Over the shock and now considering what to do...help

[Mummyto3GBG]

Hi all, I have been in a complete shocked and anxious state over the last couple of weeks and trying to work out what to do for the best. Found out I’m pregnant (I’m about 7 weeks now)....I have 3 children who I just adore (don’t we all) age 7, 2.5 and 10months. They were all born by csection. I hadn’t completely ruled out a 4th but had planned to wait a good 3 years before thinking about another. The main reason being at my last csection 10months ago the consultant didn’t recommend I have another due to scar tissue/ adhesions/ thin uterus lining and increased risk of complications with a 4th section. When I’d said I had wanted one more she said “if u did decide to have another be aware of the risks and make sure u leave it longer than you did with the last ones” (dc 2 and 3 are 21/22months apart).

You can imagine my horror when I found out I’m pregnant after not researching these risks. When I researched these I convinced myself I am going to die and booked a termination however felt I needed to speak to consultants first too to make sure I am fully informed and make the right decision.

Consultant basically said the major risk is a condition called placenta accreta where your placenta attaches to you scar tissue and become embedded in it or grows through it and attached to other organs and they struggle to remove the placenta so tend to have to perform a hysterectomy and you lose pints of blood and need multiple blood transfusions and as my uterus is thin this is why she didn’t recommend anymore. This can happen to anyone but the risk of this increases with each csection which is why they recommend the safe upper limit is 3 sections. She said my risk of this would be around 1 in 10 now however when I have looked at complications if I get this the chances of death are 7 in 100 (to me this seems very high) and I would almost certainly need a hysterectomy and potential bladder op if the placenta had gone through the uterus and attached to bladder. Had I have researchEd this in a few years....This would have been enough to put me off trying for a 4th baby.

Other risks she told me include uterine rupture (about 3% for a 4th section) which can cause Fetal and maternal mortality.

Then there would be usual risks for csection - as it would be a 4th these complications increase and I’d need to have the top surgeon performing it.

The consultant could not say whether I would get these complications or not and could only outline the main risks. She told me that I don’t have to have a termination and that everything could be fine and they couldn’t tell about the placenta till much later on but it would be up to me to weigh up these risks and decide whether to go ahead And they’d support either decision.

I am very worried my body isn’t healed enough for this and concerned I’ll get the placenta issue and die and leave my babies with no mum. I’m worried If I have an abortion and everything could of been ok and I’ll regret it for the rest of my life. I’m also aware that it’s this 4th baby or none. Partner is very supportive and just wants me to do what’s right for me. I struggle in pregnancy and get spd and anaemia so the thought of these again is a lot to handle but I’m also aware it’s only 9months of my life. I know I would manage 4 babies fine although expensive and nursery fees would be hard for a couple of years. It couldn’t of come at a worse time for us as we are currently buying a house.

Sorry for the long post I guess I just want to know what other people would do in my situation. I feel if I didn’t have to have csections my decision would be easier or if this had been number 2 csection but I’m worried about a 4th section and potential complications.

I go from thinking I need to put my current children first and get a termination to thinking well what if it’s all ok and wanting to carry on.

I go from thinking I need to put my current children first and get a termination

Sorry you're in such a tough situation OP, but ultimately this is what I'd so. Without question I wouldn't want to risk leaving my existing DC without a mother for the sake of bringing another DC into the world.

The other issues (nursery costs, etc) are pretty irrelevant in the scheme of things.

Thank you, I feel you are probably right...some days I think I just need to get it over with and have the termination cz I can’t play Russian roulette and worry for the next 9 months hoping everything will be fine....then other times I think well the chances are higher that I’ll be ok and I always wanted 4, other people have 4 csections and are ok so I probably will be 😖

It’s so hard. I look at my kids and think I couldn’t imagine getting rid of any of them but at the same time look at them and think I cant even bare to think about leaving them without a mum either 😢

placenta accreta now has a far far lower mortality rate than 7%. That's from very old literature, and although there is a rush of death, I don't think it's common any more. And as they can scan for it in pregnancy, that helps them manage it!

