Cesarean for placenta previa

[gen24]

Anyone had a section for placenta previa and want to share their experience?

I am 25 weeks pregnant with my third and have been diagnosed with complete previa with possibility of accreta (MRI scheduled next week) The doctor said there is absolutely no chance it will move.

This will be my first section. I'm ok with that but scared of the possible complications for me and my baby. I heard that autologous blood transfusion is sometimes possible for pregnant women at risk. Anyone heard of that? I will have to ask my doctor but my next appointment is in 3 weeks only.

I am not on bed rest yet but trying to take it easy as much as possible.

Any information would help

Thanks!

Edited by gen24 - 11/19/12 at 2:59pm

[parsley]

Hi Gen24 - I know you posted this quite awhile ago but I haven't been logged in and I just saw it.  Not sure if you'll come back through to see this but in case... thought I'd share the bare bones of my experience (though I also posted about this quite a bit last year so you've likely seen it if you did a search of the archives).  

I had complete placenta previa with my DD2 (born 1/23/12).  I had bleeding throughout my pregnancy, had steroid shots and visits to the emergency room and ended up on semi-home bed rest and had the baby at 36 weeks when I began hemoraging.  Every single part of the experience was awful!  I did have a MRI to rule out accreta and went into the c-section optimistic that I didn't have accreta but still scared that it had developed.  I joked with the nurses that I was the most cheerful c-section patient they ever encountered as I was so relieved when my pregnancy ended; it was the first time I relaxed in months!  It took several weeks for my anxiety to dissipate but I am relieved to say that 11 months later, I have a healthy baby (almost one year old!) and I am totally healthy (physically and emotionally). 

I'm sharing the horror of my experience to say that I totally know how scary and alarming the whole thing can be.  Complete placenta previa is not a minor problem!  But, as long as you remain relatively close to your hospital, you and your babe are going to be fine!  I coped by planning the best c-section I could and by aligning the ideal child care for my DD1.  If there is anything else I can share about my experience, please post here or pm me.  I'm happy to give you any info I can to make your experience a little easier. 

[gen24]

Hi Parsley,

thanks so much for the reply. I am now 29 weeks and still haven't bled at all. Placenta hasn't moved one bit. I still have a few questions for you. I was told my baby is transverse. Apparently very common with a previa because the placenta doesn't allow the head to come down. Was your baby like that too? Did it make the c-section more complicated? Also, they will have to cut through the placenta to get the baby out. Is that what they did for your c-scetion? It kind of scares me.

Did your baby have to spend time in the NICU? Was it difficult to breastfeed him? Sorry for all the questions, I'm just a little nervous

Thanks!

[parsley]

Hi Gen24-- I don't mind answering your questions at all!  I remember too well how scared I was one year ago and how desperate I felt for any and all info. 

So, I had a c-section with my first baby and with my second the placenta seems to have been attached just below that initial incision site and then it wrapped around my cervix toward the back.  I don't *think* they had to cut through my placenta but it was always a possibility. My c-section ended up being complicated and I don't remember exactly what happened with that aspect of things.  (I had incredible amounts of scar tissue that took a tremendous amount of time to cut through.  I was told that based on the amount of scar tissue they would have guessed that I had had 5 c-sections already.  It was a different doc in a different city but there was some hint of malpractice in the air that I didn't explore.) 

My baby was transverse for a while but she did settle into a head down position which may have been what caused the bleeding.  I was due on 2/18/12.  I had spotting throughout Oct and then had a minor bleed just after Thanksgiving and from then on had intermittent bleeding until I started to bleed heavily on 1/23/12.  I was a very long 8 weeks.  That said, my babe (and placenta) held on long enough so that while technically preterm she didn't have to go to the NICU.  We were discharged together from the hospital just two days after I entered for my emergency c. 

I was also very concerned about breastfeeding.  But, from both experience and research, there is no real reason to be worried!  I am nursing the baby as we speak and though she was a slow gainer, I've consistently had an adequate supply and no problem with nursing her.  From everything I've read it seems that what triggers the mammary glands to start producing milk is the detachment of the placenta from the uterus.  That will happen NO MATTER what when you give birth to you baby.  Even in the very worst case scenario of accreta and hysterectomy, the placenta will still detach and you will still be able to breastfeed. 

