Comments on Conversion Diary: Coumadin, clotting disorders and contraception -- ...

Joe,The issue is not that the lifesaving medicatio...

2007-08-15T16:26:25.467-05:00

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.

Have you ever heard of the Catholic principle of d...

2007-08-15T12:28:06.737-05:00

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.

Anonymous, I don't know if your comment was direct...

2007-08-15T11:18:45.090-05:00

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.

Jennifer F. -- it's not disproportionately harsh a...

2007-08-15T10:05:36.301-05:00

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.

The nonsense I see presented as Church teaching by...

2007-08-15T09:17:32.022-05:00

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.

Not breastfeeding for any reason is not a sin, and...

2007-08-15T09:06:29.601-05:00

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.

If you are saying, "I would love to breastfeed, bu...

2007-08-15T08:13:29.413-05:00

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.

Jen,I loved breastfeeding and nursed all of my bab...

2007-08-15T00:08:13.212-05:00

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!)

Just a short while after reading this blog entry, ...

2007-08-14T22:40:29.687-05:00

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

Calm down and stop reading so much into a simple c...

2007-08-14T21:42:56.364-05:00

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.

Just don't call me late for the Lord's Supper. I l...

2007-08-14T20:56:07.230-05:00

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.

Jen,I'm really hoping for option #6. And even tho...

2007-08-14T20:52:05.158-05:00

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.

Because we are in a similar boat, Jen, if I fall p...

2007-08-14T20:07:15.181-05:00

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.

Jen, I'm glad you're going to dig into your medica...

2007-08-14T19:19:13.504-05:00

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

Someone said, "doesn't the Church make exceptions?...

2007-08-14T17:47:09.686-05:00

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.

What I think is interesting in this comment stream...

2007-08-14T17:21:31.560-05:00

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

Wow, 'my name is simcha'....wow. Calm down and sto...

2007-08-14T17:03:35.771-05:00

Wow, 'my name is simcha'....wow.

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

Bunch of good thoughts here! I don't think I'll be...

2007-08-14T15:32:10.535-05:00

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!

Nutritionally, there are baby formulas that are as...

2007-08-14T15:09:57.705-05:00

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)

#7 find a catholic doctor It is SO frustrating th...

2007-08-14T14:44:08.664-05:00

#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...

I am with MrsDarwin and Michelle (and a few other...

2007-08-14T14:22:30.572-05:00

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.

I'll ditto the rest of the folks who said start wi...

2007-08-14T14:12:47.336-05:00

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.

If you look more into the Creighton Model, also ch...

2007-08-14T14:01:05.669-05:00

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.

I think I would start with 4 and switch to 3 at so...

2007-08-14T13:36:59.810-05:00

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.

I don't have specific advice, just a little empath...

2007-08-14T11:42:58.910-05:00

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,