This moving story is from Nicki, who wanted to share her story about her experience of Placenta Accreta and Placenta Previa and her incredible struggle to carry and birth her baby.
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I knew things were going to be tricky at our 12-week scan. Our baby was developing perfectly but the scan report mentioned ‘large placental lakes’. I spoke to my Obstetrician and he reassured me that it was too early to be concerned and we had to wait and see. Later scans confirmed my fears- Placenta Accreta – (possibly Percreta) and complete Placenta Previa.
I had previously had two unavoidable Caesarian Sections for breech presentation and the placenta had attached to the scar tissue.
Placenta accreta occurs when all or part of the placenta attaches abnormally to the myometrium (the muscular layer of the uterine wall). Because of abnormal attachment to the myometrium, placenta accreta is associated with an increased risk of heavy bleeding at the time of attempted vaginal delivery. The need for transfusion of blood products is frequent, and hysterectomy is sometimes required to control life-threatening haemorrhage. (Wikipedia) Placenta Previa is a disease that is characterised by placenta attachment to the uterine wall close to or covering the cervix. (Wikipedia)
I needed to know exactly what we were dealing with and turned to Google…quite an eye-opener. I found a Facebook support group called ‘Survivors of Accreta’ which on one hand was very informative, but also (as the name suggests), quite confronting. I learnt about bleeding during pregnancy. Not just a little bit of spotting, but huge relentless bleeding resulting in blood transfusions, premature babies, hysterectomies and the rare potential for maternal and fetal death. Women spoke of updating their Wills and writing letters to their families before they went for surgery…
I was very frightened. I tried to remain calm and positive for my children and actually managed to enjoy my last pregnancy. This baby was much longed for as I had experienced two devastating miscarriages following the birth of our second child. On the flip side, I would also have low days where I sobbed with my husband when the children were in bed. He said he had a ‘good feeling’ that it was all going to be fine. I wasn’t so sure. Sobering stuff.
I was closely monitored for the remainder of my pregnancy. My midwife used the phrase ‘ticking time bomb’ to describe my situation. She advised me not to travel as I needed to be within a 30-minute maximum distance from the hospital. I stopped doing pilates and was advised to stop all sexual contact (to reduce the risk of bleeding). I did do lots of walking on the flat- I walked for miles every week in an effort to keep fit and be physically prepared for the weeks ahead. I was advised to call an ambulance if I saw any blood at all.
We breathed a sigh of relief when we passed the 24-week mark. Our baby boy continued to grow beautifully and I felt physically well. I was having regular scans and midwife/obstetrician appointments. I had a placental MRI scan at 30 weeks to establish the degree of placental invasion. They were worried that the placenta was very close to my bladder (Placenta Percreta). The obstetric team had a meeting about my case. It was decided I would have a Caesarian Hysterectomy between 34 and 36 weeks. There was no option to preserve my uterus. I accepted this decision without question – our lives in their hands.
My last thought before they put me to sleep was ‘ Please don’t let us die.’
I got to 34 weeks with no bleeds. The Obstetricians decided it would be safer to wait until 36 weeks to deliver our baby. Apparently, it’s a fine balance between the risk of prematurity versus the potential risk of a large bleed. Thankfully they made the right decision and I made it to 36 weeks.
I can still remember very vividly the twenty-minute drive to the hospital at 6.40 am. I had spent the previous evening writing the dreaded ‘just in case I die’ letters to my husband, 8-year-old daughter and 6-year-old son. I also wrote one to my unborn child. One of the hardest things I have ever had to do. It can still make me feel physically sick to remember the guilt and fear I felt at the thought of leaving them. Thankfully they were oblivious to the enormity of the situation and were having a lovely sleepover at Nanna’s house.
The preparation for my surgery was huge. A very wide cannula in each arm in case they needed to rapidly administer blood or blood products. An epidural followed by the insertion of stents into my ureters. Finally, balloon catheters were inserted into my uterine arteries, guided by ultrasound. These could be inflated if severe bleeding occurred. This whole procedure took almost 3 hours and involved numerous specialists. The medical staff were incredibly kind and reassuring. They chatted and joked and I felt quite calm and distracted until the time came for me to be taken into theatres. I kissed my husband goodbye, told him I loved him and my babies and cried. There were over twenty people in theatres apparently although I was only aware of five or six. The jovial, relaxed atmosphere of the previous few hours was replaced with a palpable tension. One thing that really stuck in my head was the position they put me in on the operating table- kind of flat on my back with my arms out to my side. I’m not remotely religious but it felt like a crucifix. I wish they had told me before.
My last thought before they put me to sleep was ‘ Please don’t let us die.’
I opened my eyes and remembered hearing someone moaning and crying – me I presume. I had severe pain in my left side. I was told I was in recovery. I cried for pain relief and was given some via my cannula. I drifted back to sleep and then woke to find my husband and the Lactation Specialist hand-expressing colostrum – one on each side! My husband was a quick learner and the little syringes of liquid gold were easily collected. This had been discussed antenatally – I was determined to breastfeed and was advised I needed to express as soon as possible in recovery. I remember asking my husband if I was alive. He showed me a picture of our baby who was in the Special Care Baby Unit (SCBU) as he needed some breathing assistance. He was a good size! 7lbs at 36 weeks. Beautiful.
