low-lying placenta, anyone managed to have a vaginal birth with it?

[barelyutterly]

20 week scan showed the (anterior) placenta on the edge of the OS. Was reassured it would move up, as it does with most women.

32 week scan showed barely any movement, it was only a mm or two from the edge.

Scan on Friday at 35+5 showed it was now 13.7mm away, but they want it to be 25mm to be "safe" enough to avoid an ELCS.

Done a ton of reading since then including the recent RCOG guidelines which say:

"In what situations can vaginal delivery be contemplated for women with a low-lying placenta?

The mode of delivery should be based on clinical judgement supplemented by sonographic information. A woman with a placental edge less than 2 cm from the internal os in the third trimester is likely to need delivery by caesarean section, especially if the placenta is thick, but the evidence for this is poor and further research in this area is needed."

I have no other risk factors, haven't had any bleeding and am otherwise healthy and hardy. Not that I'm lulling myself with false hope as I realise that PP can mean bleeding to death but since they haven't given me any restrictions or admitted me, I am guessing my risk isn't that high, and certainly not as high as grade 3 or 4 PP. It would seem that their policy is blanket ELCS for all grades of PP, end of.

At the registrar's appt today she wanted to book me for an ELCS, instead I asked for another scan at 38 weeks before we decide for sure, to see if the placenta will move more or for the baby's head to engage. Consultant agreed this would be fine. Obviously if I go into labour before then or have any bleeding I need to get to the hospital right away.

Has anyone been in this position and attempted or had a vaginal birth with minor PP of 1-2 cm? Done some reading of other sites and it's not unheard of. I'm trying to balance the risks of ELCS (on future pregnancies as well) with risk of PP if the placenta is on that borderline. I'd like to avoid a just-in-case ELCS but wondering how realistic that is.

It depends a lot on the consultant but at least one of them at my hospital will try for a vaginal birth if at all possible. Her usual practice is to perform a VE in theatre and if she thinks it is safe, go for a vaginal birth. However, the risks are very real, a massive amount of blood is pumped through the placenta and a baby's head is very hard and very large and very likely to dislodge the placenta on the way down. Awful decision for you and your caregivers, but I hope you get some positive stories in reply.

Hi, I know someone who VB'd with a low lying placenta recently (not sure how low it was) she was told that it was too dangerous to attempt a natural birth and booked in for ELCS at 38 weeks, but she went into labour at 37 weeks and gave birth naturally no problems or bleeding at all.

Mine moved two weeks before giving birth so hang in there it might move yet.

My obstetrician was happy with trying induction (needed for other reasons) once the placenta moved a bit. Unfortunately, the baby wouldn't stay engaged (too much placenta in the way was the suspected reason - it was anterior and posterior and low) so I ended up with an emergency section anyway.

Can I ask why you are so against a caesar? It must be quite a phobia if you are prepared to risk death as an alternative..... waiting for another scan is certainly an idea but really don't take this lightly. Yes, you might be fine labouring vaginally (and might know others anecdotally who have done so), but WHAT IF YOU ARE NOT?? I am personally very against ELCS and refused one myself (so I do sympathise with a general wish to avoid unnecessary ops) but really this is a case where I would have thought you should just go with the ELCS . It is pretty irrelevant that you haven't got "any other risk factors"..you don't need any others, this one is completely sufficient on its own and is one of the reasons why modern scanning is so fantastic at saving lives. Imagine the trauma, physical and longterm mental, if you start haemorrhaging as you give birth even if the medical staff do manage to save your life at that point. Sorry to be so blunt, but I just think you should try to come to terms with a ELCS which you can pretty well guarantee will be smooth, untraumatic and, most importantly, safe for you and the baby.

barely I am watching your post with interest as I'm currently 31.5 with a placenta completely covering the os. Will be scanned again at 32wks and see consultant then, and if no change, will be re-scanned at 36wks.

This is a very difficult decision for you to make. I think you are being totally sensible in having another scan at 38wks and that's probably what I would do in your position. I take it this is your first baby? My problem is that it's my 3rd and DD came 10 days early and DS came 7 days early (and would have been earlier had he not been breech - but was turned sucessfully I hasten to add.)

I am struggling with the idea of an ELCS as my previous two were problem free home births and an ELCS is about as far away from that as you can get!

Good luck with whatever you decide, but remember if you do go into labour before the 38wk scan it may end up in an emergency CS so be mentally prepared for that.

I am also watching with interest. My 20 week scan showed low lying placenta close to os, being rescanned at 32 weeks.

This is my 3rd pregnancy, and think there is also as issue attatched to the placenta due to having a previous EMCS with my last which was only 7 months ago.

I am planning on a VBAC, however if it is advised that ELCS is safer option then I will be taking their advice.

I also have the same problem as girlfromdownsouth, as my 1st owas 6 days early and my second was 4 weeks early, so hopefully I make it to all the scans they need to make a safe decision, if not nature might decide for them.

Hey nunnie What is it about these 3rd ones hey? I was told by my midwife at my 20wk app that 3rd pg's are notoriously tricky and that's why most sensible midwives stop at two!!

Strange how they wait till you are prgnant with number 3 before telling you that