Pregnant after 3 csections....advice

[Mummyto3GBG]

Hi all, I have 3 kids age 7, 2 and 10 months....I’ve just today found out I’m pregnant (not planned)...had 3 sections. 1 emergency, 2 electives. I was told at my last section they wouldn’t really recommend me having another baby due to the scar tissue and risk of adesions and that if I did decide I wanted another that I should wait a lot longer than I did last time. I had thought we might have one more in a few years but I would have spoken to a consultant about it before trying...anyway now I’m pregnant and my baby is only 10 months...Has anyone been in a similar situation to me, I don’t know what to do?! I’ve asked the doctor to call me but won’t be till tomorrow, not told my partner yet he didn’t even want anymore 🙈

No, I have never been advised that. No plans to have more children though.

I’ve managed to get in to see a doctor at the hospital on Friday, they said they’d scan me and give advice on risks if I continue etc....also told my partner, I’m not sure what he’s thinking about it all as I only told him half hour ago but he was pretty shocked. Going to speak properly about it tonight

I hope you have a good conversation with your partner, OP, and that then you won't feel.so alone afterwards. My husband was the same, thinking more along logistical practicalities etc and not really knowing the risks. I made sure he knew in the end though! It's better when you're both in it together.
As for not being able to see the consultant before 16 weeks, the told me the same. Bit I called the midwife who knows me the best (do you have one you know more than others?) and she promised to speak to the consultant herself when she was seeing her a few days later, and together they had a good look at my notes. She said if there was anything that particularly stood out as being problematic, they'd see it straightaway. She got back to me quickly and said don't worry (although I'd been told the same as you after my third). I think you asked me a question in your last post to me that I wasn't sure about. But I'm seeingy my consultant tomorrow, so will definitely feed back what she says. I think you asked me if they'd actually told me that the risk of accreta etc was still low. The way I see it is, just because a risk is higher in one circumstance than another, still doesn't make it a high risk. If the risk was low in the first place, then an increased risk does not necessarily mean a high risk. But I'll certainly bombard her with questions tomorrow!

Thank you so much somethingsnappy! You’ve helped me so much these last 24 hours! Spoke to my partner, he’s very scared of the risks to me as he knows the consultant recommended against another baby and he doesn’t think they’d of done that lightly but being very supportive and I think if they say the risk isn’t that much increased compared to the previous section he will be of the same view as me that we’ll carry on. How often do you see your consultant? Are they monitoring you more closely? Aw that would be great if you could bombard her with questions 😂 Im worried about everything but I think I’m most worried about the accreta as that seems the worst of the things to have...from what I’ve read if you have placenta previa and have had multiple sections you basically will have accreta as the chances are so high in that case....I’m not sure if the chances of placenta previa actually increase the more sections you have though so so long as you don’t have that accreta may not be an issue 🤷‍♀️.

Somethingsnappy can I pick your brain again....or can you ask your consultant...I read online the chances of placenta previa are 1 in 200 and that your risk increases with each csection...once you’ve had 3 sections then your 4 times more likely to get placenta previa....does that mean the chances would be 1 in 50 for me and you? Does the length of time between sections contribute to this?

How did your consultant appointment go? Hope all was ok :)

Hi again OP! How are you feeling today? Can I ask...where did you see the 1 in 50 info? I asked the consultant if this were the case and she smiled and said 'don't worry, it doesn't work like that!' Actually, I just looked it up myself and the sources I saw stated that the rusk was 0.3% after a first section, rising to 6.74% after a third or fourth. That's not very high, I don't think. The other source talked about the percentage risk of accreta if (only if) the placenta implants over scar tissue. That risk was much higher, but obviously the chances of implanting over scar tissue in the first place are still low. The consultant says she only does further investigation into accreta if the placenta is anterior. If posterior (mine is, although low) it's not even in her radar to investigate or have concerns. None of my midwives or consultants have ever showed any concern, even from the beginning, before they knew where the placenta was.They have been quite practical and matter of fact. My consultant said 'yes, we'll have to pick through the scarring carefully, but that's what we're here for, and you'll have a very experienced team who are used to it.
As for where the placenta attaches, you will find that out at the scan, at least to know if it is posterior or anterior. In the early 12 week scan, I think it can be harder to see, but you could ask your midwife about an internal scan as you are anxious. I think they get a better picture of the placenta in that case, although do check that, as I'm not certain. If you were to find out early in your pregnancy, you could then make relevant decisions. But honestly, the risk, although higher than average, is still not high in my opinion.

I didn't get the chance to ask about the time between pregnancies....I was a bit flustered because my baby is measuring on the small side with borderline polyhydrammnios, so I am being referred to foetal medicine just in case, for a scan with my consultant herself.... She is not overly concerned, but it was enough for the conversation to take a turn away from placenta issues. However, in my own opinion, 19/20 months between your sections is not particularly close. Two years is recommended, isn't it? Have I got that right? Your timing is pretty close to that. Some people only have a year between them! I'll post this now because I could ramble on, but I think it's getting very long!