My Obstetrician came to see me in recovery. The surgery had gone well. I had lost a few litres of blood but they had given me some of my own blood back via a cell saver machine. I hadn’t required a blood transfusion. I had a six-inch vertical scar from my pubic bone to above my umbilicus. I didn’t die.
My wound now resembled a zip with loads of metal clips.
The first 24 hrs were a blur. I vaguely remember phoning my Mum and some friends but have no real recollection of our conversations. My husband left to go collect our children and I was looked after in the Obstetric High Dependency Unit overnight by a lovely midwife. She expressed colostrum every 3 hours for me as I was unable to do it myself. I had drips, a catheter, a morphine pump and a drain. I was hooked up to a monitor which took my blood pressure/pulse/oxygen saturation very regularly so I drifted in and out of sleep. My legs were in a compressor which periodically inflated to reduce the risk of blood clots. My pain was well controlled and after a few hours, I was able to have a drink – absolute bliss. I had an unquenchable thirst. The midwife wheeled me on my bed around to see our baby who was on CPAP. He looked so vulnerable and so tiny.
The next morning I was determined to get up and have a shower. The midwife helped me with all the tubes and drips and I sat on a chair in the shower. I felt so much better. Tired and spaced out but clean! I looked in the mirror and hardly recognised my face which was very swollen from all the fluids I’d been given intravenously. My husband came in and we were transferred to a private room on the postnatal ward next to SCBU. Walking was quite an effort initially so my husband wheeled me around to see our baby. He was doing well but initially, we were unable to hold him. I needed to express 3 hourly so that he could have the colostrum down his feeding tube. I had moved on to a double breast pump and expressing was a big part of my day/night. My milk supply was compromised due to my blood loss. It was very disheartening to pump for 20 minutes and only get a few mls. Luckily a lovely friend had offered to be our breast milk donor if needed so Felix, (we named him after a few days) was given only breast milk. My husband was the first person to have skin-to-skin with him in SCBU. My children came in to see us after 24 hours- I cried when I saw them – I missed them so much.
I was able to breastfeed him for the first time after 3 days. He instinctively knew what to do and I was so proud of him. He was a sleepy ’36 weeker’ and quite difficult to breastfeed for any length of time. I had a lot of support from the midwives, especially the night staff. Expressing continued around the clock.
I was up and about and doing well – walking everywhere after the first 48 hrs and all drips/drains/pumps out. My pain was well controlled on oral medication. I think all the walking had prepared me well for the recovery.
On the fourth day after he was born my vertical incision popped open when I was doing a wee. Quite a shock to say the least! Part of my ‘bowel sheath’ was protruding through my scar – not for the faint-hearted. High on morphine, I was keen to post a picture of it on Facebook but thankfully my husband persuaded me not to! I was taken back to the theatres that afternoon for another general anaesthetic, repair and re-suture. Not ideal! My wound now resembled a zip with loads of metal clips. The surgeon apologised afterwards and said I had been incorrectly sutured at the initial surgery. I appreciated his honesty. Shit happens.
Felix was in SCBU for a week and then came to the ward with me. We later learned that he had got ‘stuck’ during the difficult Caesarian/Hysterectomy breech delivery and had required seven minutes of CPR. How utterly devastating. I felt like I had failed him in some way. Even though I had been asleep for his delivery I kept having awful pictures in my head of grey, lifeless babies. The paediatrician who resuscitated him came to the ward to give us a de-brief. She reassured us that although his Apgar scores were very low, his cord blood gases were good so they didn’t suspect any long-term effects from the delivery. What a huge relief.
We stayed in hospital for two weeks. He was jaundiced initially and we needed to get the feeding established. I was pumping religiously and trying to get my milk supply up. Various staff advised me to get some rest and switch to formula… I wasn’t giving up now! He had a feeding tube initially and then he had to have expressed milk in a bottle. He switched between nipple and bottle without a fuss- what a star. My husband spent many nights with me in the hospital sleeping on a mattress next to my bed. We got into a great routine with the 3-hourly feeding/ expressing/ milk down the feeding tube scenario. We became quite institutionalised! I was ravenous and ate huge amounts of hospital food but initially lost a lot of weight. My husband went out and brought me delicious smoothies and treats. Our older children had a two-week adventure with various sleepovers and outings. Family and friends were amazing.
Back at home was harder than I expected. Felix resisted sleep and he was still pretty low on energy when he was awake. Breastfeeding was a mission and I hired a hospital pump until he was 3 months old. By that time my milk supply had finally turned a corner with the help of Domperidone, three hourly feeding/expressing and a good diet. I was horribly anaemic for the first few months and I took iron tablets and ate rare steak.
Felix turned two a few weeks ago – a beautiful, healthy, cheeky boy with lots of words and a great sense of humour. It’s been quite a journey but I’m very proud to say that we are still breastfeeding! It’s SO lovely and I hope to continue until he weans himself.
I was put on a low-dose anti-depressant when he was three weeks old which helped with the ‘pictures’ in my head. I also had some counselling for birth trauma which helped. My husband has been fantastic.
Felix has been checked over by a Paediatrician and is thriving. I am fit and healthy and back to doing pilates and working part-time. Life is good! Time has made a difference to how I feel. It was a huge, life-changing experience but I look at my gorgeous boy and I would do it all again in a heartbeat. I look at my scar and it reminds me of what we went through. We are both very lucky and I’m incredibly grateful to the wonderful medical staff who cared for us so beautifully and gave us our positive outcome.
Nicki Mitchell
