumadin, practice NFP, and be very vigilant about the possibility of pregnancy, so you can go off the medication. (Again, this won’t work until your cycles regulate.)

  27. MY NAME IS SIMCHA. says:

    So, it’s not so many real options as you think. It’s just two fairly similar options, both of which don’t seem all that difficult to stick to.

    I shouldn’t speak for Jen, but I suspect that she plotted out her options so neatly to show that she has completely thought this out — not to present them as equally possible choices. (In a blog, there’s always someone ready to leap on you for being a sloppy thinker.)

    I do find it weird that you call the first option “a personal choice, which is fine” if you have read anything on this blog at all. It’s an awfully breezy way of dispensing with Jen’s arduously formed conscience!

    That word “choice” is magic, isn’t it? It’s a fine replacement for thought and prayer.

    And another thing: raise your hand if you breastfeed mostly to make your kids healthy, smart, and trim. Everyone I know who’s breastfed did it because it’s easy, natural, and pleasant. (Naturally, many people have found it to be difficult, unnatural, and unpleasant, and so they stop — my point is that it’s a rare mother who sticks with it solely for the health benefits.)

    Maybe your nephews and neices would benefit from a little friendly, loving attention from Aunt or Uncle Anonymous. Hint: calling them “dumbass, overweight, unhealthy . . dull as ditchwater, plotzy, pimply and pudgy” is not in the job description.

    Well, I don’t know why I’m looking for a fight today.

  28. tb says:

    I don’t have specific advice, just a little empathy. We are at 7.5 weeks post partum, exclusively bf-ing and have fertility signs, so we’re on at least 7.5 weeks of abstinence with no real end in sight. I think we’re doing okay – dh isn’t complaining yet, but I am praying for ovulation just so I can get back on track.

    If I were in your shoes, I’d think that abstince in the short term is very do-able.

    God Bless,

  29. Anonymous says:

    I think I would start with 4 and switch to 3 at some point between 6 weeks and 6 months after birth. If you start with 3, you burn your boats as far as bfing goes.

  30. Anonymous says:

    If you look more into the Creighton Model, also check out the OVACUE with a vaginal sensor. Around $300 but worth it. I believe that I read that the Ovacue is in league with church teaching.

  31. Rosebud says:

    I’ll ditto the rest of the folks who said start with #4 – at least during the medically advised abstinence – and switch to #3 when you and your husband decide that is the greater good for your family.

  32. SteveG says:

    I am with MrsDarwin and Michelle (and a few others).

    I say it as a huge breastfeeding advocate, but it really seems #3 is the best option here.

    I say it also as a husband who has had to deal with the requirements of heavy abstinence. It’s really hard on a marriage to go that route.

    Sometimes it’s the only choice, but in this case you seem to have another option.

  33. Jennifer says:

    #7 find a catholic doctor

    It is SO frustrating that you have a medical treatment team that refuses to think outside the box for you.

    There are plenty other alternatives. How about continuing lovenox until weaning? Stronger than baby aspirin safe for breastfeeding safe for pregnancy.

    You see doctors are drive by litigiphobia and they are not willing to recommend anything but the gold standard in treatment and remain inflexible on this point.

    If they are willing to put you on lovenox for pregnancy they, logically, should be willing to keep you on lovenox for breastfeeding.

    The other issue is this, while you say #2 is not an option, think about this–while on coumadin you need constant blood monitoring, right? In addition to using NFP and, perhaps, frequent at home pe tests, ask them to add a beta hcg to each coumadin level test.

    Detecting a pregnancy that early via blood test would mean that you would be able to stop coumadin before implantation had fully been established–the conceptus doesn’t even share your blood supply for some time into the early part of pregnancy.

    A doctor would be afraid to advise this because of potential lawsuits (baby birth defects are the most successful and expensive medical law suits out there) but this is a very reasonable option.

    The chance of you getting pregnant while practicing ecological breastfeeding is very low to begin with. Add that to practicing NFP. Add that to monitoring your urine at home.

    Add that to frequent blood checks and you are really playing it safe.

    Here you have all worlds and the gold standard treatment.

