partial placenta praevia - elcs?

[5678group]

I am 36 weeks with placenta praevia which was completely covering at 20weeks but was 2.5cm away at last scan (35weeks)
Haven't had any bleeding or issues but DH thinks a csection would be less risky.
Was prepped for cs with first dc, ended up with forceps in theatre(no pp in thst pregnancy). All fine in the end.
As the placenta had moved a fair bit i'd prefer to try for a natural birth first.
Will hopefully see the consultant this week, but has anyone had successful natural birth with placenta 2.5cm away? Or any other experience?

I should say we are not in UK and they happily schedule csections here for almost any reason.

I had PP with my first. In the UK they have 2cm as the cut off point. Mine was deemed to be fine but either moved back a bit or the scan was wrong. Could you perhaps compromise with another scan in a week to see where it is?

Did you have csection in the end Abbey? When was the decision made?

Mine was thought to be fine at 32 weeks but we agreed they'd check again at 36 weeks. I think they would've decided after that scan. Unfortunately mine moved the wrong way (very rare so don't worry too much) and I had an emergency section before we got to the scan.

Ah. That must have been a suprise!
I think thas my issue, everyone either has an emergency section or its all fine and can have a natural. Reluctant to have an unnecessary csec, but dh thinks it'll be a walk in the park.

I don't think a section is a walk in the park but it is better than potential complications from previa!

Talk to your consultant about the risks and benefits specific to your case - I've done this and decided to go with their (strong) recommendation for a section. It'd have been great to go for a natural birth but on balance, me and the baby surviving this is priority number one.

I like you had a theatre forceps birth first time round. My second was previa but ended in an emergency csection at 33 weeks. I would have done anything to have that placenta move far enough away to have a natural birth and if we have anymore will do everything I can to ensure I don't have another csection. It is not an easy option at all. As long as the placenta has moved far enough away I would have a natural birth. The worry is the placenta coming before the baby but if it has moved up and cleared the os then babies head can descend past it. You can ask for a scan right up to going into labour and even then you could always ask them to check. If it's moving away it is likely to continue to do so as you grow in the last few weeks. Good luck whichever choice you make.

Well that's it Skipton isn't it- im assuming best case scenario and he's assuming worst. I've been seeing a gynae who doesn't do deliveries so she's quite blasé about the delivery questions. Hopefully the consultant who is delivering will be more interested!
Thank you sleepy, interesting re:forceps wonder if there is a slight correlation.
They would scan me everyday if they could get away with it, its all medical insurance, so hopefully we will know exactly where placenta when the time comes.
I just can't seem to explain it to dh why a elcs isn't actually as good as it sounds!

I know this is quite a controversial opinion, but having had a VB and an ELCS I no longer understand the stigma attached to c sections. Mine was brilliant. Labour and pushing a baby out of my vagina was an absolutely horrendous experience in comparison (and I had a waterbirth with gas and air - the sort of VB lots of women hope to have).

It may have been abdominal surgery, but recovery was a walk in the park.

So, from my perspective, ELCS really is as good as it sounds

For what it's worth (and of course I'm just one person) my EMCS with praevia wasn't that bad. Well, bits were but that was because of the emergency nature and bleeding rather than the section itself if that makes sense?
It's no walk in the park but I was up and about slowly the next day and back to normal within a couple of weeks, but obviously no heavy lifting etc. I'm going for an elective this time hopefully.
Recovery can vary so much with both types of delivery, so you'll never know for sure. I've heard though that with an elective you're not exhausted like with an emergency so recovery should on average, be better.

Just saying please don't take a risk with placenta praevia of any type (catastrophic experience in my close family). There is no stigma or issue and miniscule risk in having a section.

Thanks everyone.
The consultant is apparently very pro natural so if she thinks a csec is preferable then it makes sense to have one.
I don't really get the stigma attached to a csec, my natural really wasn't a walk in the park, but its what I know if that makes sense? As long as we are both ok in the end.
The no driving would be the biggest pain.

I didn't say this, right, but I was driving (locally and slowly) 3 weeks after my second section.

The relative I know who wasn't offered a section with a placenta praevia that had apparently moved: her son was born catastrophically brain damaged (they are pursuing a case for compensation it has been about 8 years so far) and she nearly died and had to have an emergency hysterectomy, so no more children.

Terrible errors do still happen, even in the best hospitals in the 21st Century.

You may well find you positively enjoy your elective section - I certainly did!

Good luck with it all.

I agree with driver surprise me! Had a natural birth first, in the bath, gas and air then pethadine and on the bed. Absolutely standard delivery but it's bloody sore isn't it!!

Next one was placenta previa. Lovely ELCS at 37w easy recovery, beautiful birth experience.

