Good hospital around Bexley for placenta previa care

[Coffeemadness]

I’m 27 weeks pregnant and dealing with complete placenta previa and a posterior placenta. Had two big bleeds so far. Also, I’ve got adenomyosis.

They haven’t checked for accreta or precreta in my scans since I haven’t had a C-section before, but I’m really worried about the risk due to my adenomyosis. I’m planning to talk to my consultant about it.

Honestly, I’m feeling pretty anxious about the C-section due blood loss and other complications like hysterectomy. I’m under Darrent Valley Hospital’s care, and the midwives are amazing, but I’m not sure if they have facilities/staffing needed for a tricky C-section. They have a special care baby unit from 32 weeks.

I’m wondering if I should switch to a different hospital — but only if needed, since Darrent Valley hospital is close and easy to get to in an emergency. I’m in Bexley, so any suggestions for nearby hospitals that are good with previa? Or any feedback about Darrent Valley hospital ?

I’ve also got private medical insurance and need to check if they’ll cover a C-section with previa. Anyone been through this with private care?

I’m kind of lost and would really appreciate any advice!

No experience of the local hospitals, but posterior placentas tend to be much less of a problem intraoperatively than anterior. If they thought it was likely to need off-site expertise they'd have referred you already - it's not something the obstetricians tend to just wing-it with. Hopefully they can reassure you when you see them next.

I used to work in maternity at DVH, they are a fantastic unit. I attended a number of high risk c sections and they were handled with extreme professionalism

@socks1107 Thanks 😊

Got few questions please. Your response will be much appreciated !

In case of emergency c-section, will there be a consulant available 24/7 in DVH? I am quite worried of being operated by a trainee doctor during emergency.
Does DVH have access to an oncall multidisciplinary team in case of emergency section ?
Will sufficient blood products be available in case of heavy bleeding during emergency c-section ?

I had 2 big bleeds before, so I am quite worried.

I had placenta previa and vasa previa and was told to be within 20 minutes of the hospital at all times. Can you do that if you move hospitals? I’d go for the closest one, as long as there’s a NICU.

@Zeitumschaltung Thanks! We dont have NICU at my current hospital. But there is special care baby unit(SCBU) from 32 weeks. Do you think thats sufficient ?

I cant comment on anything related to a C-section or what team they have available at Darent Valley, but I do know they had plenty of blood products on hand from previous experience.
My daughter was born there, emergency inductuon due to pre-eclampsia. It all got a bit hairy and I had a large haemorrhage following the birth and the crash button was pressed.
I dont remember all the details but I had a team of 9 senior midwives/consultants around my bed pretty damn quick and 2 blood transfusions.
They were pretty attentive during a big emergency!

I would think that the hospital won't let you schedule the birth there if the SCBU isn't sufficient based on how they see that the baby is doing. Mine had IUGR too and was quite small so potentially needed NICU (but in the end he didn't need anything different from my full-term baby aside from a few extra tests). But your discussion with the consultant about accreta seems key to your decision.

I'd also be surprised if any hospital in the UK would operate without blood available! The anaesthetist mentioned to me that they had plenty of blood for me and for the baby ready to go.

It was almost 20 years ago but my C-section and care afterwards was covered by BUPA. Because placenta praevia absolutely requires a C-section, it was (in 2005) the only pregnancy complication that our policy covered. Irritatingly, they would not cover the care I needed before delivery when I was admitted for a few weeks on bed rest but from the day of delivery onwards, I was under BUPA.
In practice this meant that I moved to another room in the same NHS hospital on my delivery day (carpet and a bigger bathroom) and started getting better food. A consultant obstetrician did my C-section and a consultant anaesthetic administered by spinal block.
I was really grateful for the food. I’d been in there for 3 weeks and the food was so crap and the portions were so small that I lost weight in the final few weeks of pregnancy.

Thanks for the reassuring messages xx

Wondering if c-section for previa (scheduled / emergency) are done by consultant or by registrar usually?

an elective section is more likely to be done by a consultant. In an emergency, depending on the time of day & degree of urgency, it's more likely to be a registrar, staff grade or associate specialist at least initially, all of whom will be appropriately experienced, and the consultant will be on their way in as necessary. You do not want to be waiting for the consultant to get in if it's an emergency for bleeding and you're hosing. Posterior placentas tend to be less likely to be an intraoperative problem than anterior. Planned section's for previas are often remarkably un-dramatic, with blood loss similar to 'normal' sections. An abnormally invasive placenta will usually have been identified in advance and plans for that scenario made, but even so, occasionally they're found intraoperatively by surprise and the drill is well rehearsed.

The lab will be appropriately stocked.
Previas are really obstetrician (and anaesthetic) bread and butter. If they believe they can look after you safely then the chances are that they can. If you're only willing to entertain consultant delivered care then you probably need to be in the private sector.

@Greybeardy Thanks for the detailed explained post. Quite informative !
Are you working in the medical field - you seem to be very knowledgeable :)

There is a chance that my insurance covers my c-section as its medically required ( need to call them and figure it out) - so was wondering if its better to go private or stay with NHS.