What I would do in your circumstance is make a great c-section birth plan.  I would consider medication, doula support, plans to have the babe with you at all times (barring emergency), "rooming in" if that not the norm in your city, etc... I was able to make a great recovery and stay with my babe the whole time because I had worked through every contingency and knew the right answer.  (For example, I refused to let them bathe the baby as I didn't want her temp to go down and then have them taking her to the warming beds.  I didn't know that the first time!).  You can't change the fact that you have placenta previa but you can develop plans to make the best of things once the baby comes.  I'm happy to help you think through some of these issues if you haven't already. 

Do you have other children?  If so, I found having my sister on call ALL of the time was a great relief.  I also packed my hospital bag in November and then just kept it there all the time after so I could have what I needed if I went to the hospital. 

How did your MRI go?  (I was scared about doing it but found it a relief in my case.)  Be sure to talk to the tech and doc as much as you can even though they might want to just send the info along to your doc instead of go over it with you. 

[MeepyCat]

Hi Gen24.

I had placenta previa with my daughter, who is now three.  She was born by c-section at 32 weeks, and spent 32 days in the NICU.  Today, you would never know.  She's a healthy preschooler.  The first few months were rough.

I agree that having a person on call for your older kids is a great relief.  Absolutely line that person up, now.  And packing a bag doesn't hurt either.  You hopefully won't need it yet, but it's good to have.

I *had* all kinds of plans, that got completely shredded.  I had planned to give birth at a particular hospital, but wound up instead at the closest appropriate facility to my home, because that was where the ambulance would take me.  The hospital I'd originally planned to be at didn't even have a NICU.  Given that placenta previa does tend to be related to early delivery, I would recommend that you check in with your doctor about what would happen if you went early, and look into what hospital you'd end up at if an ambulance had to take you there.

I didn't really have a c-section plan, but if I had had one, we wouldn't have been able to use any of it.  I hemorrhaged and had an emergent c/s.  The nurses washed DD off and brought her to me so I could give her kisses, and then whisked her to the NICU.  They did bring me up to the NICU as soon as I was out of recovery.  They'd have brought me pictures if I hadn't been well enough to go up.  Not all nurses get this, but seeing your baby is really important and it is totally reasonable to ask that every accommodation possible be made so that you can do it. 

My understanding is that it's actually the baby suckling at the breast that stimulates the mammary glands to produce milk.  Even if the baby can't suck, you can fake this with a breast pump, so I would not worry about surgery affecting breastfeeding by screwing up the placental detachment signal.  C-sections can make it harder to breast feed for other reasons - bodies don't always see the moment of recovery from an abdominal wound as the greatest moment to divert resources to milk production.  Holding the baby can be uncomfortable.  Help your body heal, so that your body can help your baby.  Rest as much as you can, eat well, and figure out what support you need to be comfy, whatever that is.  Buy extra pillows.

The prep I would do in advance is setting things up for your maximum comfort.  IMO, the optimal arrangement for a mom recovering from c-section is a bed with a firm mattress, a pack-n-play with a bassinet, and a comfortable recliner chair, in a room with an attached bathroom, and a minifridge and microwave for snacks.  Having TV or internet at hand doesn't hurt.  I don't recommend co-sleeping during surgical recovery, because you'll be on painkillers.  (Skipping the painkillers will make it harder for you to care for the baby and yourself, and can make recovery take much longer.  Take the medicine you need to stay comfortable.)  I say PnP rather then crib because my experience with the bassinet feature was that it was a good height so that I didn't have to bend over to pick the baby up.

I didn't have any problems breast feeding, but DD had trouble breathing, and with suck/swallow/breathe coordination, so she wasn't able to nurse right away.  I pumped a lot.  If you wind up in the NICU, renting a hospital grade pump for home is a really good idea.  I had a Medela Symphony, and it was great, if not at all portable.  Also - hands free bras are awesome.