P.s. to answer a question I missed....I am being monitored more closely but not because of the amount of sections I've had....it's because of my age (43!). And then only extra scans x

P.p.s. and at 28 weeks, I have had two consultant appointments!

Another P.S.! I have been talking about placenta accreta, rather than previa, because that is the riskier complication. The often go together, but not always.

Thanks so much for getting back to me! You’ve no idea how much you’ve helped me in the last few days!

I’m sorry to hear about the Polyhydramnios, i has to google it as I hadn’t heard of it! I did think if it’s borderline it’s hopefully just a precaution they’re taking...when will u get ur appointment for that? I sometimes find when you have more monitoring and seeing consultants it helps, but as you’ve probably realised I do worry!

Thanks for all the info from your consultant....I managed to get in to see a consultant today and have an early scan... They did an internal as I was so early on...she said I’m only like 4/5 weeks, I kind of knew I was though (from the one time me and my partner had sex!) even though I didn’t know my last period. I told her all my concerns and what I was most afraid of (accreta, haemorrhaging and death).

She first needed to check where it had implanted and make sure it was no where near the csection scar else that’s a problem...luckily it couldn’t of been much further away, I made her go into great detail showing me all my uterus and the chances of placenta previa and where my scar is etc...she even drew me a picture and made a guess as to where she thought the placenta would implant (she did say don’t hold me to that though and she wouldn’t be writing that in my notes) and said she’d be very surprised if it implanted near my scar or over my cervix because of where it is now which I guess reduces my risk of accreta quite a bit.

I asked her about my previous section and what the consultant had told me about my thin uterus / scar tissue / risk etc....she said she did say I had a thin uterus and that it had been a little tricky as ur bladder was a bit sticky to ur womb so u had some blood in ur urine after when they had to push it back (I remembered this) but she said she didn’t mention tonnes of scar tissue or anything. .

She told me about the risk of scar rupturing but said this only tends to happen if you have a VBAC...she said it’s very rare for a lady to rupture just walking down the street in pregnancy. She also reiterated what your consultant said that they go slower with 4th sections and are a little more careful, they would also monitor the thickness of the uterus and maybe do surgery slightly earlier if it’s very thin towards the end or admit earlier for monitoring if they had serious concerns (she said she’d done this with one lady before but there was no issues).

She told me they’d seen women on 7th sections and that the hospital is very able to cope with complications in theatre. She said I am by no means going to be a seriously high risk pregnancy (that she could tell at this stage) or be in need of terminating the pregnancy (which she also said doesn’t come without its risks).

I think she came out glad I was leaving the amount I asked but she did reassure me that it wouldn’t be too much more risky than my last.

I also forgot to ask about the gap between my sections....they’ll be 17/18 months....with my last 2 there was 22months...but she probably would of said if that was an issue in itself.

I’m booked in again in 2 weeks for another scan as I was so early today, no heartbeat or anything yet so they said they would usually rescan.

Wow, that sounds like you had a fabulously reassuring appointment and the consultant was incredibly detailed and informative! Then I must say, congratulations on your pregnancy! Do you feel better now? I'm so glad you were able to get an early appointment and clearly some great support!
As for my situation, I'm not desperately worried. I've had borderline polyhydramnios in my two previous pregnancies too, with no reason for it, other than big babies. This time, my baby is measuring on the small side (for me, that is. Not in the grand scheme of things), so it's enough for my consultant to want to take a look herself, but hopefully just a precaution. Polyhydramnios just seems like a pattern that is normal for me. I don't know where the dinky baby has come from though! All my others have been big!

P.s. my scan with the consultant is on Tuesday x

Thanks, I do feel a bit better...I still need to speak to my partner about it all as he had to have the kids today whilst I went to the appointment and we haven’t had a full chat about it yet but I feel he will be supportive so long as he knows the risks continuing aren’t too high even though prior to this in his head he had no plans for anymore kids.

Yes the consultant was brilliant, unfortunately she’s retiring soon so I can’t have her as mine but she was definitely the one I needed to see today for the reassurance. She said in a couple of weeks they might be able to reassure me more with the next scan.

Oh that’s good you don’t have long to wait for the scan. I have big babies too, well I say I do my first And second were....first was 9 pounds 6 (41+6 weeks) and 2nd was 9 pounds 10 (39weeks!) but my 3rd was only 7lb 11 (39 + 1) so average....I didn’t eat as much in my last pregnancy so I thought it was that....consultant today said it was maybe more to do with gender as boys tend to be bigger than girls and babies take what they need whether you eat a lot or not....do you know what you’re having? How big were your other babies? That’s one thing I am a little concerned about that the bigger the baby the greater the risk of rupture?? What you think?!

