vasa previa, placenta previa, they said it had to be an emergency csec bc she is too fat???

[LionessMom]

that is what they told my friend. they said she wouldhave a csec between 32 and 36 weeks. they said it would have to be an emergency csec and they would cut her straight up the middle bc she was too fat.

this cant be true, can it? does anybody know?

[karen1968]

Well, number one, since they are PLANNING it, it isn't an "emergency".

Yes, if she has complete previa at 36 weeks, she will need a c-section. It is very dangerous to both mom and baby to try a vaginal birth at that point.

Has she had any bleeds from the placenta previa? If so, the "emergency" part might be if she has another bleed (or even a first bleed, if it is a bad one). With both vasa previa and placenta previa it can be very dangerous for the woman to go into labor - even a small amount of cervical dilation can result in hemorrhage and death of either the mother or the baby. I don't know much about vasa previa, but it sounds like that might be the more dangerous condition at this point.

Secondly, I can NOT believe they would say "we have to cut you up the middle because you are too fat". I do not know how overweight your friend is, or how far along she is. I can see, from a surgeon's POV, that a large fat pad that overhangs the pelvis would make a traditional bikini cut difficult. Perhaps as the pregnancy progresses, the fundus will push the abdomen out enough to not make it an issue? In any event, the plan for a vertical cut COULD be because of the vasa previa, or even the placenta previa.

Did your friend have someone with her when she was told all this news? It might be helpful to have a friend, partner or other advocate with her at her next appointment. Someone who can be a little more objective, ask questions that mom thinks of ahead of time but might forget in the moment, etc. Emotions, IME, can cloud memory a bit. I really do hope they weren't as insensitive as it sounds.

[katelove]

It's certainly pretty common to plan an early caesar for birth placenta or vasa praevia (not sure from your post which one your friend has). The reason for that is, as the PP said, any dilation can be catastrophic.

Regarding the vertical incision, they may have been referring to a vertical skin incision rather than a vertical uterine incision. Sometimes in very overweight people a vertical skin incision makes it easier to access the lower uterine segment. I would suggest that she clarify that they still intend to do a lower segment incision of the uterus though. The skin incision will not impact her chances of a VBAC, the uterine incision will.

And I agree with the PP, I hope they were a bit kinder with her when they were discussing it.

[GuildJenn]

With respect to the emergency bit what they probably told her is if she starts to dilate or go into labour, then it would be an emergency - between 32 and 36 weeks. If that doesn't happen, it will probably be a planned one sometime after 36 weeks.

It's hard. I had a suspected placenta previa (bleeding) and researched it a few weeks ago and it really can be a huge emergency. I hope they were nicer than it sounded, but from the amount I know from looking into it for myself, the care they've outlined is pretty much what I had understood.

My doctor said if I did have a full previa I'd be on hospital bedrest from about 32 weeks on, just because it's sooo bad to go into labour (and I personally tend to go into it fast). Luckily for me I did not have one.

Best wishes to your friend!

[tracymom1]

http://www.nathanparis.com/vp.htm

I had a vasa previa. It is a life threatening condition, carrying a near 100% fetal fatality rate if the mother goes into labor. I was sectioned at 35 weeks to prevent any risk of this happening. I also had an "extra" lobe to my placenta which was at the tip of the cervix in addition to the crossed blood vessels. I was on bedrest for over 3 months because I kept bleeding. The good news is that everything was fine and I went on to have a home birth with my second child!

So, yes, if there is a vasa previa, a c-section is completely warranted. They may need to to a classical incision because of the placenta previa. It really depends on the anatomy of the mother and location of the placenta, but weight alone generally is not a reason for the vertical incision.

Perhaps the words got a bit muddied around in your friend's head when the doctor was talking to her - sometimes when a lot of info is being thrown at you all at once it is hard to make heads or tails of it. If she does have any type of previa a section will be done, but it will only be an emergency if she is in labor and bleeding heavily. In VERY emergent situations a classical incision is done because it is quicker and easier to get the baby out.

[blessedwithboys]

A veritcal skin incision doesn't necessarily mean a vertical uterine incision. I had a "massive" pannus from my 1st preg and my 2nd c-sec was horizontal/horizontal.

[LionessMom]

she has both a placenta previa and a vasa previa. they will section her before 36 weeks no question. she is a nurse so she understood the words they were using.

my problem was that she said they it would be an emergency sec. which didnt make sense since they were planning it. and it sounded off to me that that automatically meant a vertical incision. however, that might be becasue the placenta is in the front and with the vasa they dont want to upset the cord till they clamp it.

i am very scared for her and the baby. i have never dealt with this kind of complication at all. neither has she.

[Super~Single~Mama]

Your poor friend - I'm sure thats terrifying!!

If she's not comfortable with the way the dr's are treating her, she can always get 2nd, 3rd, 4th opinions to find someone she's comfortable with. I think thats always VERY important, and especially with a situation like this where there are such scary complications.

[MeepyCat]

LionessMom, there are ways that the section could be "planned" AND emergency. They might want her on hospital bed rest, because they're expecting a crisis, but want to let the baby "cook" until then - so what they might mean is that she's going to lie in hossy, being bored out of her mind, until the moment she starts bleeding, at which point the emergency will proceed as discussed. This isn't a totally uncommon strategy for previa patients, particularly ones who have had a bleed or two already. If she makes it to 35 weeks, they'll probably actually schedule, but it sounds like they just may be trying to get her as much time as possible.

[mamabadger]

Originally Posted by karen1968

Secondly, I can NOT believe they would say "we have to cut you up the middle because you are too fat". (

I do not find it that hard to believe. Some doctors have trouble being polite to fat patients. The indignation aimed at crack smoking pregnant women ten years ago is now being redirected towards fat pregnant women.

[LionessMom]

Originally Posted by MeepyCat

LionessMom, there are ways that the section could be "planned" AND emergency. They might want her on hospital bed rest, because they're expecting a crisis, but want to let the baby "cook" until then - so what they might mean is that she's going to lie in hossy, being bored out of her mind, until the moment she starts bleeding, at which point the emergency will proceed as discussed. This isn't a totally uncommon strategy for previa patients, particularly ones who have had a bleed or two already. If she makes it to 35 weeks, they'll probably actually schedule, but it sounds like they just may be trying to get her as much time as possible.

well that makes sense. she is quite upset. her first 2 were no problem and now she is scared to death for the baby and mourning her uncomplicated preg and birth.