Placenta Update

amberdcm · Apr 30, 2010

At a 19wk u/s I was diagnosed with complete placenta previa, completely central to the cervix. A 27 week u/s showed it to be marginal, just shy of 1 cm (8 mm) from the cervix. I had a follow-up u/s yesterday, which at 31 weeks, confirmed exactly the same distance that the 27 week u/s. Coincidentally, growth from the pubic symphysis to the top the uterus measured exactly the same - 29 cm - on my 28 week & 30 week prenatal visits. I figure this accounts for the lack of placental movement. 
I have yet to bleed and now that the placenta is marginal, I wonder if I've passed that risk over. It's an incredible relief that the placenta has moved from complete to marginal. This takes me out of a planned c-section, but if nothing is to change, I'll still be birthing in the hospital instead of at home. My hb midwife said that I should start preparing a hospital birthing plan and that plan should touch upon an emergency c-section, as well. If anyone has a good template to follow, feel free to pass it along. 
I oscillate between feeling positive that the placenta will move the additional 2.2 cm needed to birth at home (I still have 8 to 10 cm left of growing to do, right?!) - to worrying that its posterior position will hinder the ability of the placenta to move any further - to being swamped by the OB's (hb midwife's backup) lack of positive encouragement (most of the time the placenta has far cleared out by this point, she says, and since mine hasn't she doesn't want to give me false hope) - to making peace with an impending hospital delivery/potential emergency c-section. Irregardless if the placenta clears, I still have underlying fears of hemorrhaging and I'm generally sketched about birthing within the hospital (I'm a real sucky rule follower). 
But, I'm taking a ton of solace in the fact that my CPM will be able to deliver with me in the hospital, and although she won't be able to "catch" the baby, her relationship with her back-ups & the hospital will allow her tons of anonymity in the birth process. Basically, they'll leave us alone until the moment of delivery. And, then they'll run interference =( Nonetheless, I'll have a rad birth coach and doula by my side. 
I've been internet shy for a while & haven't been following much of what's going on around here; but, I appreciate the support I received when I initially posted and wanted to give an update. I've been thinking a lot about burnindinner...hope she & her placenta are doing well...and I'm sending her strength and good vibes. 
If you can point me to a good birth plan template, or if you have any stories of 3rd trimester marginals moving during the last 8 weeks, send them along. Peace & love to all you mamas.

Aka mommy · Apr 30, 2010

No advise, just lots of peaceful birthing vibes. <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/hug2.gif" style="border:0px solid;" title="Hug2">

Burnindinner · May 1, 2010

Hey! Well, I had a bleed at 32 weeks and the hospital u/s showed mine to be 1 cm from my cervix as well. Maybe our placentas are hanging out together. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/wink1.gif" style="border:0px solid;" title="wink1"> So I would say "not out of bleed risk yet, but moving in a good direction". 
So to get clearance for home birth it needs to be just 3 cm away? I thought my hb mw said a full 10 cm away. I have been more and more adjusting to the idea of planning a hospital birth. My CNM (we are doing parallel care with her) said we aren't past the planned c-section range yet. What did they tell you? 
I am interested and encouraged to hear your story! We have another u/s on Weds to see where the placenta is at 34 weeks. The u/s machine used 2 weeks ago was decent, but this one is more clear and precise. Honestly, I am not sure they'll give me any clear answers then. I am feeling like we won't be able to make any decisions til about 37 weeks.

