What People With a History of Blood Clots Should Know About Pregnancy
Pregnancy certainly isn't all butterflies and glowing skin, but you wouldn't necessarily expect it to come with something like life-threatening blood clots. However, Serena Williams developed some scary complications involving clots after giving birth. In her new five-part HBO docuseries Being Serena, Williams reveals more details about the events leading up to those complications, including the moment she gave birth via emergency C-section.
"The C-section was low on our wishlist because of her history of blood clots," Williams’s husband, Alexis Ohanian, says in the first episode. "Any surgery that Serena has is potentially life-threatening." She previously had a pulmonary embolism in 2011, meaning a blood clot had made its way to her lungs. But at the end of the first episode, we learn that Williams eventually had to have a C-section for her safety and the safety of her baby.
As SELF reported previously, Williams developed a pulmonary embolism after her C-section surgery. "I just remember getting up and I couldn't breathe, I couldn't take a deep breath," Williams says in the second episode.
Williams’s embolism was discovered and successfully treated. But she reveals in the second episode that she developed other blood clots, including one in her leg. She ended up needing another surgery to place a temporary filter that blocked blood clots from reaching her heart.
Some people are more prone to developing blood clots than others.
People are at a higher risk for developing blood clots after surgery because they usually can’t move around a lot, which means their blood isn't flowing as easily. If you have a history of blood clots like Williams does, you’re at a higher-than-average risk for getting them again, especially after surgery.
It’s possible to get a blood clot without a personal or family history of them, but there are many diseases, disorders, and conditions that make it more likely that you'll develop them at some point, Richard Becker, M.D., director of the University of Cincinnati Heart, Lung and Vascular Institute, tells SELF.
The list includes the following conditions, according to the Mayo Clinic:
- Antiphospholipid syndrome (when your immune system attacks some of the normal proteins in your blood)
- Arteriosclerosis/atherosclerosis (when blood vessels that carry oxygen and nutrients from your heart to the rest of your body become thick and stiff)
- Factor V Leiden (a mutation of one of the clotting factors in the blood called factor V)
- Arrhythmias (a problem with your heart rhythm)
- Peripheral artery disease (a common circulatory problem where narrowed arteries reduce blood flow to your limbs)
- Polycythemia vera (a slow-growing blood cancer)
Taking hormonal birth control pills, smoking, being pregnant, having surgery, and prolonged sitting or bed rest can also increase your risk, the Mayo Clinic says.
If you have a history of blood clots or at a high risk for developing them and you’re pregnant or planning to become pregnant, it’s important to let your doctor know.
Given that pregnancy is already a risk for developing blood clots, having a personal history of blood clots is definitely concerning, Jennifer Haythe, M.D., assistant professor of medicine and codirector of the Women's Center for Cardiovascular Health at Columbia University Medical Center, tells SELF.
You may need to go on a blood thinning medication (such as heparin) during your pregnancy, George Welch, M.D., a cardiologist at Manhattan Cardiology and NYU Langone Medical Center, tells SELF. This may be the case even if you were not on a blood thinner before you got pregnant, Dr. Becker notes.
It’s important that you’re closely monitored by an experienced doctor or team of care providers during your pregnancy to look for signs you might be developing a clot, Dr. Becker says. It’s also crucial that you know the signs yourself, like swelling, tenderness, or redness in your leg or calf, shortness of breath, and a fast heart rate, Dr. Haythe says.
Your doctor’s approach to your labor, delivery, and postpartum period may be slightly different from what other pregnant people experience if you are at a high risk for blood clots.
During delivery, your doctor won’t want you to be on a blood thinner or anticoagulant (a medication that prevents your blood from clotting) because they can cause you to lose extra blood, Jessica Shepherd, M.D., an ob/gyn at Baylor University Medical Center at Dallas, tells SELF. “It can be very tricky,” she says.
If you’re on a blood thinner or anticoagulant, your doctor will want you to stop taking them when you go into labor or between 12 to 24 hours before you’re induced, Dr. Shepherd explains. And, unfortunately, it's not recommended to have an epidural if you're on an anticoagulant because it can cause severe bleeding in the spinal region, she adds. After you give birth, you’ll be monitored closely for blood clots and put back on your medication anywhere from 12 to 24 hours after you deliver your baby.
So, all of this requires a fair amount of planning beforehand to make sure you get the care you need and to formulate an effective pain management plan.
If doctors do actually find a blood clot in your leg (where many blood clots originate), they may place a filter, as in Williams's case, in your inferior vena cava (a large vein that carries deoxygenated blood into your heart) to prevent it from traveling to your lung, Dr. Haythe says. Generally, this is used when your risk for a pulmonary embolism is high and blood thinners can’t be used or haven’t been effective, Dr. Becker says. But the filter is temporary; it can be taken out anywhere from 6 to 12 weeks after it is put in, once your risk of clotting is lower or you can safely use blood thinning medication again, he says.
Williams’s story is scary, but you don’t have to assume that you’ll experience the same thing—even if you do have a history of blood clots. Communicating with your doctor early on will help ensure that you have a safe and healthy delivery.
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