Anyone had a Grade 3 or 4 Placenta Praevia???

[MadMommie]

Hi there,

I'm 33 weeks pregnant with our first child and have been diagnosed with a Grade 3 Placenta Praevia, which is where the placenta almost completely covers the cervix.

We had our first meeting with the Obstetrician today, who told us that, given the fact that the placenta is also located at the front, it is hospital policy for the c-section to be performed under a general, rather than using a spinal or epidural, due to the fact they have to cut through the placenta to get the baby out.

This has come as a terrible shock - we had originally planned a home birth with minimal medical intervention, and we now find ourselves at the almost complete opposite end of the spectrum, with a very highly medicalised birth....and potentially I won't even be allowed to be awake to see my baby born.

I'm interested in hearing if anyone else out there has had a c-section for an anterior Grade 3/4 PP, and if yes, did you also have to have a general?

Times like this I REALLY wish I could have a seriously large glass of wine!

MM

I had a grade 3 with the placenta at the front. My daughter was also transverse. I also had a general and it was fine. I had a massive bleed during the op apparently and had to have transfusions, but we both survived.

I understand that as it's your first birth you wanted it to be so different, but at the end of the day all that matters is that you and the baby are safe and well.

Have a glass of wine, and relax!

Best wishes.

MadMommie

I'm sorry to hear that things aren't going according to plan.

I had grade 4 placenta praevia with dd1, diagnosed when I bled heavily at 27 weeks (and on and off thereafter till she was born at 36 weeks). Like you I had wanted a home birth with minimum intervention, partly at least because I was terrified of hospitals. I ended up spending 10 weeks in hospital (which did at least cure me of my phobia!). I didn't have to have a general anaesthetic. I'm guessing that this was because my placenta was exclusively low-down (they described it as being 'sunk in my cervix like a plug in a sink') and so they felt that they could safely cut me open without cutting into it.

When is your obstetrician planning on doing the section? And will you be scanned again before then? Have you had problems with bleeding, or was the placenta praevia picked up on a normal scan? I think that, unless there are reasons to the contrary (e.g. you start bleeding and they feel that they need to do the op immediately) I'd ask, at least, for another scan before the op to check the position of the placenta and to see whether a c-section under local anaesthetic might be possible. Depending how much faith you have in your obstetrician you could also ask for a second opinion on the need for a general anaesthetic.

However, it does sound as if the general might be the only option in your case. I think that the thing that really made a difference for me was to explore as fully as possible the reasons why a section and/or a section under g.a. is necessary and really think it through. I was really very distressed at first to think that I'd have to spend the last two months of my pregnancy in hospital and that I wouldn't get to be in labour at all. It just felt 'all wrong'. However, talking it through with the midwives (including some really fab student midwives) and my consultant I did come to realise that the section was really my only option. Without it my baby would certainly have died and there was a good chance that I might have died too. It wasn't the birth that I had originally hoped for, but I managed to focus on the positive things. In my case, there had been a very real chance that I would have to have an emergency section (which would have been under general anaesthetic, as there wouldn't have been time to do a spinal) at any time from 27 weeks onwards. So I focused on the fact of how lucky I was to have got to 36 weeks and to be planning an elective section which could be done calmly with my dh present and after which my dd was likely not only to survive but also to be healthy. I had been shown round the SCBU when first admitted, so it was a relief that dd avoided having to be taken there and that I was able to keep her with me after the operation. All these things are positive things which you need to hold on to.

For a long time I did feel that my body had somehow let me down and I felt cheated when other people talked about their birth experiences (however horrendous!) which I couldn't join in with. However, I now have a happy healthy, gorgeous 6-year-old who simply would not have been here if I hadn't had the option of giving birth to her in the way that I did.

I didn't find the recovery from my section as bad as it had been made out to be. I was up and about the next day (albeit tentatively!) and was able to lift (though she was small, only 4lb 12oz) and change my baby as normal. Actually, I think the stitches in my nethers when I had dd2 (VBAC) were more painful than the stitches from my section. I stayed in hospital for a week because dd had problems feeding, but I'd have felt OK to go home after about 3 days if it wasn't for dd being kept in.