In 2019 there were 640,370 births. Placenta accreta occurs in 1 in every 217 births, which equates to 2951 births a year. A mortality rate of 7% would mean 207 would die from this complication alone, every year.

In the entirety of pregnancy and 6w pp, around 70 women die a year, of all causes. Around half of these are from heart disease, blood clots, epilepsy and strokes. Bleeding is 8% (about it 5.5 women a year) of maternal deaths, and that would include all bleeding, of which accreta is only one cause.

Have a look at some studies for more realistic estimates of the risk:

• pubmed.ncbi.nlm.nih.gov/11945088/

310 cases of accreta = 11 hysterectomies and 1 death.

• documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:b3e38237-79ca-48c6-95a8-5dc2590d5d04

295 cases = death rate was 7 in a thousand, though weirdly 66% had a hysterectomy, which is a huge difference from the other article.

Whichever way you go is upto you, but you should make the decision based on the actual risks, which are much lower than what your mind goes to. The likelihood of you have accreta is reasonably low, you are very unlikely to bleed to death because they can diagnose it before you have the baby, and plan for the birth. The death rate these days is thankfully pretty low.

I imagine the 7% death rate is where it's not detected, and given not all babies are born in hospitals (they happen with vaginal births too sometimes), it could be a medical emergency very quickly. That's very different from the too doctor doing your section, where it's been diagnosed, they have a plan, and they have huge amounts of blood on hand, should you need it.

Thank you both.

The doctor said it depends where my placenta implants, so long as it’s not low down or previa the chances of accreta would be very low like 2% but she also said that my chances of placenta previa are around 10% as the chances of this increase for each section so for a 4th section would be around that but that if I was to have previa then my chances of accreta along with it would be like 60%.... she didn’t give me my risk of it then being percreta or increta (the more serious types) but I believe less people get these than just accreta but I know of one lady who has had previa and increta, she had an awful time but survived. I’m not sure that my womb being so thin and my bladder adhering to my womb last time would make me more likely to get the worst type though if I did have it 🤷‍♀️

It’s all very scary to think I could get these, enough to make me seriously consider a termination. I have the pills at home I’m just finding it hard to decide whether to risk it or not. Obviously the chances are higher that everything will be ok and stupidly I didn’t even realise the placenta could cause an issue with my previous babies because I could have got it then too but I suppose they say 3 is a safer upper limit for csections before these complications become more common. I only looked into these complications after I found out I was pregnant a couple of weeks ago and remembered the consultant had said no more because of the risk of these complications.

I don’t know if the fact my egg has implanted far away from my scar helps or not 🤷‍♀️ I guess as the baby grows it will fill the whole uterus though and the placenta could therefore attach anywhere...the consultant told me they wouldn’t be able to tell where the placenta attached/ if there was accreta till later around 20weeks they look for this.

I did want 4 children but I wouldn’t of risked getting accreta and would have stuck at 3. Just hard when now it’s happened the what ifs. You see lots of people who have had 4th sections and had no complications then others who aren’t so lucky...doesn’t seem like there is any guarantee 😞

What a difficult situation to be in! I’m so sorry you’re going through it.
You definitely are right to be concerned with your own health. The statistics and literature provided by @Thespottytortoise seem to bring it into perspective.

If I’m not mistaken, there’s a low chance you would have accreta, and even if you do, there’s a low chance that there would be serious complications from it. A low chance multiplied by a low chance equals an extremely low chance!

It sounds like you’re overestimating the chances of something going wrong. You aren’t sure if previous outcomes make it more likely to get the worst type, but you’re assuming that just maybe possibly it might be. You’re not sure if the baby’s implantation location makes a difference or not, but maybe possibly it might …

I totally and completely understand why these different fears and assumptions are going through your mind, but have you checked any of these ideas with your medical providers? Even if it means going private (though it shouldn’t), for this important of a decision, I would try to seek a second opinion.