    Or, safer for potential baby and less hassle for you, apply for the silver or bronze standard and just stay on lovenox as if you were still pregnant until weaning.

    Or..

    it goes on.

    See if you can find a RC doctor—I know you probably have looked.

    I can’t find one either and I live in the Catholic capital of the country.

    Of course it is KENNEDY style Catholicism so…

  34. Literacy-chic says:

    Nutritionally, there are baby formulas that are as good for (or better for) your baby as breast milk. Ummmm… not better.

    I’d go with Mrs. D on this one–abstain until the 6-week check-up, or possibly later than that (since you will have–count ‘em–3 very young ‘uns!) ;) I face the same thing soon, except that the 10 year old is not that young. He’s catching on to the “when mom & dad take a nap” trick, though!–o.k. TMI. But I’m wondering how hard abstinence will really be for us (me) this time around. It didn’t get challenging until… ummm… we conceived again! (O.K.–at about 6-10 months things began returning to normal! Yes, again, TMI).

    But when intimacy becomes desirable and feasible (when exhaustion improves a bit), yes, I’d go with formula. I am a real breastfeeding advocate, but I would have to concede in this case that formula would nourish your baby, you could still bond, and that your medical condition must be considered.

    This really seems to be a situation where contraception makes the most sense
    Unless you consider the abortifacent properties of contraceptives and the unreliability already mentioned (and that whole moral thing) ;)

    Another thing to investigate are the Lady-Comp and Baby-Comp fertility monitors. They are perfectly compatible with Church teaching, relying on temps. Very pleasant and easy to use. But there is still that .7% chance of conception, so the most conservative rules of NFP would apply (only after the temperature rise that begins phase 3). Here’s the web site:

    http://ladycomp-babycomp.com/show.php/index

    Again, they’re pricey, but claim to be the only fertility monitor that can detect a return to fertility while breastfeeding. As long as you don’t chart yourself and second-guess the computer, like I did! ;)

    I have a Deacon friend who practiced NFP with his wife while she was fighting a medical condition that made it life-threatening to conceive. It requires a lot of discipline, and I’m not sure what I would have the strength for, personally. I could give you his email address if you would like… He’s also a convert and we have exchanged a lot of emails that you would have enjoyed! I will certianly be praying for you, but I have to say thank you for posting this and reminding me how much can really be at stake… (giving me a dose of humility)

  35. Jennifer F. says:

    Bunch of good thoughts here! I don’t think I’ll be able to remember all the points I want to address, but here are a few.

    Jennifer – I think you really hit the nail on the head. From my experience, my advice to other women in this situation would be to remember that options in these kinds of circumstances are very rarely as black and white as they seem (and as they are presented by doctors, who are very worried about litigation). You’ve GOT to do your own research with an open mind, and also be willing to have a backbone with your doctors (something I’m terrible about) and put your foot down and politely but firmly make it clear what you are and are not willing to do in terms of treatment.

    I also really like the idea of asking for a beta each time I get a Coumadin blood draw. Though I still think abstinence is the route I’d want to go, I think that’s a good option to have in my back pocket in case I’m ever in a situation where I truly have to be on Coumadin for an extended period.

    As for Lovenox and breastfeeding, two things: 1) the hematologist told me that it’s really bad for breastfeeding. I haven’t confirmed that on my own. Evidently it doesn’t cross the placenta during pregnancy but does get into breastmilk. I need to double-check that. 2) My insurance almost definitely wouldn’t cover it for more than one or two months postpartum and, as I’ve used this space to whine about many times, the out of pocket cost is more than $2,000/month.

    And I actually do think that some form of #5 may be worth investigating, especially if I chug Omega-3′s and take baby Aspirin (great suggestion — thanks to those who thought of that one). Per the above point about these things never being as black and white as they seem, the question is: what kind of risk of DVT/PE are we talking about if I were to breastfeed sans Coumadin for, say, another four months? 2%? 0.02%? That’s another thing that, oddly, is rarely discussed in these kinds of conversations with doctors. Throughout this process I’ve frequently been told statements like, “You can’t do XYZ because of the risk of a clot…” but it’s never been volunteered *what* the risk is. I always have to ask. And it frequently comes out that the risk is very small, like 0.05% or something.

