C-Sections have become common now more than they have ever before. And there is a lot of controversy surrounding the benefits, risks, etc. Why women should or should not be able to choose C-section over natural birth, whether there is a certain number of C-sections a woman can have, whether or not a V-Bac is safe or risky and so on. I’m not here to talk about my opinion on any of those matters. I’m here to tell you about one of the risks associated with repeat c-sections, and why every woman should know about it. And hopefully in doing so, I can help share with you the importance of pre-natal care, and offer support to those that have endured pregnancy and delivery with this complication, or who may now be facing this complication.
Our first baby, born in 2003, was an unplanned emergency c-section. It was absolutely necessary for the situation, and I am very thankful for it. That being said, had I known the risks of c-sections, I likely would have been more firm in wanting to have my other children via VBAC. Our hospital at the time had a policy: “once a c-section always a c-section” and that was just the way it was. I didn’t know I could argue against it. So, in 2004,’06,’08,’10 and 2012 I had babies, all via cesarean.
With number 5 we learned of the risk of something called Placenta Accreta (my risk for it was 67%!). Fortunately we did not encounter it, but because of previous sections and the way my body likes to go into labor early he was born at 35 weeks. Very healthy, but early still.
We had thought about one more, and knowing the risk at this point, decided it was best to look at adoption or fostering if we were going to grow our family anymore.
We had JUST finished training and getting licensed as foster/adoptive parents when we surprisingly found out we were expecting. From the VERY beginning of this pregnancy everything was different. I had excessive bleeding on 3 separate occasions and thought we were losing a baby all three times. The first was right around when we found out we were pregnant, the second was around 13 weeks and the third time was at 23 weeks. At approximately 18 weeks Doctors determined I had a condition known as Placenta Accreta.
If you’ve never heard of it don’t worry. I hadn’t either until I had my 5th baby! But that’s why I’m telling you about it now, it’s so important to know this risk if you have multiple c-sections! It is a risk associated with pregnancy that can be life-threatening if not discovered before delivery, and even if found can still become life-threatening.
According to the ACOG Placenta Accreta is a cinical condition in which a part of the Placenta or the entire placenta invades the uterine wall. When the chorionic villi invade only the myometrium, the term placenta increta is appropriate; whereas placenta percreta describes invasion through the myometrium and serosa, and occasionally into adjacent organs, such as the bladder. Clinically, placenta accreta becomes problematic during delivery when the placenta does not completely separate from the uterus and is followed by massive obstetric hemorrhage, leading to disseminated intravascular coagulopathy; the need for hysterectomy; surgical injury to the ureters, bladder, bowel, or neurovascular structures; adult respiratory distress syndrome; acute transfusion reaction; electrolyte imbalance; and renal failure. The average blood loss at delivery in women with placenta accreta is 3,000–5,000 mL (2). As many as 90% of patients with placenta accreta require blood transfusion, and 40% require more than 10 units of packed red blood cells. (See article here)
Women at Greatest risk of Placenta Accreta, Increta or Percreta are those with previous scarring or myometrial damage due to previous c-sections.
The risk of Placenta Accreta was 3%, 11%, 40%, 61%, and 67% for the first, second, third, fourth,
and fifth or greater repeat cesarean deliveries, respectively.
I was diagnosed with Placenta Accreta and Complete Placenta Previa (CPP) at the same time, commonly associated together. I was immediately put on pelvic rest (for those who don’t know,this means no Sex. Period.) and I was put on bed rest.
When I had bleeding at 23 weeks I was put on hospital bed rest for 1 week. It felt like the LONGEST week of my life. I was not able to get up unless I needed to use the restroom or shower. Nothing more. We were terrified we were going to be delivering a baby at 23 weeks. It was scary, and stressful.
Any sign of bleeding with this condition is a HUGE red flag and could be a sign of the placenta tearing away from the uterine wall, which is extremely dangerous for both Mom and baby.
I went home after one week in the hospital, and was able to stay home a short time, before having more complications on Valentine’s Day 2015. Back to the hospital we went, and I was immediately put on hospital bed rest again. Indefinitely. This time, I was in the hospital 20 days. It was awful. I had to worry about 5 other kids at home, and whether they were getting enough love and attention from whomever was watching them, while my husband was at work. And I constantly worried that we would be delivering a baby incredibly early. On top of that, I was terrified that I wouldn’t survive the surgery.
