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ICAN Accreta Awareness Month – Katie’s Birth Story
I had my first son in October 2009. He was 10 days late and after being induced for over 24 hours and having “failure to progress” during labor the doctor said that we could do the cesarean now or we could continue the induction the next day. I was tired and realized another day of induction would be miserable so I elected to have a cesarean at that time. When my son was born he had marks on his head from trying to move down my pelvis. It was clear that I would not have been able to have him naturally.
Fast-forward 18 months April 2011, and my second son was born. At this time I really wanted to VBAC and thought I had a supportive team behind me. As we got closer to my due date, I had a growth scan, and the doctors convinced me that the baby would be too big, that I should just plan for a cesarean. I do believe this was my biggest mistake. The second baby was my opportunity to VBAC. He was much smaller and his head was significantly smaller than my first son’s head! I remember asking my midwife before I chose to have a cesarean, “I realize trying for a VBAC is dangerous but isn’t having multiple cesareans even more dangerous?” I honestly don’t remember the answer. After my son was delivered, I hemorrhaged. The cause was uterine atony. I ended up with two blood transfusions, and the OB told me the next day that if I didn’t stop bleeding I would need a hysterectomy. Of course, I was devastated with this news, but with Methergine my uterus finally contracted and the bleeding subsided. The recovery was hard. It took me a good few weeks to finally feel normal and my milk never fully came in so I was forced to supplement with formula right away.
My husband and I were rightfully concerned about getting pregnant again (in addition to two boys 18 months apart) so we decided to hold off on another child for a while. Then in June 2015 I became pregnant again but miscarried in September at 14 weeks. There was no known cause of my miscarriage. The doctor actually told me the embryo probably tried to implant into my scar tissue and was unable to. I did not need a D and C as I was able to pass the fetus naturally. I got pregnant again in December. This time I was super cautious and prepared. I found a doctor that supported VBAC after two cesareans. I started bleeding at six weeks but at the ultrasound, we did see a heartbeat. The doctor said the bleeding was either a vanishing twin or subchorionic hematoma. Whatever it was, the bleeding stopped. Everything was going great. At my 20 week visit, the doctor was very positive: “Everything is great! Your weight, your blood pressure, your urine and the baby!” I felt overjoyed. After my miscarriage, I was so worried but this visit calmed my fears.
Then two days later at my ultrasound, my bubble was popped. Baby looked great; it was ANOTHER boy. My husband had jokingly said “One more time!” But as the exam continued the sonographer asked how many cesareans I had had. Something in her voice told me she saw something. When the doctor came in, he diagnosed me with placenta previa and later placenta accreta. He seemed pretty nonchalant about the diagnosis; he basically just said I’d deliver at 34 to 35 weeks. I was to come back in eight weeks for another scan and he’d keep it monitored. I was shocked to say the very least, but it seemed not very serious if I didn’t need to come back for eight weeks. I quickly researched and of course started to freak out. After finding the Hope for Accreta website and Facebook group, I learned of a placenta specialist in Hackensack, about an hour and a half from my house. While visiting with him, my husband and I decided that he would be the doctor to deliver us. He was calm and reassuring and seemed knowledgeable. He took accreta very seriously. He thought I had placenta increta which would mean keeping me monitored throughout the rest of my pregnancy. Five weeks later, when I was 25 weeks and five days, I started to bleed. We went straight to Hackensack. The bleeding had stopped by the time we got there but to keep me safe the doctor wanted me to stay for a few days. A few days turned into 20. I continue to get ultrasounds and an MRI to diagnose my accreta. The MRI confirmed increta without a little bit of percreta. Since I had no more bleeds I was released from the hospital and instructed to come back at 34 weeks and three days to deliver and have a hysterectomy. Everything went fine for about five weeks. Of course, I was always paranoid that I would start bleeding. I questioned every sensation.
