In a nutshell, turns out the bigger worry is the fact that I had a placental abruption, not the presence of lupus anticoagulant antibodies in my blood the day after. An "official" diagnosis of lupus anticoagulant disorder requires two positive tests six weeks apart, but nobody re-tested my blood in that time frame. It's also possible that these antibodies can show up in blood after a trauma--an abruption, for example. Without that "missing piece of the puzzle," as the doctor told us, it's impossible to say whether I actually do have this clotting problem. Certainly, it can cause an abruption, but that doesn't mean it did. Sometimes abruptions happen for no perceivable reason. The fact that I haven't had a positive test since tends to lend support to the idea that I don't have this clotting disorder. But. We don't know for sure, because of that missing six-week test.
He sent me for more lab work. If it comes up positive for lupus anticoagulant, the course is clear: a regimen of heparin and baby aspirin if we decide to get pregnant. The dose of heparin is calibrated to ensure that it's still safe to get an epidural or have a c-section, if necessary, although the plan is to stop the heparin 24 hours before a scheduled c-section or at 37 weeks or so. (My preference would be for another natural childbirth, like I had the first time, but I realize having one c-section and an abruption would tend to make OBs want to perform another c-section. But I tell you, NOTHING in either birth was as bad as that god-awful spinal epidural, not even the contractions during the abruption. THAT'S how much I hated that needle.)
He thinks, though, that the lab work will most likely not show the lupus anticoagulant or any other factors that can lead to excessive clotting, which, of course, makes things far more difficult. Theoretically I could take the heparin anyway (oh, did I mention it's an injection? more needles...), but I've had an abruption, which, although caused by a clot, is a bleeding event, and blood thinners + bleeding event = very bad things. Most likely if we decide to try for a third and no clotting issues show up, I'd take a daily dose of baby aspirin and we'd test my blood monthly.
So. I was thinking the clotting thing was the big problem, but it's not. It's actually quite manageable if you know about it beforehand (AND if you were tested correctly to begin with...sigh). The problem is the abruption. Having one puts me at risk for another, and there's no warning for an abruption--once you have signs, it's already begun. I didn't even present with signs of an abruption the first time, just contractions. Of course, having one abruption doesn't mean I'd definitely have another, either. Nicholas was born at 34 weeks, but an abruption can happen at any time, and if the baby isn't viable...or isn't delivered in time...
On the other hand, this doctor didn't see any reason not to have a third child. Each pregnancy is, essentially, different. I've had one completely normal, full-term, uncomplicated pregnancy resulting in an uneventful (and relatively quick) labor and delivery. And then I've had my own little episode of ER. Basically what I heard was that this gestational history of mine, while including some scary events, doesn't mean any of those events will repeat.
Now I guess we're back to having long, protracted discussions on whether we should have another baby. I have a follow-up in mid-July, to hear what today's blood test revealed. I left the office feeling that getting pregnant would not be a dangerous, foolhardy event. And that's kind of where we're at. Nowhere at all, but with a little more information.
Afterwards, we went out to lunch and to the zoo. This is Nicholas on the way home, the boy who hasn't napped in almost two years unless he was sick--tuckered out by all the recent birthday fun. Happy Birthday, buddy.














