Assuming that your section won't be scheduled for another 3 or 4 weeks, try to spend this time talking to as many people as possible who have positive c-section experiences to share. (You could start a thread on here.) Try to get your head around the reasons why this is necessary, and to focus on the end-product ... your wonderful baby.

Good luck!

Oops, sorry for the long essay!

Thank you both soo much, and Ellbell, don't apologise - bless you for taking the time to share your experience, and for being so positive.

I am trying to look ahead and focus on the end result of having a healthy baby. Generally I'm a pretty pragmatic person, but I guess I'm battling with how completely powerless I feel about the whole situation. It feels like I am being prepared for a medical procedure - not the birth of a much-longed for child!

So far, I've only had one small bleed about 10 days ago, which resulted in 24 hours in hospital, but I've been taking it very easy since then and so far, so good.

The Obstetrician is recommending a further scan at 35 weeks, with an elective c-section planned for 38 weeks. Due to the fact that I conceived immediately after an ERPC, he also said there is also a high-risk of the placenta being 'morbidly adherrent', which in the worst case scenario means they can't stop the bleeding and I may have to have a hysterectomy.

I guess I just need to take it a step at a time. We have another meeting with the Ob next week, which my private Midwife is going to come along to. In the meantime, we'll do some research about exploring the options available - although at this stage it looks like these are limited given the situation.

Many thanks once again to both of you for your advice.

MM

hi i had grade four placenta praevia and spent 3 weeks in hospital before my first ds was born at 37+4, i went into labour on my own and the mws were marvellous and kept a vvv close eye on me , but unfortunately with on rather strong contraction i bled really heavily and had to have a cs under general,I recovered fine and was home after five days, and just relieved that we were both safe, my son weighed 5lb 40z and is now a strapping 10 year old!!

Hi there, I had Grade 3 placenta praevia and had our little girl July 2005. I was very lucky and didn't have any bleeding before hand, so went in for a planned csection at 39 weeks. I lost a pint of blood during the op but apparantly this is not a lot. I didn't have a general just an epidural. To be honest, I would have preferred a general though as I found the whole thing quite traumatic. Husband was allowed to stay with me even during the epidural bit so that was nice.

I don't suppose the consultant would have suggested the general unless it was absolutely essential, but it is always worth asking and asking again, why? Often it is just the consultants/hospitals preference and you can get your own wishes respected.

I am about to have #2 and no sign of praevia this time so at least having it once doesn't mean you have the problem next time too.

Good luck and don't forget that a caesarian birth can be just as special as a "normal" one. There are lots of things you can do to personalise it, especially when you have the luxury of knowing when it is happening!

I think the reason why they don't like to do an epidural C section in these circumstances is partly because an epidural lowers your blood pressure, which you really don't want if you bleed heavily. What you need is professional opinions from Mears or tiktok.

this thread should answer some questions

Many thanks to all of you for your responses,and Lulumama for the link through to Magnolia1's thread, which was very useful. I see that she got to have her lovely db in November under a regional, rather than GA.

Lots of research for us to do in advance of the meeting with the Ob next week, and hopefully this meeting will help resolve some of the issues.

Once again,many thanks and I'll let you know how we get on.

MM

Hello MadMommie

There is some kind and fantastic advice on this thread and I would definalely agree with Ellbell who said you should have another scan, especially when there is still some time for change and so different choices can become available if the distance from the OS is more or less.

I had placenta Previa but not 3/4th grade - mine was 2.5 cms from the OS which was 'boaderline CS'. I was admitted into hospital 'just in case' when they realised that a previous scan (which had said 4.5cms) was wrong. In making the decision to let me labour or CS, I had an internal scan carried out by a specialist. He noted that the head was in a good position and so, depsite being told conflicting things by almost every doctor I saw, my designated consultant advised me to go for the natural labour but I would have a 50/50 chance of needing an emergancy CS. Although, I ended up experiencing a high internvention, highly medicalised labour which resulted in forceps (depsite the previa not being an issue.), i was grateful that I had been given the option to attempt a labour.