amberdcm · May 1, 2010

I feel like yer my previa partner in crime! 
I think the criteria for hb with previa/low lying placenta is very individual, not to the person per se, but to the agreement between backing doctor and hbmw. In my case, my hbmw's back-up doctor will clear me for a hb if my placenta is 3 cm or greater from the cervical os. 
I see a CNM at the practice that backs my hbmw. Getting ANY answers from her is like pulling teeth. She's incredibly vague. When I wanted specifics after the 19week ultrasound, all she said was numerical specifics were unimportant because her experience showed that my complete previa would move. Now that it hasn't, she hesitates to provide specifics because she doesn't want to give me "false hope". I find her infuriating. Just give me the black and whites so I can comprehend my sitch. That's how I feel. 
My hbmw and this CNM did confer after yesterday's u/s, and through that convo my hbmw felt comfortable and confident that we would not be planning a c-section. As it stands today, and should the placenta not more, I will be birthing in the hospital, so I'm making birth plans (which also include c-section should I begin to bleed during vaginal birth). Instinctively, I think this placenta will budge 2 more inches. My gut tells me I'll be birthing at home. 
Here's a weird secret neurosis that I've been hanging onto tight, though: 
I'd be remiss if I didn't admit that I'm slightly terrified of a strong bleed that sends me rushing to the hospital. FAR BEFORE I was diagnosed with the complete previa I had this general "anxiety"/a feeling that something wasn't quite right. Early on, I kept checking my pants when I peed for blood, which I think (and thought at the time) was neurotic and strange, but it was this REALLY strong feeling. I even thought to myself - straight out - once, "I wonder when The Bleed is going to happen"? It came out of my head as The Bleed. Like "I knew" something impending was coming. The whole thing feels foreboding. I don't know. Feels good to finally say it out loud. 
I have yet another u/s 5 weeks from now, at 36 weeks. As my situation seems to allow for much more leniency than yours, I'll keep checking til the end, being so close to 3 cm and all. 
I'm sorry to hear about the bleeding. That's got to be really frightening. I think this whole thing just sucks, in general. How far away does your placenta need to move for you to be able to birth naturally in the hospital?

SeattleRain · May 1, 2010

I also heard that the placenta needed to be 2cm away from the cervix to get out of planned csection territory. Mine is at 1.7cm and I'm also having an ultrasound on Wednesday to check my progress at 33.5 weeks. Since I only have 3mm to go, we're pretty confident it won't be a problem. 
Burnindinner, I'd double check with your midwife about her 10cm rule. That seems extreme. I wonder where its coming from? Maybe its her PERSONAL rule, not really a medical rule. If so, would you be confortable delivering at home with someone else if it came down to it?

Burnindinner · May 1, 2010

Hm, these are good questions. We also have a consult in 2 weeks to really look at the u/s results and the what and why's. Basically, CPM's are not licensed in my state, so it would be pretty difficult to get continuity of care if we transferred. The free standing birth center near us requires 10 cm, perhaps it is based on that? 
I think it would be a combination of factors. And the licensing issue means there aren't other mw's, especially this late in the game! Mine are the best, anyway. 
amberdcm, I think my CNM also doesn't want to commit because she doesn't want me to get my head around something that may not happen for me. However, it sounds like she was a lot more forthcoming with guessing though! She said she expects it will be vaginal birth in hospital, which both CPM's also corroborated - and we all say "unless something changes".

amberdcm · May 1, 2010

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<div>Originally Posted by Burnindinner <a href="/community/forum/post/15358666"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I think my CNM also doesn't want to commit because she doesn't want me to get my head around something that may not happen for me.</div>
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What frustrates me about this lack of commitment/vagueness is that I feel like by not completely collaborating with me there is this underlying message of "being "managed". I suppose our CPMs don't do that because they aren't institutionalized within the technocratic model of birth, and instead see the mother as the active & most important actor in the birth process, therefore completely worthy of being clued in to the vast treasure trove of knowledge they possess. Honest frankness would be refreshing. This concept of "false hope" is ridiculous. It posits that I am some kind of emotional creature unable to either act as my own agent or make sound or safe decisions for myself and my baby. 
Just treat me like your equal in the process & give it to me straight, ya know?