    Anyway, thank you all for your comments!

  36. Anonymous says:

    Wow, ‘my name is simcha’….wow.

    Calm down and stop reading so much into a simple comment already. Jesus.

  37. Anonymous says:

    What I think is interesting in this comment stream are the assumptions underlying the choices. One assumption is that NFP is not going to be effective, so we’re just going to assume you’re going to get pregnant. IIRC (and correct me, Jen, if I’m wrong), you started using NFP *before* you took any classes about how to use it, and subsequently got pregnant. With correct use, NFP should be comparable to other bc methods.

    Another interesting assumption is that abstinence is too great a sacrifice to make in the interests of your child’s health. While it’s true that it is okay to formula feed, I am looking at what is behind the choice. If you are saying, “I would love to breastfeed, but I just can’t deal with abstinence while I’m on this breast-feeding safe medication,” how is that different from saying, “I’d love to abstain from sex until I’m married, but it’s just too difficult and it’s not realistic.” Your cross is your cross, right? You don’t get to pick it. Why hand it over to someone else if you can avoid it? Most babies are okay on formula, but a few of them have serious problems. So, ultimately, while I think there are many valid reasons to formula feed, sexual gratification seems kind of selfish.

    What I think the average woman would do is rely on her regular birth control, which would usually be the pill. I don’t know much about NFP, but I have been told that if used correctly, it is about as effective as the pill.

    Lastly, please don’t attempt option five. The risk is death, and it is much higher for you than for someone without your disorder. There is no sense in risking your life over this. I would much rather see you choose formula and protect your health so that you can raise the three babies you have.

    Ersza

  38. Tracy says:

    Someone said, “doesn’t the Church make exceptions?”

    This decision is being made by someone that wants to follow Church teaching, not simply bc it is Church teaching, but bc she consciously agrees with the Church about the use of birth control.
    (from what I have inferred by reading this blog)

    For me, even if a priest said, “Oh just use abc, it is medically necessary…” I still would not be able to do it in good conscious, bc I agree with why the Church teaches against it in the first place!

    I know prolonged abstinence is hard, but isn’t *it* medically necessary sometimes? In certain pregnancies or illnesses, abstinence needs to be maintained for really long times Can’t this situation be seen as similar?

    I would go with breastfeed for a bit and then bottle. Or straight to bottle even. For me, the desire to breastfeed just isn’t strong enought to outweigh the decision not to use abc (or to be abstinate for a really long time!)

    Jen, I’ll be keeping you and little one in my prayers.

  39. Anonymous says:

    Jen, I’m glad you’re going to dig into your medical options again. I will be praying that you find a good solution here.

    I highly recommend Dr. Mikeal Love, in Austin. He’s an outstanding doctor (and the only NFP-only OB/GYN that I know of in Central Texas). He’s affiliated with the Pope Paul VI Institute in Omaha.

    I’m certain that he will help you figure out just what your options are, and exactly what the risks are.

    T. Frances

  40. Jennifer says:

    Because we are in a similar boat, Jen, if I fall pregnant again, I looked into it and as far as I know lovenox does NOT pass into the breastmilk. Your hematologist may not understand this because he is not an obstetrician.

    I could be wrong or remembering incorrectly.

    Your insurance is covering lovenox for pregnancy but only two months post-partum?

    Hmm. Well certainly two months of breast-feeding is better than none. If you get some help you may even be able to pump a lot during that two months and get some stored and extend that by a month or two.

    You could also try raising hell with the insurance company about “religious discrimination”—those words are way scary for most big corporations.

    Yes, I think you’ve arrived at it. It is either abstinence or take a small risk in the name of openness to life.

    Scientists especially have this skipping record faith vs. reason, faith vs. reason, faith vs. reason—so they push things into that order of black and white too quickly and easily while remaining blind to the way they work together so very intimately.

    If they tell you its ONLY A or B—it never is. When someone tells you the answer is A or B and only A or B the answer is always Q. (Or something like that.)

    I’ll pray and let me know what you decide as I may end up in the same boat, though I think I’m sticking with fishoil, prescription bioactive B vitamins and baby aspirin.