I can totally relate to the feelings of dissapointment and anxiety. I used to wish I could fast forward in time to know if everything would be OK. Just try and keep calm, keep things in perspective, try and get that extra scan - with an internal scanner and a specialist if possible, and find a consultant that you trust to help you come to the decision that is right for you. You may have more choices further down the line than you do know if things are in a different position or you even if you don't, you can have reassurance that the choice you have is the right one.

Remeber as well that 25% of all births are via CS, so there are thousands and thousands of woman out there who go through a similar thing. The fact that it will be planned will make it a calm affair which you can prepare for and know what to expect. Just look at it like this: if its as low as they think it is and they hadn't picked up on it, you may have been giving birth at home, it may have abrupted and then yo wold have been rushed off to hospital for an emergancy CS. My MIL had undiagnosed placenta previa and that's what happened to her (except she wasn't at home luckily).

If you do have an elective CS, you will be

Hello,
I had my first baby by c-section at 37 weeks just 3 weeks ago, due to a grade 4 placenta previa.

I understand your shock - we'd just completed a 5 week hypnobirthing course and were planning to have the baby at our local midwife-led unit! Then i had my first bad bleed and discovered the placenta was too low for her to be delivered vaginally. Another bad bleed at 35 weeks meant i spent 10 days in hospital and was pencilled in for a c-section on Jan 19th, but due to more bleeding she was delivered on the 17th. Anyhoo, I was advised that i would need a general as there is always a risk of heavy bleeding during delivery with previa and if you are awake it can make you feel quite ill. As it turned out, because the placenta was more to the side than front i was able to opt for a spinal block. I had the chance to discuss it fully with the anaestetist (excuse spelling!) before and she said that she would always recommend a general if the placenta is across the front as blood loss is inevitable and it can be scary if you start to feel very unwell during the op - both blood loss and the spinal block can lower your blood pressure and cause faintness and sickness. However, you will be closely monitored during the op and if you had a spinal and did start to feel unwell, they can administer a general within moments. But that could be scary for you and your partner - i did start to feel faint when the placenta was removed and it wasn't pleasant, and my blood loss was quite small.

A c-section birth CAN be a positive, enjoyable experience - the actual moment of birth might not be all you'd hoped for but the end result - healthy baby and healthy you - makes it worthwhile. I found knowing that i was having a section in advance a real bonus as i could 'psyche' myself up for it, ask lots of questions and have a good idea of how the op would go.

All the very best!

Thanks to all for messages so far, and Pollyblue, masses of congratulations on the safe arrival of your little one.

Been doing quite abit of research about PP and c-sections. Hadn't really considered the emotional impact of experiencing the c-section, but a couple of people now have mentioned about the trauma of the procedure -especially with PP - so this is something we clearly need to discuss with the Ob when we see him next week.

Pollyblue, can I ask how much input did you and your partner have about what happened after your daughter was born? Were you able to hold her and have skin-to-skin contact?

Cheers,
MM

I had a grade 4 (and was also planning a homebirth!). My story is on that other thread.

They had to cut through my placenta to get it out - and I heard the whole discussion. Including the pause and the sharp intake of breath and the stressed tones of voice. And the relief when ds came out yelling (and breathing) and I didn't require the 10 pints of blood they had waiting. There are arguments for having a general! They worried about the placenta not coming out with me too. They said, during the op, as soon as they could see that that wasn't happening.

But actually I felt rather calm and peaceful. And recovery was great because I wasn't actually looking after a newborn for the first week (albeit expressing 3-hourly and doing lots of skin-to-skin). Ds and I came home after 2 weeks. He is 2 on Tuesday.