SeattleRain · May 1, 2010

<div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by amberdcm <a href="/community/forum/post/15358380"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I feel like yer my previa partner in crime! 
I think the criteria for hb with previa/low lying placenta is very individual, not to the person per se, but to the agreement between backing doctor and hbmw. In my case, my hbmw's back-up doctor will clear me for a hb if my placenta is 3 cm or greater from the cervical os. 
I see a CNM at the practice that backs my hbmw. Getting ANY answers from her is like pulling teeth. She's incredibly vague. When I wanted specifics after the 19week ultrasound, all she said was numerical specifics were unimportant because her experience showed that my complete previa would move. Now that it hasn't, she hesitates to provide specifics because she doesn't want to give me "false hope". I find her infuriating. Just give me the black and whites so I can comprehend my sitch. That's how I feel. 
My hbmw and this CNM did confer after yesterday's u/s, and through that convo my hbmw felt comfortable and confident that we would not be planning a c-section. As it stands today, and should the placenta not more, I will be birthing in the hospital, so I'm making birth plans (which also include c-section should I begin to bleed during vaginal birth). Instinctively, I think this placenta will budge 2 more inches. My gut tells me I'll be birthing at home. 
Here's a weird secret neurosis that I've been hanging onto tight, though: 
I'd be remiss if I didn't admit that I'm slightly terrified of a strong bleed that sends me rushing to the hospital. FAR BEFORE I was diagnosed with the complete previa I had this general "anxiety"/a feeling that something wasn't quite right. Early on, I kept checking my pants when I peed for blood, which I think (and thought at the time) was neurotic and strange, but it was this REALLY strong feeling. I even thought to myself - straight out - once, "I wonder when The Bleed is going to happen"? It came out of my head as The Bleed. Like "I knew" something impending was coming. The whole thing feels foreboding. I don't know. Feels good to finally say it out loud. 
I have yet another u/s 5 weeks from now, at 36 weeks. As my situation seems to allow for much more leniency than yours, I'll keep checking til the end, being so close to 3 cm and all. 
I'm sorry to hear about the bleeding. That's got to be really frightening. I think this whole thing just sucks, in general. How far away does your placenta need to move for you to be able to birth naturally in the hospital?</div>
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I'm actually starting to get worried for myself. My OBGYN clears me for vaginal birth at 2 cm which is the least of the two of you. I wonder if there's a chance something could still go wrong at 2 cm that could be more resolved at 3 cm. Perhaps the difference is because I'll be birthing in a hospital which makes "transfer for csection" a lot easier than from home. Like maybe they're more ready to take the risk than a hbmw would be. <div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by amberdcm <a href="/community/forum/post/15358812"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">What frustrates me about this lack of commitment/vagueness is that I feel like by not completely collaborating with me there is this underlying message of "being "managed". I suppose our CPMs don't do that because they aren't institutionalized within the technocratic model of birth, and instead see the mother as the active & most important actor in the birth process, therefore completely worthy of being clued in to the vast treasure trove of knowledge they possess. Honest frankness would be refreshing. This concept of "false hope" is ridiculous. It posits that I am some kind of emotional creature unable to either act as my own agent or make sound or safe decisions for myself and my baby. 
Just treat me like your equal in the process & give it to me straight, ya know?</div>
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</tr></table></div>
It's bizarre that your CNM won't give you the numbers. Mine didn't initially, but when I asked her for them she gave them to me. She also doesn't give me my test results numbers unless I specifically ask. I don't know that it has anything to do with a "technocratic model of birth" as much as that your CNM is just weird. I think some HCP don't give you the numbers right away because it may not matter to you. I have friends who just want to hear whether its good or bad and they don't really care how far from good or bad it is.

Burnindinner · May 1, 2010

I got the impression mine doesn't actually know. Not that she isn't competent, just that she doesn't want to speak to something that isn't her expertise. She doesn't want to promise me 3 cm and find out she's wrong. 
SeattleRain, I think for me, clearance for vaginal birth in the hospital is a lot less than 10 cm. The 10 cm is clearance for home birth.