I was struck by some of the things you said about looking at your older children and realizing you could never get rid of any of them. It might really cause a lot of mental anguish afterwards if you went through with it based on something that could happen but isn‘t likely.

Sincerely wish you health and happiness now and in the future. You’ll be in my thoughts. x

Thanks @Urbanewell3 you are completely right the chances of these things happening are low but are higher than when I had my previous sections and it worries me more this time as the consultant didn’t say it would be safe enough for me to have another based on what they saw of my womb 10 months ago at my last section and if I did want to risk it I should wait a good few years to try and reduce the risks of some of these things.

When I spoke to her recently about it she said they hadn’t recommended another due to my womb being very thin where my scar is and I had a bladder complication....she said it’s not to say it would be unsafe And you have to have a termination but that I would be taking more of a risk and the chances of things going wrong would be higher this time. The accreta and uterine rupture due to my womb being thin being the biggest 2 risks I believe although these are rare occurrences they happen more with the more sections you have and the less chance you give your body to heal...and if I carry on I would have 3 pregnancies in 3 years which would be of concern as they say leave good gaps between sections to let your body recover. Having said that as you say it is all very much “what if”.

I have one side of me that knows I will find it very hard to terminate and always wonder what could of been and never know that it all could of worked out ok and I know I will be extremely sad. But then I have the other side of me that thinks well if I carry on and get diagnosed with accreta or My uterus ruptures, I would never forgive myself, for putting my family through all the worry and god forbid die from it. I also had a very hard pregnancy last time and spent much of it on crutches which is a worry when I have 3 young children.

I’ve tried to justify having a termination/ keeping the baby not based on the heath factors alone by weighing up other things like nursery costs, house, car, holidays, the fact we have no help from family, that work wouldn’t be impressed at me having another year off maternity leave etc but to be honest these all seem irrelevant to me as they wouldn’t be reason enough for me to have a termination on their own.

So I am therefore literally basing my decision on whether it is safe enough for me to have this baby without serious complications that could implicate the rest of my family and as I can’t be sure it’s very hard but my sensible head is saying I shouldn’t be risking it 😞

Sorry you have found yourself in this position. I can relate a little, I chose to carry on an unexpected pregnancy and have had a c section before. I realize you face greater risks with your previous sections but I have also heard a lot about risks and whatnot from my midwife this time round. My previous section ended up with me losing a lot of blood and although it doesn't compare to the elevated risk you might have, I do understand that it is a scary thought. I think you are being very sensible in considering your health. At the same time, although knowing all the risk factors myself, I tend to think the risk of serious problems is usually fairly low. I'm considered a higher risk pregnancy and have got to say that my appointments and the level of care/referrals to specialists have been impeccable and feel that when I do go in, everyone will be well prepared. It's a tricky situation to find yourself in when your health is concerned. I think in most situations the logical choice is to terminate an unplanned pregnancy. Personally, I couldn't shake the feeling that I would always have regret, wondering what if and plunge myself into a hole. I have no history of mental illness but I was very concerned about the damage it would do to me. It's purely an emotional reason and to me it felt much better deciding not to terminate.
I'm not trying to sway you at all, that's just my personal experience.
I would try to get the clearest picture possible from your consultants, what the plan would be for your worst case scenarios ect.
On the other hand, I would also make sure that should you decide to terminate, your provider is aware of your medical history as it may affect your risks, especially with a surgical termination. As with any procedure there are usually risks.
Wish you all the best and hope you have or will take enough time to think things through and come to the best decision for you and your family.

Thanks @laura212 I agree emotionally I will find it a lot harder to terminate. However I can also see how emotionally carrying on with the pregnancy will also cause me a lot of anxiety and stress although I can also see that this (all being well) would only be for 9months.

I spoke to the consultant about my worries, she said they have to be honest with risks and I will have these worries for 9 months but that they would do all they could to support me whether these complications happened or not. I think if they could tell me all would be ok whether I got these complications or not I would have no issues in continuing.

