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Well, a retained placenta will often prevent your milk from coming in, because the progesterone suppresses prolactin.<br><br>
OTOH - if your placenta is normally attached, it will detach and come out on its own quickly after the baby is out. It's possible to allow the placenta to deliver spontaneously with a cesarean...check it out: <a href="http://www.blackwell-synergy.com/doi/abs/10.1111/j.0001-6349.2005.00729.x?journalCode=aog" target="_blank">http://www.blackwell-synergy.com/doi...ournalCode=aog</a><br>
In this study it even seemed to improve maternal outcomes vs. manual removal.
 

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Discussion Starter #22
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<div>Originally Posted by <strong>alegna</strong> <a href="/community/forum/post/10815101"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Any retained placenta bit can keep milk from coming in.... can't imagine what a whole one would do...<br><br>
-Angela</div>
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This just keeps getting better and better... <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad">
 

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Discussion Starter #23
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<div>Originally Posted by <strong>time4another</strong> <a href="/community/forum/post/10815112"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Oh and yeah...how do you know you have accreta?</div>
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I don't - this OB thinks it's "likely" though. I asked for a %, she said she couldn't provide that. I said then make an educated guess...she said 25%.
 

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Studies I've seen put the risk around 3% for a 5th cesarean. It's highly associated with previa - if you have previa, the risk would be around 70%. I don't know if there are other factors at work for you that would make it more or less likely. But it can be hard to diagnose with ultrasound, it is very much associated with multiple prior cesareans, and if it happens, it's a pretty big deal.<br><br>
I can see an argument to be made that, nutty as it sounds, what the OB is proposing could be a safe option. If you don't have accreta, your placenta will come on out shortly after birth, and you'll avoid some possible risks of manual removal as in the study above. If by chance you do have accreta, you'll get a big clue when the placenta doesn't come out normally - and if I had accreta and wanted to keep my uterus, I'd want it left in situ. Does that make sense?
 

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Discussion Starter #25
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<div>Originally Posted by <strong>ccohenou</strong> <a href="/community/forum/post/10815308"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Studies I've seen put the risk around 3% for a 5th cesarean. It's highly associated with previa - if you have previa, the risk would be around 70%. I don't know if there are other factors at work for you that would make it more or less likely. But it can be hard to diagnose with ultrasound, it is very much associated with multiple prior cesareans, and if it happens, it's a pretty big deal.<br><br>
I can see an argument to be made that, nutty as it sounds, what the OB is proposing could be a safe option. If you don't have accreta, your placenta will come on out shortly after birth, and you'll avoid some possible risks of manual removal as in the study above. If by chance you do have accreta, you'll get a big clue when the placenta doesn't come out normally - and if I had accreta and wanted to keep my uterus, I'd want it left in situ. Does that make sense?</div>
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Honestly? I think I'd rather lose my uterus and be able to nurse my daughter. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad">
 

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Discussion Starter #27
The more I think about this the more pi$$ed I get. To project a risk of 25% & not even mention the effects on nursing, what if this happened & I didn't know until AFTER? I cannot imagine how distraught I would be. <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/gloomy.gif" style="border:0px solid;" title="Gloomy">:<br><br>
I'd have an infant on formula and a prematurely weaned toddler. I cannot even conceive of it. There's no doubt I'd contend with some serious depression. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad">
 

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Hun, that dr might be trying to do something she thinks is safe,but it is YOUR BODY, and yu have the right to tell her that you under no circumstances consent to her leaving your placenta there, and if she can not handle that, you will be reporting her to the medical board, and looking for a new OB right now.
 

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Is there another Dr. you can have look over your records?<br><br>
I just have this feeling that something is being lost in translation, mainly from your OB to you, but still. This is something serious and if your OB can't tell you if your placenta is over your scar (even though you said it was high and posterior), which would increase your risk for 3rd stage difficulties there is a problem. Either way you are asking for explanations and I don't feel like you think you are getting them.<br><br>
Good luck and please keep us updated!<br><br>
Heather
 

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Discussion Starter #30
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<div>Originally Posted by <strong>time4another</strong> <a href="/community/forum/post/10816068"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Either way you are asking for explanations and I don't feel like you think you are getting them.</div>
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Thank you someone for noticing! They are so dismissive. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked">: No other OB will take me, I am nearly 39 weeks and this place I am going to is where all the local OB's refer their high risk patients. I have a section scheduled for Monday so I am REALLY feeling the urgency to make a decision NOW. (FWIW, I did not consent to the scheduling of this surgery and have said multiple times I did not plan to go, this last appt...yesterday...is making me have second thoughts, but I just don't know...)
 