Paige CPM · May 2, 2010

2cms shhould be just fine. Home 2 -3 cms. 10cm is dialation for pushing, not having anything to do with placenta previa. Good luck ladies!!!!! My fingers are crossed for you!!! 
> A new classification of placenta previa: Measuring progress in 
> obstetrics 
> 
> <a href="http://www.ajog.org/article/PIIS0002937809006309/fulltext" target="_blank">http://www.ajog.org/article/PIIS0002...06309/fulltext</a> 
> 
> Lawrence W. Oppenheimer, MD, FRCOG, FRCSCa, Dan Farine, MD, FRCSCb 
> 
> Article Outline 
> 
> • References 
> • Copyright 
> Old obstetric dogmas can take a long time to debunk. Witness castor 
> oil, enemas, and lying-in hospitals, to name but a few. So it is with 
> the traditional classification of placenta previa. The original 
> description of placenta previa is credited to Portal in 1683, although 
> Schacher in 1709 was the first to demonstrate postmortem the exact 
> relationship of the placenta to the uterus.1 The classification of 
> placenta previa into complete, partial, and marginal probably had its 
> origins in the 19th century. The description was meant to refer to the 
> extent to which the placenta could be palpated through the cervix.1 
> Complete previa referred to an implantation over the internal os where 
> the margin of the placenta could not be felt; partial previa referred 
> to the placenta covering a closed internal os, but not completely 
> covering a dilated os; and marginal previa meant an implantation in 
> which the margin could be easily felt. Lateral (or low-lying) previa 
> is the variety in which the margin of the placenta can only be felt 
> with difficulty. In the United Kingdom, the description of placenta 
> previa into grades I-IV or major and minor has been used commonly. 
> 
> See related article, page 266 
> 
> The distinction between placental abruption and previa was based on 
> the ability to palpate the placenta through the cervical os; the 
> difference was important because the treatment of previa involved 
> rupture of the membranes, internal podalic version, and use of the 
> fetus as a tamponade! The realization that digital palpation might not 
> be such a good idea, and the introduction of conservative management 
> with blood transfusion by MacAfee2 in 1945, lead to the need for a 
> more accurate diagnosis. Imaging modalities to investigate placental 
> location were introduced after the advent of radiology. In the 1930s 
> amniography and cystography were explored. Gottesfeld et al3 
> introduced the use of ultrasound for placental location in 1966, and 
> the first description of vaginal sonography, attributed to Kratochwil, 
> followed in 1969.4 Transvaginal sonography (TVS) for the diagnosis of 
> placenta previa has become the gold standard.5 Transabdominal 
> ultrasound is inaccurate in the diagnosis of previa and should be used 
> only as a screening tool.6 TVS is safe, even in the presence of active 
> bleeding.7,8 The accurate localization of the placental edge in 
> relation to the discrete point of the internal os by TVS makes the use 
> of the terms marginal, partial, and low-lying outmoded (Figure). What 
> the clinician really wants to know to guide treatment is the 
> likelihood of antepartum hemorrhage and need for cesarean section 
> delivery, based on the exact distance from the cervix. There is now a 
> growing literature on this relationship.9, 10, 11, 12, 13 A placental 
> edge lying <2 cm away from the internal os on TVS has become generally 
> accepted as the threshold for the performance of cesarean section 
> delivery for previa at term. An inherent problem in all the published 
> studies to date is the likelihood that knowledge of the distance 
> itself may have lead to the decision to perform the cesarean section 
> delivery, rather than the clinical features of the case. In this 
> respect, the contribution by Vergani et al14 in this edition of the 
> Journal is valuable. Although also a retrospective study, the authors 
> describe a policy of expectant management in the largest series to 
> date of 53 women with a cephalic presentation and a placental edge–to– 
> os distance on TVS between 1-20 mm. Cases were divided into 2 groups: 
> 1-10 mm from the os (n = 24 cases) and 11-20 mm (n = 29 cases). They 
> found a cesarean section delivery rate of 75% and 31%, respectively, 
