My OB appointment went well, she decided to wait until next week to do the internal check and swab. Baby B has it's head to my right now, rather than left, but is still transverse up top. Baby A is still breech on the right. We only have 3 more OB appointments before our scheduled c-section, assuming we make it that far.
I did discuss some concerns with her and went over the risks with staying on Lovenox. Lovenox is great if you need it, really it is, but it doesn't come without risk. One of the obvious risks is hemorrhaging. One of the less known is the risk of becoming paralyzed from a spinal hematoma in the event that you need to deliver with a spinal/epidural before it's out of your system.
Basically that won't be an issue if we make it to our scheduled c-section. I would just skip my dose the night before, and my system should be clear for a spinal. The issue comes from spontaneous labor, which is a real possibility since I'm carrying twins and my c-section isn't scheduled until 38w4d (average delivery for twins is 35w, most happen before 37w). If I go into labor spontaneously the hospital will have to look at when my last dose was; Lovenox can last up to 24 hours in the system but it might be safe after 12 hours for me since my dose is low/preventative. They'll then have to do blood work to check if it's safe or not. If it's been long enough, or blood work shows it's safe, then I can have the spinal and that's alright. If it's NOT though, I will need to have my c-section under general anesthesia. Which means that neither A or myself will be "present" or "awake" for the birth of the twins.
Last time we switched to Heparin later on, since it can be reversed and doesn't last as long in the system. Lovenox is once a day, while Heparin is twice a day (since Lovenox lasts 24hrs, Heparin lasts 12hrs). This time my OB and MFM would rather keep me on Lovenox. Lovenox is safer in pregnancy since it's low molecular weight, so it stays more stable in the body. Heparin is safer for delivery though. My OB did say they could switch me to Heparin if I wanted, but we opted to just stay on the Lovenox since it's safer overall (not to mention I am running out of non-bruised places to inject as it is). I just have concerns about it and worry about delivery. I'm trying to wrap my head around the possibility of having to deliver under general anesthesia- I know that there's a chance that may not happen, but I'd rather mentally prepare just in case. It's really hit or miss how things will go down.