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<div>Originally Posted by <strong>rmzbm</strong> <a href="/community/forum/post/10815415"><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 more I think about this the more pi$$ed I get. To project a risk of 25% & not even mention the effects on nursing, what if this happened & I didn't know until AFTER? I cannot imagine how distraught I would be. <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/gloomy.gif" style="border:0px solid;" title="Gloomy">:<br><br>
I'd have an infant on formula and a prematurely weaned toddler. I cannot even conceive of it. There's no doubt I'd contend with some serious depression. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"></div>
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<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug"> I hope you won't have to make that decision. <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/praying.gif" style="border:0px solid;" title="praying">:
 

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I have no information to add, just wanted to <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug">. I hope it works the way it's supposed to!
 

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<div>Originally Posted by <strong>rmzbm</strong> <a href="/community/forum/post/10816141"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Thank you someone for noticing! They are so dismissive. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked">: No other OB will take me, I am nearly 39 weeks and this place I am going to is where all the local OB's refer their high risk patients. I have a section scheduled for Monday so I am REALLY feeling the urgency to make a decision NOW. (FWIW, I did not consent to the scheduling of this surgery and have said multiple times I did not plan to go, this last appt...yesterday...is making me have second thoughts, but I just don't know...)</div>
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I don't know if this will be helpful or not, but:<br><br>
You will either have a placenta accreta or you won't. Having a c-section does not impact whether or not the placenta is stuck to the uterine wall. If you do have a placenta accreta, then you will have to have medical help dealing with it whether you have a c-section or not. I agree with you and with the PP that you are getting lazy, reckless, insensitive care, but whether or not you choose to have surgery with this team, your chances of accreta are the same.
 

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Discussion Starter #34
Agreed. I'm just not sure the OUTCOME would be the same. If that's the case being in the OR already would definately be handy. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad">
 

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so if the placenta is accreta to not remove the placenta is called "conservative management" and is practiced more in European countries. The doc has the right of it in my mind. If you wait the placenta will detach because it will no longer have a way to replenish/stay alive, if there is an attempt to remove it you may end up bleeding bad enough to require an emergency hysterectomy - it is a real life risk to remove a firmly attached placenta that isn't bleeding- even if they can control the hemorrhage it can weaken your uterine wall. yes there may be issues with milk production it is % chance not every mom/baby will experience problems- but if you hemorrhage severely it too can have an inhibiting effect on milk production.<br>
here is an abstract of a French article on the subject--<br><br>
J Gynecol Obstet Biol Reprod (Paris). 2007 Nov;36(7):680-7. Epub 2007 Jun 15.<br><br>
[Conservative versus radical management in cases of placenta accreta: a<br>
historical study]<br><br>
[Article in French]<br><br>
Kayem G, Anselem O, Schmitz T, Goffinet F, Davy C, Mignon A, Cabrol D.<br><br>
Service de gynécologie-obstétrique, CHI de Créteil, université<br>
Paris-XII-Henri-Mondor, France. <a href="mailto:[email protected]">[email protected]</a><br><br>
OBJECTIVE: To compare the impact of conservative and radical strategies for placenta accreta on maternal morbidity and mortality. METHODS: We retrospectively reviewed the medical records of all patients diagnosed with placenta accreta admitted to our tertiary center from January 1993 through October 2005. Two consecutive periods, A and B, were compared: during period A (january 1993 to June 1997), our written protocol called for the systematic manual removal of the placenta, to leave the uterine cavity empty. In period B (July 1997 to October 2005), we changed our policy and attempted to treat patients with a placenta accreta conservatively. The following outcomes over the two periods were compared: need for blood product transfusion, hysterectomy, intensive care admission, duration of stay in intensive care unit, sepsis and disseminated intravascular coagulation. RESULTS: Fifty-one cases of placenta accreta were observed among 40281 deliveries (1.3/1000). Period B saw a reduction in the hysterectomy rate (11/13 versus 10/38; P < 0.01), the mean red blood cells transfused (3230+/-2170 versus 1081+/-1370 ml; P < 0.01) and disseminated intravascular coagulation (5/13 versus 1/38; P < 0.01) compared with period A. Seven cases of maternal infection were recorded during period B and none during period A (p = 0.22). CONCLUSION: Conservative management of placenta accreta appears to be a safe alternative to radical management.<br><br><br>
PMID: 17573204 [PubMed - in process]
 

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wow!<br>
It sounds fascinating for them to leave the placenta in to detach on it's own, read the French study it says that outcome is better.<br>
(correct me if i read it wrong)<br><br><b>Here is a reassurance for your milk supply:</b><br>
If you choose to have them manage it by leaving in the placenta, I would not worry about your milk supply since once the placenta is birthed you then have a full supply for your newborn, in theory this can work for you because you already have an established milk supply for your older child, so the newborn will have milk available for the few days until the placenta detaches on it's own.<br>
Once the placenta is out then colostrum for the newborn will come in.<br><br>
So everyone does this theory about her milk make sense?
 