> and an incidence of antepartum hemorrhage of 29% vs 3%, respectively. 
> The scans were all performed within 28 days of delivery at a mean 
> gestational age of 36.4 weeks, and delivery occurred on average 10 
> days later. None of the 11-20 mm group required cesarean section 
> delivery for antepartum hemorrhage, and none required cesarean section 
> delivery in labor. They conclude that women with a placenta that is 
> situated 11-20 mm away can be offered a trial of labor. The data of 
> Vergani corroborates well with the 2 other publications that have 
> reported the same distance groups.10, 11 Pooling the 3 data sets gives 
> a cesarean section delivery rate of 78% (17/50 cases) for a distance 
> of 0-10 mm and 34% (39/50 cases) for 11-20 mm. 
> 
> 
> 
> FIGURE. Transvaginal sonogram 
> 
> The tip of the probe is located at the top of the picture. The 
> cervical canal is seen in the upper half of the image, and a posterior 
> placenta is seen in the lower half of the image, with the placental 
> edge lying 7 mm away from the internal cervical os. Part of the fetal 
> head is seen on the left side. 
> 
> Oppenheimer. A new classification of placenta previa. Am J Obstet 
> Gynecol 2009. 
> 
> 
> Vergani et al propose that the time-honored classification of placenta 
> previa should be abandoned. We agree with them and others who have 
> published the same sentiments.15, 16Admittedly, the data is imperfect. 
> The numbers of cases that have been reported is still small and are 
> based only on retrospective studies, although it might be difficult to 
> mount a trial in which the obstetrician is blinded to the exact 
> location of the placenta. 
> 
> We need more information on the likelihood of antepartum hemorrhage 
> based on placental edge distance and the safety of out-patient 
> treatment.17 Treatment decisions should be based on the measured 
> distance of the placental edge to the internal cervical os by 
> transvaginal ultrasound whenever possible. The routine reporting of 
> this distance will enable us to confirm the current assumptions 
> rapidly. Recognizing that measurements of <1 cm may be subject to 
> error and operator variability, it probably makes sense to group the 
> distance to the nearest centimeter. 
> 
> A new classification could describe the distance on TVS that is 
> performed within 28 days of term in the following way: (1) >20 mm away 
> from the internal os; cesarean section delivery for previa not 
> indicated; (2) 11-20 mm; lower likelihood of bleeding and need for 
> cesarean section delivery; (3) 0-10 mm; higher likelihood of bleeding 
> and need for cesarean section delivery; and (4) overlap of the 
> internal os by any distance: cesarean section delivery indicated. 
> 
> The distance alone should not be a replacement for clinical judgment 
> in regard to factors such as unstable lie or significant antepartum 
> hemorrhage. As more data accumulates, we can add better estimates of 
> the risk of bleeding before and during labor and the likelihood of 
> successful vaginal delivery. We still have 4 groups, but the 
> description makes a lot more sense. The education exercise really has 
> to start not just in the obstetric domain but with the sonographers 
> and physicians who perform and report obstetric ultrasound. 
> 
> Approximately 3% of the obstetric population in the second trimester 
> will have a placental edge low enough to justify follow up with 
> transvaginal ultrasound.18 The study by Vergani et al also allows an 
> estimate of the incidence of a placenta lying within 2 cm of the os at 
> 36 weeks of gestation at approximately 0.6%, one-half of whom will 
> have a placental edge overlapping the internal os and a similar number 
> will have a placental edge of 1-20 mm away that will warrant a 
> decision regarding treatment. The benefits of accurate diagnosis by 
> TVS include risk assessment for outpatient treatment, selection for 
> trial of labor, and screening for placenta accreta.19 In addition, 
> exclusion of vasa previa, which is associated strongly with a placenta 
> that is initially located in the lower segment,20 can also be achieved 
> with color Doppler sonography. Investigation of antepartum hemorrhage 
> by TVS should be routine whenever there is doubt about the exact 
> placental location. 
> 
> The capability to measure accurately placental location has been 