After 20 days in the hospital I was able to go home and try to get to 35 weeks. They were not going to let me get past 35 weeks as the risk of pre-term labor and hemorrhage was significantly greater at that point, having had a history of early babies, due to pre-term labor.
I made it a few more weeks, and then on April 1st, 2015 I went into the hospital with consistent contractions. I was immediately put on magnesium. Magnesium is a drug used to stop pre-term labor. They attempted to stop the contractions with no luck. Not wanting to deliver a baby in the middle of the night, without a team of doctors prepared, they held off until 6:30 am on April 2nd.
Throughout this pregnancy I had been seeing a Maternal Fetal Medicine doctor, as well as another specialist that was a gynecological oncologist. The reason for this specialist was that he was familiar with surgeries involving uterus as well as every other organ surrounding it. If they had to deliver in the middle of the night, it would have been scrambling, without MY doctors, and it would have been much more challenging. Every nurse and doctor there felt it was important to have a bit of time to plan and prepare, and I am SO thankful for that.
Early that morning, they rolled me into a general operating room on the main floor of the hospital. Lying flat on my back, surrounded by numerous people, I was terrified. I was going to be put under general anesthesia so that the environment could be well controlled. I look around counting, I counted 17 people in the room before I was completely out. I remember thinking, “please God, let me survive this surgery.” A few hours later, and I was being rolled into recovery, fighting the nurses because I didn’t want to wear the oxygen mask.
Here is what I know from the delivery:
* I lost my entire blood volume during surgery
* The MFM doctor and assistants had to squeeze my uterus until all vessels were clamped off, in an effort to stop the massive bleeding
* The diagnosis was Placenta Percreta, the most invasive of the 3 types.
* The placenta had attached to my bladder, leaving a huge hole in my bladder that needed repair.
* My doctor said on a scale of 1 to 10 of how scary this surgery was for him to perform it would be an 8.
* The gynecological oncologist that is usually a very cool, relaxed doctor, was said to be sweating bullets during surgery.
* Once the baby was delivered, it took a few hours to repair, and sew everything back up.
* I was given 2 units of blood in the operating room, and another the day following delivery.
* I survived. I thank God, every day that my baby and I both did.
*Every nurse that cared for me in Antepartum said it took them 15 minutes to read the Post-Op report, and they all came in commenting on how terrible it sounded. I have yet to read it.
Recovery was excruciating, and long. My daughter spent 15 days in the NICU, and I spent 10 days wearing a catheter and 7 weeks going to wound care, as my body struggled to heal properly. Those 2 weeks my daughter spent in the NICU, were some of the hardest days of my life.
I still have a difficult time saying that if I had to do it all over again to get my daughter here that I would.
I love my daughter with my whole heart, and we are absolutely blessed that she is in our lives. I WOULD do it all over again. But I am SO glad that I don’t have to.
It is an experience that I will never forget, and one that I am so glad is over. Just thinking back on it, causes me to become a bit tense. It was scary. Period.
The risk of Placenta Accreta, is dependent on many factors, including but not limited to: Number of previous c-sections, amount of scarring there is within the uterus, the way your body heals after c-sections, where the embryo implants, and so on. There is NO way to predict who will, and who won’t have this complication.
And so, there is power in knowledge. If you know about these risks ahead of time, you can make more informed decisions regarding your family, and the number of kids you can physically carry. But also, you can know the importance pre-natal of care. The importance in finding doctors that you are comfortable and confident in. If you are reading this, and you are facing this right now, know that there is support! I have been there, and I will offer support in any way that I can.
Pre-natal care is so important. If there is anything I want you to take away from this, it’s that. Missed diagnosis of Placenta Accreta, becomes life-threatening very quickly. It’s when it is diagnosed well in advance, that you can have all the interventions, care and doctors needed to make sure that Mom and baby are safe throughout the entire pregnancy and delivery.
Kinslee Grace Hall – April 2, 2015.
Weighed 5 lbs. at birth. Got down to 4.lb 4 oz.
Spent 15 days in NICU
Now a happy, spunky, silly 17 month old that we love to pieces!
Jalynne is a stay-at-home Mom to 6 kids; 4 boys and 2 girls. She enjoys homeschooling, baking, camping, spontaneous weekend trips as a family, and blogging in her spare time.
Want a peek into their life as a family of 8, you can check out their YouTube channel here