I think each pregnancy I’ve become more anxious and having the responsibility of 3 kids has made me even more anxious and risk averse.

My last section was only 10 months ago and it still feels very raw, I wonder how I’d of felt in a couple of years if this had happened.

Yeah I’m worried about the termination too, they have given me the pills, I’ve just not taken them yet. It all just feels like such a mess 😞

Nobody can and should make the decision for you and it's a difficult place to be. I've been made aware of uterus ruptures and emergency c sections, hysterectomy, blood loss and all that.
When I explored termination, I was also given a list of possible complications and possibly elevated risks due to my section and history. So no matter where you turn, you can't really escape the possibility of complications however small. Like I said, it doesn't compare to you, however I completely understand your worry about your health.
It sounds like your deciding factor in this will be your health. I think the best thing you can do is just to gather as much information from your consultants, talk to your OH, have a good think, consider how you would cope either way and hopefully you'll have an inkling what might be best for you now and the future. I urge you not to research too much online, you can scare yourself silly with all the possible things that can go wrong.
I didn't base my decision on my health to be honest, it was a case of me and DH having different opinions. It was very much an emotional decision, it's only in recent months that I've been told about all the risks coming up but wanted to comment as it can feel like a very lonely place when you're faced with this decision.

@laura212 thank you for your reply. I am going to decide by today what I am going to do. It’s really hard, I would find it very hard to terminate, the baby would be very loved but I feel like I’d be taking a risk to continue which could be very bad for me and my family. I have awful pregnancies too and this has come at completely the wrong time. I should of listened to you telling me not to google, I joined a couple of csection groups on Facebook and an accreta one and last night I read all peoples stories and scared me so much I nearly took all the pills there and then. I just sat and cried all night. I think because it was a worldwide group but everyone had the same thing it felt like it was so common and made me think I can’t do this. X

Hey, may I suggest you also join a group on FB for women having sections, and ask about repeat section experiences? that way you'll get more of a cross section of experiences.

Obviously if you join a group for people that have had accreta, then you will read about accreta stories, but what you won't read is about is the vast majority of women who don't suffer this.

It's like deciding whether it's safe to cross a road by reading the accounts of people that have been runover, rather than everyone who crosses.

Best of luck.

Excellent, balanced advice above. 😊

@Mummyto3GBG You make a good point that the most likely scenario if you continue with the baby, is that you’ll have stress and anxiety and perhaps some other problems, for the rest of the 9 months, which will seem like a long time. But you can manage that anxiety partly by thinking logically and quantitatively: It did sound like the consultants told you that you have a higher risk of serious complications than last time, but still low? Higher than very low can still be very low, if that sentence made any sense! And then ... if your worst, partly google-fueled fears don’t come true, the anxiety during your pregnancy is temporary, and at the end you have your much loved baby - which you can’t put probabilities or values on when making a logical decision, but of course, in any major life decision there are factors that can’t be quantified. The emotional distress of termination otoh isn’t necessarily temporary; it can last much longer and can really eat some people up, though others are just fine.

Most definitely not telling you what you should or shouldn’t do. It’s a complicated situation, many factors. Keeping you in my thoughts and do take as much time as you need before you take a step you can’t go back on. xx

7 in 100 would be FAR too high a risk for me. That's like handing someone a bag of M&Ms and saying, go on, eat one - you've got a 93% chance of being fine and a 7% chance of getting one of the poisonous ones. I get what a horrible, hard decision this is, but I would terminate, no question.

But as @Thespottytortoise shared, the modern data shows numbers like 1 in 310 (0.3%) and 7 in 1000 (0.7%) for the mortality rate - so less than 1%, not 7%. And the chance @Mummyto3GBG will even have accreta is about 10%.

Anyhow aside from the numbers ... I hope you are doing all right!!!

There is no perfect answer to this, it is such a hard decision. I hope you have a lovely DP who is supporting you through this. Whatever you decide, it is going to be difficult. Thinking of you OP, stay strong xx

Hi, how did it go? Did you have your baby?

Came here to ask the same thing!