    Call me reckless, call me arrogant, but don’t call me late for (the Lord’s) supper.

  41. Christine says:

    Jen,
    I’m really hoping for option #6. And even though you may have already found all of this info I thought I might be able to pass it on. Here is a link all about Factor II. http://circ.ahajournals.org/cgi/content/full/110/3/e15
    And the same doctor had a list of thrombophilia specialists. I don’t know if any are near you – but it might be worth it to give them a call.
    TX, Arlington, Charles Deur, 817-274-6532
    TX, Houston Area(?), Dr. Muntz- no number given
    TX, Houston, Miguel Escobar 713-500-8360

    The one doctor from the article Dr.Moll. He’s seems to be one of the leading experts in the field, even if most of his stuff is Factor V. He might even be able to suggest a few things if you e-mailed him.

    I have a slight thrombophilia which isn’t at all dangerous to me – just my unborn children. I hope one of these doctors can help you find an option 6. But take care of yourself and so you can be a great mother, whether or not you choose to breastfeed.

    Another option might be to call a place like Tepeyac which is an awesome Pro-life, cutting edge obgyn in Northern Virginia. They might be able to recommend something or know of someone where you live in Texas who can help.
    http://www.tepeyacfamilycenter.com/
    Even if they don’t know of anyone down there, I’m sure they deal with things like this all the time. They helped me with my thrombophilia.

    Sorry, this is kind of pulling straws out of the air, but I wanted to put some concrete suggestions out there, even if I’m repeating thoughts you’ve already had. You are in my prayers.

  42. Abigail says:

    Just don’t call me late for the Lord’s Supper. I love that one Jennifer!

    Jen, You will be in my prayers. Please don’t think that you are alone just because this is an uncommon medical issue. All of us Catholic mothers are struggling with the “culture of death” in the medical establishment and are trying to faithfully shoulder our respective crosses. (I’m personally struggling with doctors who hate to do multiple c-sections and sharing a positive Cystic Fibrosis gene with my husband.) There is an option “Q” for you which will become glaringly obvious through prayer with your husband.

  43. MY NAME IS SIMCHA. says:

    Calm down and stop reading so much into a simple comment already.

    Anon -
    You’re right — I apologize. I was upset about something else, and it came out while I was reading the comments.

    Now back to the topic at hand, to which, unfortunately, I have nothing to add.

  44. Anonymous says:

    Just a short while after reading this blog entry, I read that eating kiwis may help thin blood (they are also fantastically full of vitamin C!). On any other day, that info would seem completely random to me. Today it made me think of you. Could be completely useless in the grand scheme of things, but there you have it.

    God bless you as you struggle with this situation. Your faith that God will bring you through it is inspiring.

    – Bridget

  45. Catholic Bibliophagist says:

    Jen,

    I loved breastfeeding and nursed all of my babies, but I would say that, given your medical situation, bottle feeding would be the best option. Yes, breast milk is best, but my mom (who was unable to nurse) raised 8 healthy babies on formula.

    If you decide to breastfeed during the 6 weeks of post-partum abstinence, be sure you do some research beforehand on the best way to quit nursing in order to avoid discomfort and/or a possible breast clog or breast infection. (I had to suddenly stop nursing after 4 months — a very difficult process!)

  46. Sarahndipity says:

    If you are saying, “I would love to breastfeed, but I just can’t deal with abstinence while I’m on this breast-feeding safe medication,” how is that different from saying, “I’d love to abstain from sex until I’m married, but it’s just too difficult and it’s not realistic.”

    I don’t think the two are comparable. Premarital sex is a mortal sin; not breastfeeding is not a mortal sin, or at least hasn’t been officially declared as such by the Church. It may be a sin not to breastfeed without serious reason, but I think this situation definitely counts as a serious reason.

    I think what it comes down to is what effect prolonged abstinence would have on the marriage. If it would have a severe negative effect, then it would probably not be worth it to breastfeed. On the other hand, some couples may be able to handle prolonged abstinence quite well. Only Jen and her husband know what effect it would have on their marriage.