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<div>Originally Posted by <strong>dewi</strong> <a href="/community/forum/post/10822526"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Once the placenta is out then colostrum for the newborn will come in.<br><br>
So everyone does this theory about her milk make sense?</div>
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Not really- the milk changes to colostrum DURING pregnancy.<br><br>
And as for the rest, well, wow. I had never heard of leaving the placenta before... If I'm understanding correctly, it is so it will detatch from the scar tissue on its own? But OP's placenta is not attatched to the scar?<br><br>
rmzbm- <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug"> I can't imagine how scary this is for you. I say trust your instinct. If you feel like Monday is just a bad day, cancel.<br>
Like you, I'd rather have a hysterectomy than loose the ability to bf. And I wouldn't consent until ALL of my questions had been answered.
 

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Discussion Starter #38
Not an option, I will choose a hysterectomy if it comes down to it. I have spoken with several MDs the last few days, some say it can take OVER 6 weeks and 6 full weeks is not uncommon. So milk supply is a HUGE worry. I am not willing to chance it. In the meantime I have an infant on formula with total nipple confusion, no way, NO WAY. And yes, I had milk for my toddler but it's been gone for a few weeks and, of course, has changed to colostrum. I don't believe it will just reappear.<br><br>
Thanks, thixle, I am utterly terrified. If I knew all this I may not have even gotten pregnant. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"> But she's here now and I will probably have the damn section. The stress is killing me and I want it over with. I am done caring if it's right or if it's wrong or if I'm being an idiot...again...because the bottom line is, for HER, there's a near 100% guarantee she'd be just fine if birthed surgically. I don't give a crap what they do to me once she's out. As long as they lose this idiotic idea of leaving the placenta in me. It is what it is and worrying doesn't benefit anyone an iota. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/shrug.gif" style="border:0px solid;" title="shrug">
 

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<div>Originally Posted by <strong>rmzbm</strong> <a href="/community/forum/post/10822757"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Thanks, thixle, I am utterly terrified. If I knew all this I may not have even gotten pregnant. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"> But she's here now and I will probably have the damn section. The stress is killing me and I want it over with. I am done caring if it's right or if it's wrong or if I'm being an idiot...again...because the bottom line is, for HER, there's a near 100% guarantee she'd be just fine. I don't give a crap what they do to me once she's out. As long as they lose this idiotic idea of leaving the placenta in me. It is what it is and worrying doesn't benefit anyone an iota. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/shrug.gif" style="border:0px solid;" title="shrug"></div>
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<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug"><br><br>
Remember- from the u/s your placenta is nowhere near your scar. This hasn't changed. Perhaps another u/s showing the placenta STILL nowhere near your scar would help?<br><br>
My understanding is that the risk of acreta (sp, sorry...) is the placenta growing into the scar. If the placenta is miles away (okay, not miles, but around your uterus over a foot easily at this point) from the scar, why would it be an increased risk?<br><br>
From the description it sounds like your placenta isn't ANYWHERE near your scar. Has anyone shown anything that shows there's an increased risk of acreta at a NON-scar site for you?<br><br>
-Angela
 

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<div>Originally Posted by <strong>thixle</strong> <a href="/community/forum/post/10822631"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Not really- the milk changes to colostrum DURING pregnancy.And as for the rest, well, wow. I had never heard of leaving the placenta before... If I'm understanding correctly, it is so it will detatch from the scar tissue on its own? But OP's placenta is not attatched to the scar?.</div>
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Thixle,<br>
She has Placenta Accreta, that means the placenta is embedded in the wall, and one treatment to avoid hemoraging and/or hysterectomy is that her docotr sugested letting it come out on it's own in the days after the birth. Eveyone mentioned how her milk would not come in, then i added that it would once the placenta comes out.<br><br>
I know milk changes during pregnancy but her "newborn" milk will not come in until the placenta is birthed. So my theory is that it would only be delayed and the newborn will have her established mature milk to drink (no need for formula). Her toddler has been nursing during her pregnancy.
 
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