> around for >20 years. All it will take to consign the old 
> classification of placenta previa to the history books is a shift in 
> our thinking by a couple of centimeters. 
> 
> References 
> 1. In: Chassar Moir J, Myersough PR editor. Munro Kerr's operative 
> obstetrics. 8th ed. London: Balliere, Tindall & Cassell; 1971;p. 771– 
> 804. 
> 
> 2. MacAfee CHG. Placenta previa: a study of 174 cases. J Obstet 
> Gynecol Br Commonwealth. 1945;52:313–317. 
> 
> 3. Gottesfeld KR, Thompson JH, Taylor ES. Ultrasound placentography: a 
> new method for placental localization. Am J Obstet Gynecol. 
> 1966;96:538–547. MEDLINE 
> 
> 4. Merz E. Ultrasound in obstetrics and gynecology. 2nd ed.. New York, 
> NY: Thieme; 2007;. 
> 
> 5. Farine D, Fox HE, Jakobson S, Timor-Tritsch IE. Vaginal ultrasound 
> for diagnosis of placenta previa. Am J Obstet Gynecol. 1988;159:566– 
> 569. MEDLINE 
> 
> 6. Smith RS, Lauria MR, Comstock CH, et al. Transvaginal 
> ultrasonography for all placentas that appear to be low-lying or over 
> the internal cervical os. Ultrasound Obstet Gynecol.1997;9:22–24. 
> MEDLINE 
> 
> 7. Timor-Tritsch IE, Yunis RA. Confirming the safety of transvaginal 
> sonography in patients suspected of placenta previa. Obstet Gynecol. 
> 1993;81:742–744. MEDLINE 
> 
> 8. Leerentveld RA, Gilberts ECAM, Arnold KJCW, Wladimiroff JW. 
> Accuracy and safety of transvaginal sonographic placental 
> localization. Obstet Gynecol. 1990;76:759–762. MEDLINE 
> 
> 9. Oppenheimer L, Farine D, Ritchie K, Lovinsky RM, Telford J, 
> Fairbanks LA. What is a low-lying placenta?. Am J Obstet Gynecol. 
> 1991;165:1036–1038. MEDLINE 
> 
> 10. Dawson WB, Dumas MD, Romano WM, Gagnon R, Gratton RJ, Mowbray D. 
> Translabial ultrasonography and placenta previa: Does measurement of 
> the os-placental distance predict outcome?. J Ultrasound Med. 
> 1996;15:441–446. MEDLINE 
> 
> 11. Sallout B, Oppenheimer LW. The classification of placenta previa 
> based on os-placental edge distance at transvaginal sonography. Am J 
> Obstet Gynecol. 2002;187(suppl):S94. 
> 
> 12. Bhide A, Prefumo F, Moore J, Hollis B, Thilaganathan B. Placental 
> edge to internal os distance in the late third trimester and mode of 
> delivery in placenta previa. BJOG.2003;110:860–864. MEDLINE | CrossRef 
> 
> 13. Predanic M, Perni SC, Baergen RN, Jean-Pierre C, Chasen ST, 
> Chervenak FA. A sonographic assessment of different patterns of 
> placenta previa "migration" in the third trimester of pregnancy. J 
> Ultrasound Med. 2005;24:773–780. MEDLINE 
> 
> 14. Vergani P, Ornaghi S, Pozzi I, et al. Placenta previa: distance to 
> internal os and mode of delivery. Am J Obstet Gynecol. 2009;201:266– 
> 268. Abstract | Full Text | Full-Text PDF (197 KB) | Summary PDF (186 
> KB) 
> 
> 15. Oppenheimer LW, Farine D, Ritchie JWK. The classification of 
> placenta praevia-time for a change?. Fetal Matern Med Rev. 1992;4:73–78. 
> 
> 16. Oyelese Y. Placenta previa and vasa previa: time to leave the Dark 
> Ages. Ultrasound Obstet Gynecol. 2001;18:96–99. MEDLINE | CrossRef 
> 
> 17. Wing DA, Paul RH, Millar LK. Management of the symptomatic 
> placenta praevia: a randomized, controlled trial of inpatient versus 
> outpatient expectant management. Am J Obstet Gynecol. 1996;175:806– 
> 811. Abstract | Full Text | MEDLINE | CrossRef 
> 
> 18. Mustafa SA, Brizot ML, Carvalho MHB, Watanabe L, Kahhale S, Zugaib 
> Z. Transvaginal ultrasonography in predicting placenta previa at 
> delivery: a longitudinal study. Ultrasound Obstet Gynecol. 2002;20:356– 
> 359. MEDLINE | CrossRef 
> 
> 19. Yang JI, Lim YK, Kim HS, Chang KH, Lee JP, Ryu HS. Sonographic 
> findings of placental lacunae and the prediction of adherent placenta 
> in women with placenta previa totalis and prior cesarean section. 
> Ultrasound Obstet Gynecol. 2006;28:178–182. MEDLINE | CrossRef 
> 
> 20. Oyelese Y, Catanzarite V, Prefumo F, et al. Vasa previa: the 
> impact of prenatal diagnosis on outcomes. Obstet Gynecol. 2004;103:937– 
> 942. MEDLINE 
> 
> a Division of Maternal Fetal Medicine, University of Ottawa, Ottawa 
> Hospital General Campus, Ottawa, Ontario, Canada 
> b Division of Maternal Fetal Medicine, University of Toronto, Mount 
> Sinai Hospital, Toronto, Ontario, Canada 
> PII: S0002-9378(09)00630-9 
> 
> doi:10.1016/j.ajog.2009.06.010 
> 
> © 2009 Mosby, Inc. All rights reserved.