    BTW, I second whoever mentioned Tepeyac in Northern Virginia. I go there and they are AWESOME. If I were you, Jen, I would definitely check out that NFP Dr. in Austin. It’s entirely possible there’s another option no one has thought of. You’re very lucky there’s someone like that where you live. I feel incredibly blessed to have Tepeyac nearby.

  47. Anonymous says:

    Not breastfeeding for any reason is not a sin, and the Catholic Church has never even come close to suggesting such a thing in any official capacity whatsoever. To even hint that this might be the case is wrong.

    The nonsense I see presented as Church teaching by people who are not qualified to make such claims is just appalling.

    Jesus Christ did not die on the cross so various groups of people with their own personal agendas can run around claiming things are sinful, or that the Church considers them sinful, when there is zero basis for such a claim.

    Please don’t pass off personal opinion as either Christian theology or Catholic doctrine. It’s that sort of thing that does the Catholic Church more harm than anything else.

  48. Jennifer F. says:

    The nonsense I see presented as Church teaching by people who are not qualified to make such claims is just appalling.

    Anon – I think this response was disproportionately harsh. Please either log in with a blogger account or at least choose a screen name. It gets confusing to have heated discussions with anonymous commentors.

  49. Anonymous says:

    Jennifer F. — it’s not disproportionately harsh at all.

    To publicly assert that a woman who is bottlefeeding her child may be in a state of sin is as harsh as it gets, as well as being dead wrong.

    It is EXACTLY this kind of thing that hurts the Church the most. For all that the Catholic bloggers love to quote Sheed, they tend to have a rather large blind spot when it comes to asking themselves if they’re part of the problem he speaks of.

    It’s also a rotten, stupid thing to say on a comment thread in which a few women have already stated that they or their relatives didn’t breastfeed. It’s selfish and mean, frankly, as well as being an outright untruth.

  50. Sarahndipity says:

    Anonymous, I don’t know if your comment was directed at me, but I want to reiterate that I specifically said that not breastfeeding is NOT a mortal sin, that the Church has NOT said that not breastfeeding is sinful, and that I’m almost positive that Jen would NOT be sinning if she chose not to breastfeed.

    I simply said that not breastfeeding may be sinful in some situations. Definitely not in this one. And that’s just my opinion/speculation anyway, not Church teaching.

  51. Joe Magarac says:

    Have you ever heard of the Catholic principle of double effect? It means that if X has good and bad outcomes, and you do X because you only want the good outcome, then you have not sinned. In this case, I think that even a completely orthodox Catholic theologian would tell you that taking medication which could be life-saving good is legitimate even though it prevents conception (bad), so long as your goal in taking it is not to contracept.

    I applaud your zeal to do the right thing, and pray that your questions will be answered. But I don’t think you need to make the perfect the enemy of the good.

  52. Kate says:

    Joe,

    The issue is not that the lifesaving medication contracepts. The issue is that the life-saving medication causes birth defects. The question then becomes, how can Jen reduce the risk of conceiving and injuring a baby while on this medication. She’d rather not take that risk at all, and I can’t blame her for it. I suggest rereading the post and the reasoning behind each option again before commenting.

  53. MindyRiddle says:

    It’s great that we are able to receive the loan and that opens completely new possibilities.

  54. Char H. says:

    New to your blog so not sure if this has been discussed, but have you looked into Nattokinase for your DVT?

  55. Jaime says:

    Just wondering why your hematologist insits on coumadin for the duration of breastfeeding? Mine only considered 6 weeks postpartum to be the risk-time (and she showed me the literature). I’m confused about breastfeeding serving as a clotting factor (and we know you need two to be at risk for the clot). Glad your doc knows coumadin is tested for breastfeeding women while Lovenox (or fragmin) has not been–props there!

    I have breastfed three children to 14, 18, and 21 months while homozygous for a clotting disorder, too. My hematologist was a clotting disorder/coagulation specialist, and didn’t feel any concern with nursing being a clotting factor. Wonder how this worked out for you?
    Jaime recently posted..This Side of Thirty

  56. Diane says:

    Dilemna :)
    First kid i did breastfeed. Second i decided not to do. Best choice ever!
    Diane recently posted..Ma pilule Méliane

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