If your surgeon is not comfortable doing the op under a spinal, don't push him into it. Let him keep within his area of expertise / comfort zone!

It may be possible for a junior nurse / trainee / somebody to take photos of the birth, if you give them a disposable camera. Or photos of the baby immediately after birth (still all mucky etc) which I think might really help. My hospital wouldn't let us but its worth asking.

I saw ds when he was still covered in vernix and gore. With dd (another cs, footling breech) they cleaned her and wrapped her in a pink blanket before I saw her. I've always had trouble connecting the baby who was inside me with the one that they handed me. Didn't affect bonding as such, I just wonder where that other baby went.

There's a website somewhere with suggestions for planning a good cs, I'll try to find it.

You might also want to gen up on premature babies though; there is a fairly high chance that you might be having one. (although none of the professionals were the slightest bit worried about ds being born at 34 weeks).

Csections.org

Mostly about csections under spinal but may be useful.

Your dh should be able to be with the baby straight after birth and he can do skin-to-skin (and fend off the formula) until you come round. Don't think it takes that long for the general to wear off.

Tell him not to phone the relatives until you're awake and have cuddled the baby. Otherwise it will feel like everyone else knew about the baby before you did (esp if you don't know the gender yet).

Fruitful, thanks for the advice and tips. The link that Lulumama gave was for Magnolia1, so please could you post the link to your thread as would like to read it.

Out of interest did you have to push hard to have the delivery under spinal rather than GA? My midwife has spoken to the Obstetrician who has confirmed he has handled both deliveries using spinal and GA. It just seems the GA is preferred for PP3.

I'm not worried about bonding with my baby, but I do feel very strongly about being able to see him being born. Don't know if I'm placing too much importance on this, but I feel I'd gladly deal with all the potential nasty stuff around the delivery just so that I can see my baby being born.

Regards,
MM

Hello again,

we were both made to feel very much part of what was going on, I never felt that the c-section was something that was just 'done' to me, if you know what I mean. The atmosphere in theatre was very lighthearted, there was music playing and all the surgical team introduced themselves. During the op a theatre nurse stood by my head and told me what was going on and as soon as our daughter was born she was wrapped and handed to her dad - the anaestetist then volunteered to take photos of them together! Her dad held her while I was stitched and cleaned up. As soon as we were taken into recovery, they asked if i would like to hold her skin-to-skin, in a semi-propped position, and a midwife loosened my gown so she could be placed on my chest for a cuddle. We were left like that until we were taken back to the ward, about 2 hours later. My blood pressure etc was being checked regularly all the while, but the midwife did that as gently as possible and pretty much left us undisturbed for much of the time.

I had asked about what would happen if i had a general, as I'd been warned to expect a general,and it sounds very similar - in that case the baby is still handed to dad as soon as possible - although he will not be allowed to be in theatre, he'll wait in an ante room - you are taken to recovery and as soon as you have come round and are feeling ok the baby will be passed to you for a skin-to-skin cuddle and first feed, if that's what you'd like to do. This can easily be done while you lie on your side, if you're still a little woozy and don't want to sit up. I was also told that we could delay having the baby weighed and washed until I was conscious and able to witness that.

Hope this is of help - all the very best!

Hi, I had a grade 4 and spent weeks in hospital in case I burst all over the place. Your hospital are quite right, they will have to do a general. I didn't have to have general as mine was more to the back than the front. Lots of blood loss. You'll probably be anaemic afterwards and poss need a blood transfusion.

xxxx

It'll all be fine.

Hi MM

I also had plenty of input into what happened during my section. DD was born and wrapped up (she was a bit cold at birth, but nothing too serious - she spent some time on a heated pad, but didn't need to go into an incubator) and then given to dh to hold. After a bit they passed her to me and I was able to have her on my chest. It wasn't skin-to-skin, because they were trying to keep her warm, but I did at least get to hold her and the anaesthetist took some photos of us while we were still in theatre. I was able to try to bf her as soon as we were out and in the recovery room. (She didn't want to know, but that's another story.) The whole thing was very un-invasive. The anaesthetist chatted to me and dh at the beginning, but as soon as dd was born she faded into the background and just let me and dh be with our baby. Obviously there were quite a lot of people in the theatre at the time, but I felt that they all treated me very respectfully.