[gen24]

Hi Parsley,

Thanks so much for all the info. The MRI didn't show accreta. I have 2 other kids and never had a c-sec before so accreta is unlikely but my doctor is still worried a bit because the placenta covers the cervix completely and hasn't moved at all.

I visited the hospital and according to a nurse, the only time the baby and me will be separated is when they stitch me back up because the ER is too cold for a baby???? That doesn't make sense to me so I will talk to my doctor about it. I don't understand why baby couldn't just stay in dads arms while they finish the surgery.

Anyway...I see my OB in 2 days so we will see!

[MeepyCat]

Gen24, they have to keep ORs really cold, and babies (especially if early) aren't great at thermal regulation, so they don't love having the baby in there any too long.  Dad's arms might be great, but ask what happens if the baby's temp drops too low - if hospital policy requires that they do a lumbar puncture to check for infection on a baby who can't keep temp up, it might be better to have the baby waiting for you in recovery.

Are you limited to one support person, or can you bring one for the baby and one for you?

[gen24]

Thanks MeepyCat for the good info. Was your first bleed at 32 weeks or did you have smaller ones before that? Was it a complete previa? Were you able to exclusively breastfeed even if your baby was premature?

Thanks!

[MeepyCat]

32 weeks was my third bleed - I had small bleeds at 26 and 29 weeks.  The earlier bleeds were really quite small though.

I'm not sure where the previa was, exactly, by the end.  They seemed to think it might be in the process of clearing, but it was also pretty obviously unsafe for me to stay pregnant.

DD was not exclusively breast fed, although I had enough breast milk to do so.  Because she was premature, we fortified my breast milk with preemie formula to get her extra calories.  When she was about seven or eight months old, I started sending her to daycare with formula because I just, emotionally, was not handling the breast pump at all well anymore.  She kept nursing when we were both home.

[gen24]

MeepyCat,

that makes more sense. I didn't know the OR was so cold. 

Yes I only have one support person (my family lives in another country) and I would rather my husband stay with the baby so I guess I will be alone in the OR  

[LaughingHyena]

I had placenta previa with DD, now 8. I had several bleeds form about 26 weeks onwards, each time I want into hospital  and remained there for a few days till the bleeding stopped and then I was able to return home. I was on bedrest in the hospital but between bleeds I was allowed to do most things, just no heavy lifting, vacuming, hanging out washing or sex.
 

DD was born by C/S at 34 weeks after several days of bleeding which did not seem to be stopping she started showing some signs of distress. I'd had a steriod shot at the first bleed and had another the day before she was born, while she was better out than in it was not such an emergency that we couldn't wait the 24 hours for that, though I was on nearly constant monitoring for that last 24 hours.

DD was transverse and the placenta was across the front of my tummy so in my case they did have to go through the placenta first. I have a horizontal scar though I remember there was some debate about if they did a vertical cut they may be able to avoid the placenta. In the end that was only decided after a final ultrasound after I was in the OR. Because they had to cut the placenta the time form incision to baby being out was very short, much shorter than with DS anyway. DH got to have a quick cuddle before DD went up to NICU. He stayed with me till I was in recovery then went up to sit with her for a while and brought me back some photos. For various reasons (my health and the fact that the NICU was very overstretched) I was not able to go up and see her for several hours.

DD was in NICU for a couple of weeks, for the first couple of days she needed a little bit of help with breathing and it took her a while to get started on breastfeeding. She was getting my pumped milk through a tube for a week before she latched on. After that she was able to feed for short times but still needed top ups via the tube for a few more days before we were able to breastfeed full time and come home. She was also cup fed overnight or when I was not able to be with her before being topped up via the tube.

I did have some initial supply  problems and was never able to get much milk from the pump, though it's definitely worth reading up on pumping before hand. There are a few tricks to helping things along. However once she was feeding directly I felt I caught up fairly well and we didn't have any ongoing problems. Some positions I found quite hard to feed in at first and I found a breastfeeding pillow useful in the first few weeks while I was healing.