Then five days before I was scheduled to deliver, I started to bleed again. We went straight to the hospital, and I was monitored overnight. The next morning I was told we would deliver that day. The bleeding was subsiding but not stopping, and my uterine irritability led the doctor to this decision. I was scared beyond belief. I cried and worried as everyone around me prepared for my delivery. I was wheeled into the OR at 12:30 pm. It was crazy in there with 20-30 people in the room. Anesthesiologist got me ready with an epidural and a spinal. My husband was let into the room. Surgery started. It felt like forever but it really was only 1:10 pm when I finally heard my baby cry. It was the best feeling ever! After all that worry and anxiety, I knew he was okay. My husband left with the baby, and I was put under general anesthesia. I woke up at 5:45 pm in recovery. I was wheeled down to the NICU to see my baby briefly, but I was pretty out of it from the medication and could only stay a few minutes. The recovery the next day was pretty brutal. By the second day, I was starting to feel a little bit better; the third day even better, and then so on and so on. Since my son was born at 33 weeks and three days, he needed help eating. His stay in the NICU ended up being 18 days.
If I could tell the world anything it would be: Do your research! As long as you’re willing to advocate for yourself, you can do it. Having a baby six weeks early and a hysterectomy at age 33 is not ideal. If I could have avoided it, I would have. We probably would’ve been done at three anyway but having the option to have more children taken away is heartbreaking. I urge anyone wanting to VBAC to advocate for themselves to do so.
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ICAN Accreta Awareness Month – What is Placenta Accreta?
By The Well-Rounded Mama, August 26, 2013
Placenta Accreta, Part One: What Is Accreta?
Read the full article here.
Summary:
Placenta accreta comes in three levels of severity ─ accreta, increta, and percreta.
Thankfully, most accretas don’t involve an increta or a percreta. However, even without these severe forms, an accreta is still a very serious complication that has the potential to become life-threatening.
Fortunately, foreknowledge of an accreta, careful management protocols, and being in the right delivery setting can significantly lower the risk of mortality and morbidity. So if you have been told that you have an accreta, don’t panic. Chances are that you and your baby will be okay.
However, you need to know that a significant blood loss is likely, a transfusion may be needed, and a hysterectomy is a distinct possibility (depending on the severity of the accreta). In the most severe cases, nearby organs may be damaged as well. Management and delivery at a large regional hospital with OBs that are very experienced with dealing with accretas will optimize your chances for the best outcomes.
Sadly, the incidence of accretas has increased in parallel with the rising cesarean rate. This is because scarring and damage to the uterine lining during a cesarean predisposes to abnormal placentation. Indeed, the more cesareans a woman has, the higher her risk for placenta accreta.
Some risk factors for accretas cannot be controlled, but a high underlying cesarean rate is a risk factor that is preventable on a population-wide basis, and routine repeat cesareans is a risk factor that is highly preventable on an individual basis.
Placenta accreta is an extremely serious complication that is becoming all too common. A casual attitude towards cesareans, an over-utilization of them in low-risk mothers, and a lack of access to Vaginal Birth After Cesarean (VBAC) is part of the cause.
This is yet another reason why reducing the cesarean rate and keeping access to VBAC is so important.
ICAN Awareness Month – Placenta Accreta: Multiple C-Sections Can Kill Mother
Barbara George nearly hemorrhaged to death while doctors delivered her fifth child at Hackensack Medical Center in New Jersey — and that was in 2010, not 1910. The stay-at-home mother from South Orange was diagnosed with placenta accreta, a life-threatening condition where the placenta grows into the uterine wall and sometimes beyond. George, 38, had the most invasive form — percreta — and the placenta dangerously penetrated the entire uterine wall and had attached itself to her bladder.
Once a rare event that affected 1 in 30,000 pregnant women in the 1950s and 1960s, placenta accreta now affects 1 in 2,500 pregnancies, according to a 2007 report in the Journal of Obstetrics and Gynecology. In some hospitals, the number is as high as 1 in 522. And doctors say the main reason is the dramatic rise in the number of cesarean sections — about 38 percent of all pregnancies in New Jersey, the second highest in the nation.
“The rule of thumb is if you have one C-section and the placenta sits right on top of the scar, the risk of placenta accreta is 25 percent,” said Dr. Abdulla Al-Khan, director of the Division of Fetal Medicine and Surgery at Hackensack University Medical Center. “If you’ve had two previous C-sections the risk is close to 50 percent and three, it’s 75 percent and four, it’s invariably closer to 100 percent.” Al-Khan and his team performed seven hours of complex surgery on George, first delivering the baby in a sternum to pubic bone vertical incision, then cauterizing veins to detach the placenta from the bladder and finally a hysterectomy.