Now preg with number 3 and seriously considering another ELCS without medical reason just because it was so calm and nice.

minty that's just so sad :(

,.... and frankly, exactly why I'm not taking the risk (I have an extra, slightly scarier complication too so I'm absolutely not able to have a natural birth.)

consultants see the best and the worst outcomes all the time. I know sometimes you can get one with a god complex, and I'm knowledgeable enough to feel comfy asking questions, but with me there came a point where it stopped being about what I wanted and started being about getting us both through delivery alive and unscathed.

I'm still quite frightened. Not of the section, but of something going wrong beforehand.

Good luck with the birth - i hope it goes smoothly and you have a quick recovery.

Oh minty that's awful :(
You just don't know who will be the unlucky one.
my dd's nursery is so close but impossible to walk to so driving would be a massive benefit. Not least because I would have a bit of toddler free time.
Will just have to see what doc says.

Sorry to hear that Mintyy

My experience was very scary but I lived near the hospital luckily. I know what people mean about the c section thing. Evern though it's daft I had the birth I was going to have in my head, and the one I had was nothing like that. I'm usually very logical and scientific but pregnancy / birth does funny things to the brain

With the driving, I'd check with your insurer. It's something to do with the emergency stop. I've heard of women whose insurers are happy before the 6 weeks if a doctor oks it.

Well i went to see the doctor, ended up see a different one, the one I wanted was away.

He looked at my previous scan, asked a bit about my first birth. Saw that placenta was 2.5cm away and booked me in for a csec at 38+2. I was a bit shocked that it was that quick and decisive, DH was happy obviously! I forgot to ask any questions.
Went off for another scan and bloods, doctor popped his head in and looked at scan, placenta is between 2.5 and 3cm away so I asked if that's now ok to try a natural birth, he just said csection better.

I'm so annoyed I didn't question it more. Why 38weeks? I have had no bleeding or issues, so what are the increased risks of natural? chances of an emcs?
I need to go back I think.
What else should I be asking?

DH doesn't get it, why would I go through another potentially risky birth, when I can have a lovely csection. I don't know!! Tell me its pregnancy hormones.

I think the risk is the baby bashing it on the way out. My large bleed at 35 weeks (when placenta was 2cm away) was thought to be caused by DS turning and engaging. I'll never know for sure if that's correct but I did feel him engage and he was breech at my appointment the same morning so seems possible.
The risk would be a bleed. My 35 week bleed was 2 litres in 45 minutes and more during surgery (cat 1). I guess they go for 38 weeks in case you labour spontaneously before 39/40.

Check all this with your consultant of course and go with what you feel comfortable with. If you labour yourself perhaps check they have your blood ready and can do an EMCS quickly - I think most hospitals can.

If it helps, when I first spoke to my consultant I asked (and they answered)

• if it's moved, can I have a vaginal birth? ( yes, but it's not a cut off to low risk at 2cm away. There's still a good chance of a significant haemorrhage and emcs.)

• what are the risks of giving birth when it's 'just far enough' away ( basically as above, it's an arbitrary distance, there's no sudden drop to a lower risk and there is a degree of error in measurement. You still have a chance the baby will trigger a bleed as they descend. If that happens it's crash section time.)

In the end, and after a very thorough examination, they found foetal vessels near the os, so for me, a definite no no for a VB.

I also asked her (she was the head honcho for the entire region) that taking emotion out of it, with her experience seeing everything that goes right and wrong, what would she do? She answered 'section, without hesitation.' So I'm with your dh. Mine had a very similar reaction actually - he had been worried that it'd be marginal and I'd go for a vb and it'd go wrong...

38 weeks is the sweet spot that strikes a good balance - late enough that the baby is sufficiently developed and technically full term and early enough to be reasonably sure that they catch you before labour starts.

I know it's disappointing but try to take emotion out of it and look at the risk/benefit ratio. It's one day in your life, the important bit is how you raise your child, not how you get him out into the world. I suppose it's like people saying that unless you have a big 'perfect' white frothy wedding, your marriage is doomed - it isn't, the wedding is just one day, the marriage is the hard bit, and the bit that's more fulfilling.

Good luck with whatever you decide, but my opinion is with your dh and your consultant :)

The risk is that if the placenta is too near the cervix it can detach as the baby descends (called a placental abruption). This can lead to catastrophic bleeding and risk the lives of mum and baby. They prefer to do an earlier section to reduce the chances of you going into labour before as an elective section is safer than an emergency one if the bleeding has already started.

Thank you all so much.
Love the marriage analogy- I loved my big frothy white wedding - that I was in control of every aspect of!! Marriage is definitely harder work though.
Thanks Skipton for the questions, I think you've all answered my concerns. Abbey that's a terrifying amount of blood.
I'm not in a country that has the best reputation for looking after patient needs before what is convenient but they might just have my best interests this time. still wont let them take my newborn off to the nursery though!