I don't think that it's a foregone conclusion that you will need a transfusion and/or become anaemic. I think that you should be prepared that that might happen, but I think that funkimummy's post was a bit alarmist (probably unintentionally; no offence meant). Are they taking bloods from you to cross-match and save? I had this done twice-weekly when I was in hospital and I found it reassuring to know that if I did need a transfusion they had blood ready and waiting for me.

Good luck with your next appointment.

Thanks Pollyblue, I'm so glad your birth experience was such a positive one. We're going to start working on a revised birth plan that states our preferences, and we'll discuss this with the Ob when we see him next week.

We're going through the Australian system, having emigrated here last year, and whilst the standard of health care is very good, my perception is that you're expected to go along, to a certain degree, with what your Ob recommends,whereas in the UK your wishes are considered more. Could just be the manner of the Ob we're dealing with, although he comes very highly recommended.

MM

Thanks Funkimummy - you're a ray of sunshine aren't you? . But I like the note of positivity that creeps in at the end!!

MM

Thanks Ellbell. I will post an update on how we get on next week - keeping fingers crossed we 'bond' better with the Ob this time!

MM

Sorry MM - just read back my post and it does sound rather alarmist, tho it wasn't meant to be.

I had to stay in because I lived miles and miles away from nearest hospital, and I was a grade 4.

Blood loss I think is a little more than usual, and I was anaemic afterwards, but refused transfusion and took iron tablets instead.

Birth itself was fine. Absolutely no different to my first c-section actually. got to hold baby straight away, and cried!!

As I said, don't panic, it's not as rare as you think, and everything will be fine.

I've just found this thread again. Sorry, I wasn't clear. If you look down Magnolia's thread, I've posted on there. I was told I was having a general, and when I got to theatre they did a spinal. The anaesthetists weren't happy but the surgeon won the toss.

If you have a spinal, you can ask them to lower the screen so you can see your baby being born/lifted out - they'll have dealt with all the nasty placenta stuff by then and things should be calmer. You won't be able to see the cut, your belly will be in the way. And you can ask not to be told the gender, but to see for yourself.

There is a thread on here somewhere about what to do if you "missed out" on your baby being born in some way - the suggestion is to get you and baby in a warm bath as soon as poss (even if its a fortnight later), and cuddle up together all warm and wet, and feed the baby like you might if you'd just had a water birth. Dim lights and dh waiting with the fluffy towels and all that.

I lost 4 pints of blood and didn't need a transfusion. And I didn't take the iron tablets they kept giving me either (the last thing you need after a cs is constipation). I took 2 sachets of Spatone a day throughout pg and carried on after the birth. They did a bloodtest a week after and said my iron levels were rising nicely. Don't know if you can get Spatone in Aus; its a natural iron supplement.

If you make it to 38 weeks without bleeding/emergency, insist on a scan before they do anything - placentas do move, even really late on.

Hello
As you saw I had stage 4 palcenta previa and had ds1 at 37 weeks by c section with a spinal.
We were told of the high risk of severe bleeding and possible hystorectomy. The section went more smoothly than we thought possible and ds1 was born really healthy

The surgeon was amazed that I actually lost less blood than with my previous straightforward c section. They did do the cut slightly to one side which was to avoid the possibility of catching the placenta with the knife. But 10 weeks on and the scar blends in with the old one lol.

Hope everything runs smoothly for you xxx

Sorry meant to add, ds1 was given to Dh straight away and dh helped dry him ect... He was kept naked (apart from nappy) and skin to skin was started as soon as I was in recovery. Marslady is a fantastic person to chat to about having a good c section. It was thanks to her that I was able to relax and enjoy having ds1