Paige CPM · May 2, 2010

Homeopathic cinnamomum has been said to help move the placenta. You can do a google search to see what people have been doing.

Burnindinner · May 3, 2010

That was an interesting article. What it says to me is that if my placenta is 1 cm or more away from the os now (well, it was at 32 weeks), there is a high likelihood of being totally fine for vaginal birth, no need to plan a c-section. 
What I am wondering, though, is how to know when the risk out is for home birth? I saw that once you get past a cm it is a 3% occurrence of hemorrhage, which seems like pretty good odds. About the same as for most any other adverse event in birth...

GoBecGo · May 3, 2010

Burnindinner i think most HB MW's have their own protocols based on experience and "feel". I know my MW said to us at the start that she doesn't do vaginal breech, but recently she commented (when we couldn't figure out which way up this kid was) that in fact she would be happy to do one for me. I think that is based on knowing me better and having a better feel for this baby and pregnancy. 
I'm not sure if it was you who said something about it having to be 10cm away for a HB...? But that does seem preposterous to me - a non-praevia-never-been-praevia placenta could be 10cm from the os, and no-one would ever know since they were never even looking at it to see the distance it was at. My placental noise is clearly audible low on the left with the fetoscope - it's very possible that's where it is. It could well be 10cm from the os. For most MW's i know, 3 or 4cm would be fine for homebirth.

Burnindinner · May 3, 2010

I'm starting to feel like *I* would probably be comfortable at home in the 3-5 cm range, which is likely to happen. The key is though, that my hb mw is a student, and her proctor is the one who said 10 cm. Neither she nor I will be comfortable if her proctor will not attend. We have a strategy session next week, I am hopeful I'll get more information then and can plan better.

birthdancedoula · May 4, 2010

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<div>Originally Posted by Burnindinner <a href="/community/forum/post/15358666"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">The free standing birth center near us requires 10 cm, perhaps it is based on that?</div>
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DDCC.<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/winky.gif" style="border:0px solid;" title="Wink"> 
You had me wondering about this (because I had never heard this mentioned while I was there as a RN or during clinical) so I dug out the clinical practice guidelines to double check. Basically what the birth center says is that if the placenta is still marginal (defined as 1.3cm from the os) at 34 weeks than a hospital birth should be planned. 
I went through something similar with our mw about the location of Iris' placenta. She really wants it to be above the lower uterine segment because if it isn't, the risk of bleeding is greater. Didn't you bleed a bit after M's birth? You may want to let her know what the birth center's protocol is though, especially if your placenta is more than 1.3cm away from the os this Wednesday. 
I'll be thinking about you, mama. Be sure and let me know how it goes, k? <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug">

Burnindinner · May 5, 2010

Maybe I completely made that up about the BC requiring 10 cm? I have no mental capacity. Perhaps I did. 
I didn't bleed excessively (though I may not recollect this exactly accurately) after the birth though the 3rd stage was really long, over an hour (1.5 hr even?). I am sure that was not ideal. I think if they are willing to be really on top of that, and I am OK with very active management of that state, then I personally have a good feeling about it. 
U/s at 11 am, so I hope to have some good news after that!

Burnindinner · May 5, 2010

Measured 1.77 cm from the os today at 34+2. OB said it was out of automatic c-sec range, but I am now waiting to see if any of the midwives will clear me for home birth. I don't even know what to think will happen!

Paige CPM · May 6, 2010

Want me to post the measurement to the international midwifery list I am on (has CNM and CPM and traditional midwives on it) to see what they say about homebirth?

Burnindinner · May 6, 2010

Our state doesn't license CPM's, which would lead to continuity of care issues if we needed to transfer. I do feel comfortable trusting my midwives and their opinion.

Burnindinner · May 9, 2010

I thought this article was really helpful: <a href="http://www.aafp.org/afp/2007/0415/p1199.html" target="_blank">http://www.aafp.org/afp/2007/0415/p1199.html</a>

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