“I always thought it would never happen to me,” said George, who delivered at 34 weeks gestation. “Mother nature protects the uterus,” said Al-Kahn. “The Nitabach layer kind of prevents the placenta from invading the uterine wall.” But a cesarean, or any kind of surgery, including an abortion or a D& C, can destroy that layer allowing the placenta to invade the body cavity.
The risk of the mother dying in childbirth has been cut by 99 percent since the turn of the 20th century, from 850 deaths per 100,000 births in 1900 to 7.5 in 1982, according to the Centers for Disease Control and Prevention. But between 1998 and 1999, the maternal mortality rate rose by 13 percent and continued to creep upwards, according to the CDC. New Jersey saw 40 maternal deaths last year, according to Dr. Joseph Apuzzio, chair of the state’s morbidity and mortality review committee and an obstetrician at New Jersey Medical School in Newark.
Doctors are also seeing other complications in pregnancy that increase maternal risk: more diabetes and preeclampsia, a higher number of twins and multiples and advanced maternal age. “When we natural age, we have more medical conditions,” said Al-Kahn. “Pregnancy always exacerbates things.” Babies are also larger, compared with a century ago, even though the size of the female pelvis has not changed at all, he said. A rise in cases of placenta accreta due to multiple cesareans is also contributing to maternal death statistics.
“Now patients have a right to make shared decisions with their doctor,” he said. “It’s self-empowerment. If I can have a tummy tuck and rhinoplasty, why can’t I have a cesarean delivery?” Al-Kahn jump-started the high-risk program at Hackensack after one of his patients nearly died in 2004. The woman had had only one previous cesarean and the placenta in her second pregnancy had implanted right on top of her scar.
“She started bleeding at 35 weeks and we took her into the operating room to deliver the baby,” said Al-Kahn. “It got to the point that she went into shock and needed 33 units of blood. We intubated her and she was three days on a ventilator. She lost half of her bladder and it took 12 hours in the operating room to save her life. I said to myself, ‘God save this individual so she can live to be with her two kids and her husband,” said Al-Kahn. “I never wanted that to happen again.”
Since the program was started in 2005, Al-Kahn has seen more than 60 patients with the risky condition. Both mortality and the number of transfusions have dropped, he said. George, who had four other high-risk pregnancies because of preeclampsia and diabetes, was referred to Hackensack after her own doctor saw something ominous on an MRI.
“I could just see her trying to maintain a professional exterior and see she had more concerns than she wanted to let on,” said George. When she learned she had placenta accreta, she prepared for the worst and got her affairs in order. “It was very difficult,” said George. “I’m the type of person that tends to think it’s not going to happen to me. I didn’t want to deal with the what-ifs. But we had to have that conversation. It was so surreal.”
Her doctor sent her straight to Hackensack where George was given magnesium and steroids to encourage the baby’s lung development. In the middle of New Jersey blizzards on Dec. 27, Hannah was delivered by a long cesarean cut from the sternum to the pubic bone. There was never any danger to the baby, who was born in 45 minutes, but doctors were worried about George, cauterizing every blood vessel using hypothermic techniques so they could slowly peel away the placenta from the bladder.
“I feel so grateful,” she said of her now 3-month-old daughter. “Hannah is amazing and has really brought this family together in such a way, I can’t explain it.” But George said that her experience is a warning to other women who opt for cesarean sections when surgery is not medically necessary. “A cesarean should never be done to accommodate your schedule or because of your fears of pain,” she said. “It’s an unnecessary trauma to the body and it should not be treated as an alternative to natural childbirth.”
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Reposted with permission from ABCNews
ICAN Accreta Awareness Month – Connecting with Social Media
One of the ways ICAN honors every woman and family that has experienced a form of placenta accreta is by holding space for them in ICAN’s Accreta Awareness Facebook group. Considered as sacred as an ICAN meeting, this group is a safe place of confidentiality for those facing a diagnosis of accreta, percreta, increta, and previa and the wide range of feelings that invariably comes with those experiences. The purpose of the group is to help bring awareness and education about this increasingly common diagnosis in conjunction with the mission of the ICAN. We hope to pave a path of support, advocacy, and education for the mothers who will face this diagnosis.
Have you checked out ICAN’s Pinterest? We’re dedicated to meeting women wherever they are on their journey to support, educate, and advocate for families as they explore their birthing options.
ICAN is also on Twitter and Instagram! October will feature more graphics about Accreta Awareness but be sure to follow for future educational articles, support features, and advocacy campaigns!
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