That's interesting about the sizes of your babies! So were your first two boys and your third was a girl? My first was a girl, 8" 5. Second a boy, 10" 5. Third a girl, 9" 1. But she was a week early, whereas my others were nearly two weeks late, so she would probably have got bigger if she'd stayed inside longer! Your difference in the pattern of your babies' sizes is quite reassuring to me! I guess random genetic influences comes into play too. My husband and I were quite big babies, but my mum's family were not. So maybe her side has influenced this little bean!

As for the risk of rupture, I really really wouldn't worry about that. The risk is slightly raised in a vbac, but still not massively. And as far as I know, it's the contractions that put the pressure on the uterus, which is why induction is not used for a vbac, because it increases the strength and intensity of contractions. And in all I've read, I've certainly never come across a big baby mentioned as a risk factor.

I've had 4 c sections. I was advised after my third to wait 5 years for another baby as I had scar tissue and complications but I fell pregnant 9 months later. Everything was ok, they booked me in for a double slot for the c section as they were working slowly as a precaution and there was the option to put me to sleep, but I didn't need that in the end. It was probably my most straightforward birth, though I did get sterilised before they closed me up.

@Crystal87, that's good to hear! Thank you.

No I had girl first but she was like 2 weeks late so might of been like a pound to a pound and a half lighter had she been born at 39 weeks like the other 2. Then had a boy who was my biggest then another girl (my smallest). I think genetics definitely factor in it yeah,Me and my parTner weren’t little babies so I expected them to be quite big.... my partner is really broad on top too and when my son was born he was all chest! Still is!

Yeah consultant said rupture is rare, and so long as I’m not planning a vaginal birth I shouldn’t worry too much about it.

Have you found each section easier or harder in terms of anxiety level? Even though I’ve done the section thing 3 times before, I feel like each section I’ve been more and more anxious about it than the one before.

@Crystal87 that’s exactly my situation at the moment! I’m glad everything went well for you! I told the consultant yesterday I would also be sterilised....did you find that part straightforward?

Yes the sterilisation was fine. It took a while for them to do it as they said my fallopian tubes kept bleeding when they were putting the rings on, but was done successfully in the end. I never felt any different afterwards during the recovery either to my other sections. The surgeon will take your medical history into account and make sure they give you the right care so try not to worry.

I've had heavier periods and slightly more painful since being sterilised but it's so good not having to worry about getting pregnant.

@Crystal87 thanks for this...I worry about everything...I might have to get my partner to have the snip, I want to be sterilised but I hate the whole csection experience I just want it over and done with as soon as possible. Last time I asked about having a GA because I was so scared after the previous section (not that it went badly I was just so scared) but they said it carried more risks so that’s the only reason I didn’t. My first emergency section was the worst and most traumatic because my daughter was stuck in the birth canal yet i found it the easiest as I was so out of it on gas and air and tired from Labour that I nearly fell asleep once they put the spinal in, my 2 electives the staff couldn’t of tried to reassure me anymore but it didn’t help I was such an anxious mess.

I’m starting to panic again 🙈 only saw the consultant on Friday but I still find myself googling placenta accreta and thinking I’m going to get it...I didn’t even know about it in my previous pregnancies....It wasn’t even on my radar and now I’ve been told about complications I’m assuming I’m going to have them all 😖

@Mummyto3GBG

I’m starting to panic again 🙈 only saw the consultant on Friday but I still find myself googling placenta accreta and thinking I’m going to get it...I didn’t even know about it in my previous pregnancies....It wasn’t even on my radar and now I’ve been told about complications I’m assuming I’m going to have them all 😖

I know someone who did have it with her fifth baby. In the end her final weeks were spent resting in bed and the baby was born slightly prematurely. She needed a hysterectomy but both are fine and well.

OP, sorry it's taken me a while to get back to you. I feel a bit drained at the moment because something has come up with my baby which could be something or it could be nothing, but it's worrying and the not knowing is difficult. It's not placenta related though!

I understand how you feel, because I have also felt just like this during this pregnancy. Like you, it didn't occur to me to worry about accreta etc in previous pregnancies and yet this time I was preoccupied with it. But it is still very that you'll have it. Your chances of not having it are way way higher than having it. It's still a rare condition. And if the worst came to the worst and you did have it, the good thing is that they would know about it in advance and would be prepared. The danger comes when it has not been diagnosed and women go ahead with a vaginal birth and the bleeding is unexpected. In your case, with previous sections, they'll be in the lookout for this and so you'll know one way or another. If the bleeding is difficult to manage, they will do a hysterectomy and that is his they manage the bleeding. How do you feel about that? I am OK with this possibility. I don't intend to have any more children. And it would be a partial hysterectomy and so you'd still have your usual hormones in place and even the possibility of periods still, though lighter. And it wouldn't affect breastfeeding either, if that's what you plan to do, as the hormones needed for this come from the brain. I hope you're OK x