While Callahan has a clotting disorder and not a bleeding disorder, a study in Haemophilia in 2023 revealed that in more than half of cases of delivery or postpartum hemorrhaging, a woman’s bleeding disorder wasn’t diagnosed prior to pregnancy.
When you have an inheritable blood or bleeding disorder, you have an elevated risk of bleeding complications during labor, delivery, and postpartum, says Jerome J. Federspiel, M.D., a maternal-fetal medicine physician at Duke University.
Federspiel and other experts recommend these four tips:
1. Make a Birth Plan with Your Team
Different bleeding disorders require different care plans tailored to your needs. “When a patient presents, even prematurely, the team on call already has a well-thought-out plan for your care. That kind of advance planning makes a huge difference,” Federspiel says.
“I had very detailed birth plans in place before giving birth to both of my children, and had several meetings with adult and pediatric hematology teams,” says Elaine Lai, of San Francisco, who has mild factor VIII deficiency.
2. Go to a Tertiary Center
The safest care is often delivered in a place that combines expertise in both high-risk pregnancy and hematology. Your team should consist of an obstetrician, an anesthesiologist, adult and pediatric hematologists, a pharmacist, and a maternal-fetal medicine specialist. “I respect the relationship that the woman has developed with her regular obstetrician, but I want them to understand that the delivery and immediate postpartum care are very important and might be lifesaving for the mom as well as the infant,” says hematologist Maissaa Janbain, M.D., director of the Louisiana Center for Bleeding and Clotting Disorders.
3. Get Your Factor Levels Checked
Knowing your baseline factor level will help the team know what type of replacement therapy you will need during labor and delivery, and especially in the postpartum period. That therapy in turn will make it more likely that you can safely be given an epidural.
Janbain says close monitoring of factor levels after delivery is important to prevent bleeding and other complications. “My birth plan specified that my factor levels would be checked at 24 and 36 hours after giving birth,” Lai says.
4. Expect Postpartum Follow-Up
Women with bleeding disorders are more likely to experience postpartum bleeding problems than those without such conditions. Because of that, your team should follow you for at least a few weeks postpartum.
Watch NBDF’s Collaborative Learning Exchange training for clinicians on this topic.