Delivery After C-Section: UPDATE

Parenthood really likes to remind me on a daily basis that no Becca, you do not know it all. Actually, what do you really even know… like AT ALL??

You know that feeling… Like how after you tell everyone that your baby has an awesome immune system and start to hi-5 yourself just before said baby gets THREE ear infections in the same month. Or like how when you leave the room for a second because “what could happen?” and then baby finds the only unpadded corner of the couch and runs his head right into it. Or when you think that you don’t need to go back inside for the pacifier because graham crackers will keep him happy the whole 20 min ride, right? Uhhg, OK Motherhood, we got it, I know nothing.

Well right on par with the rest of the unexpected happenstances of motherhood, my first ultra sound with baby #2 came with some unexpected news.

No, not the gender, I actually got that one right! I was even telling people when they would ask whether I was finding out the sex that “no, I’m just confirming that it’s a boy”. Somehow, I just had a feeling. And a boy it was! But just as soon as we got that happy confirmation at the ultra sound, my doctor paused with a look on her face and told me not to freak out BUT, she was not going to complete the full ultrasound that day because she wanted me to see a specialist.

She pointed to some dark spots on the screen which she said were very near where my c-section scar was. She told me that she couldn’t tell for sure, but it was possible that the dark spots were the placenta which may have attached to the scar tissue and was possibly starting to grow into my uterine wall.

Of course I had no idea what the implications of that were so I asked my doc and she responded with a matter of factly “You could bleed to death”. But she then went on to explain to me more in depth what it is and what the risk factors are.

Placenta Accreta

  • The placenta can attach anywhere in your uterus, and it’s just a matter of chance that it would attached to scar tissue.
  • Scar tissue is never as strong as the original muscle and in the case that the placenta attaches to the scar, it could implant itself too deeply into your uterine wall.
  • If the placenta grows through the uterus, the main concern is that after baby is born, the placenta could tear when detaching and cause hemorrhaging which can be life threatening.
  • In some cases the placenta starts to grow through the actual muscle of the uterine wall, attaching itself to tissue and blood vessels. This is called placenta increta.
  • In very advanced cases, the placenta actually grows through the uterus and starts attaching to other organs which is called “placenta percreta“.

How Placenta Accreta could affect my birth plan

  • In the most serious case:
    • I would need to have a c-section scheduled at 32-34 weeks to avoid any risk of spontaneous labor.
    • The placenta would be embedded to such a degree that during the c-section they would remove my entire uterus i.e. a hysterectomy. (But they would still leave the ovaries).
  • Best case scenario:
    • I would have a c-section scheduled around 36-38 weeks (still with the goal of avoiding spontaneous labor) and while the placenta would need to be surgically removed, I would not need a hysterectomy.

Of course I was bummed to learn of all the potential risks and complications... I mean, had this been my first pregnancy I would have started balling as soon as we got in the car. But having gone through a c-section last time with all of my carefully thought out birth plans thrown out the window in an instance, I wasn’t scared. And I’m not scared now either.

Sure, during the week between my partial ultra sound with my regular OB and seeing the specialist, there were times where I would be on the brink of wallowing in self pity. But those feelings were almost always drowned out by a stronger mama bear instinct which made me feel that I could and would do absolutely whatever it takes to deliver a healthy baby. Even if I have to give up a major part of me, it’s horrible and scary, but it’s worth it.

Really to me, the hardest sounding part of a potentially progressive placenta acrreta/increta is knowing that the baby would need to spend of bit of time in the NICU. I did not have to experience that with Baby H and I can’t even imagine what it would be like. But I’m sure that’s how a lot of moms who have had successful vaginal births feel about c-sections. I guess we just don’t know how strong we are until something like that happens, and remarkably, somehow, we make it through.

So with that attitude, I went into my specialist ultra sound appointment.

Just when I thought I was in safe waters, I got some more concerning news.

First of all, the good news:

From what the specialist could tell, the placenta had not attached itself to the scar. He was also very confident that it was not growing through the uterine wall which was the main reason for seeing him. He even told me that the placenta of other mamas at this stage have already grown outside of the uterus, beginning to attach to other organs. So it sounded like I really didn’t have much to worry about there!

But at these ultra sound appointments, they check EVERYTHING.

And not everything passed with flying colors….

For one, the placenta is in the front and it is currently right over my cervix.. In other words, there’s no way out for the baby at delivery time. It is possible that your placenta can move away from the cervix though so I will be re-checked in a few weeks. If the placenta is not at least 2cm above my cervix, I will not be able to try for a VBAC whether I want to or not. It’s crazy to think that my last post on delivery was all about making the decision on whether or not to try for a VBAC and now here I am, possibly without even having the choice. I can be at peace with that though.

The other concern the doctor brought up was the fact that there is calcium build-up on the arteries of the baby’s heart. While he stressed to me that it was NOT an indication of a heart defect, he did say that it was a “soft marker” for down syndrome.

There are different options of testing (one with risks, one without) that can tell me with more certainty whether baby #2 does in fact have down syndrome. Pat and I have decided to try the less invasive test which is just a blood draw. (On a fascinating side note, apparently your placenta’s cells die off as new cells form, and they get absorb into your blood stream, and thus your blood contains the very DNA of your baby!).

My mom had gone with me to this appointment since Pat was on a business trip and as we walked out of the hospital she asked me if I even want to know if the baby has DS or not. The answer is, I do. A baby is a baby, is a baby, is a baby. I believe that wholeheartedly regardless of what stage, size, condition, or whatever the baby is in. If my baby happened to have a different chromosome, I would absolutely give him the chance to live in this world. With that said, I would like to know in advance so I could be as prepared as possible.

I’m sure it would change our life plans a bit and I can only imagine the struggles at times, but I always think of this incredible mom that I’ve gotten to know through work who has a DS son in his thirties. Whether or not my baby has DS, I would want to be the kind of mom that she is.

So here I am, a few weeks ago not knowing what to expect for my delivery, and then fast forward a few weeks and I have just as much uncertainty. There may be A LOT that I don’t know, but I do know this: I love my little kiddos and will love them no matter what. That will get us through. 🙂

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