At my 20 week ultrasound the radiologist noted then something was a
little funky with my placenta. Her exact words were “I’ve never seen one
this wide spread before, it’s everywhere” It was anterior, also wrapped
around the right wall, then extended from the fundus to fairly low down
by the cervix. She didn’t mention it at the time but on the report she
also wrote that it was thin. It was recommended I have a repeat
ultrasound at around 28-32 weeks to see if the placenta had moved away
from the uterine scar, as it was ambiguous at the time whether or not
the placenta was encroaching on the scar.
I tried not to devote to much thought to the concept of accreta,
although being who I am I did have to read a few studies and inform
myself a little on the likelihood of it occurring. I decided that yes
there was a significant increased risk having both a low lying and
anterior placenta following a c/section, but that risk was still low
enough I wouldn’t change my plans from a homebirth on the basis of ‘what
if’. Although I didn’t plan to make any firm decisions either way until
I’d had the later scan.
The 32 week ultrasound showed the placenta looking fairly normal, well
nothing abnormal was noted about it anyway. The lower edge was about
16cm’s away from the internal os which probably meant it was well away
from the internal scar also, although the scar itself could not be seen
to confirm this.
With this new knowledge I put all thoughts of accreta away and continued
with my plans for a homebirth.
The birth itself, although a few weeks early, was uncomplicated and
occurred at home as planned. It was a fairly rapid birth and although I
had good intentions I never actually got around to calling the midwife
so it was an unassisted homebirth.
Oscar was born at 5:30pm, and the first half hour after his birth was
spent exploring him and introducing him to his brothers and sisters.
Around 6:00pm they were getting hungry for dinner and started wandering
off, and I turned my attention to myself and wondering when the placenta
would make its appearance. So far I’d had no blood leakage, not even a
drop. Oscar was still attached to me, and I didn’t want to cut his cord
until the placenta had arrived. My husband had rung the midwife and on
my instruction told her I and the baby were well and all was fine. She
gave him instructions to ring if we needed her so somehow he had implied
we didn’t need her to come up right then, which in all honesty we didn’t
as all was well at that stage.
Around 6:30pm I felt an afterpain and decided I’d give a little push and
fully expected to see a placenta as a result. What I got instead was a
rush of clots about the size of a placenta but no actual placenta. How
very weird, this has never happened before. I gave a gentle tug on the
cord to see if it ‘gave’ any. It didn’t budge. I put my fingers inside
myself to see if I could feel it sitting in the vagina, no placenta but
another large flood of clots and liquid blood came out. I decided this
wasn’t quite right and asked my daughter to call my midwife and get her
to come up. She came back in to sit with me and I had another flood of
blood. I was sitting in it up to my hips now. I asked her to pull the
birth mats out from under me and replace them with some new ones. We did
this another three times, after the third time my husband popped back
into the room; he’d been busy settling the other children up till then.
I looked up at him and felt decidedly dizzy and faint. I said ‘Ring an
ambulance NOW’. I knew I was bleeding a lot and needed to get that
placenta out so I decided to cut the cord and sent them both of for the
scissors out of the medical kit and some wool to tie it. I had intended
on making some cross stitch thread braided cord ties but the early birth
caught me unprepared. Once he was unattached from me I got myself into
a position to try and push out the placenta. All that came out of me was
more blood though. I had a very strong suspicion by this stage that it
was adhered and despite my best efforts it just wasn’t going to come out.
Around 7:00pm the ambulance arrived and the midwives arrived about 5
minutes after them. I was really pleased that one of the medics was an
old friend I’d met about 13 years earlier when we were both having our
first homebirths. The first thing she said to me was ‘congratulations’ I
can’t tell you how much that meant to me and how much it set me at ease.
The other guy was equally as lovely and commented on how much better
this transfer was going than his last homebirth transfer where he
stepped firmly in the ice cream container holding the placenta.
My midwife inspected my uterus and the blood loss and decided it was a
lot around 700-800mls but not too horrid. She gave a little tug on the
placenta but nothing was a budging. I expressed my concern she be gentle
as the last think I wanted was a severed cord from the placenta or an
inverted uterus. She assessed there was a very full bladder and little
to no contractions going on. She gave me an injection of 10 units synto
IM and a few minutes later contractions started up, she tried again to
gently pull on the cord while I pushed with all my worth. Just more
blood, it was coming faster now with the synto bringing on contractions
and I was getting very light headed and loosing strength. She agreed it
was most likely adhered and we needed to transport.
There was a quick scramble for baby clothes and something for me to
wear. They were concerned about covering me but really at that point I
didn’t care if I was starkers, I felt like my life was slipping away and
clothes were the last thing on my mind. I left knickerless and in a bra
and tee shirt with my dressing gown over me. My daughter and midwife
came with me in the ambulance, my daughter rode up front, she came to
look after Oscar as my husband needed to settle things at home before he
could follow. He other midwife took her car and followed us.
Once in the Ambulance my midwife put in a venflon and set up a running
line. More synto was run through with the saline and I was put onto O2.
I continued to loose blood in the ambulance, and started to loose
consciousness. They set up a line in the ambulance and ran more ecbolic
through a drip. I asked if it was ok to sleep and they said yes so I
did. I woke up every time I felt a rush of blood come out of me and
asked Sandra to check it. At one point after a check she told John the
ambulance driver to go to lights and sirens. I remember the ambulance
picking up speed dramatically and thought of my daughter up front and my
new baby inside and begged them to slow down, it seemed so unsafe to me
to be traveling so fast. I must of fallen back asleep or fainted because
my next memory was of pulling into the ambulance bay and heading up to
maternity.
I was wheeled into a LDRP (Labour, delivery, recovery and postnatal)
room and the ob on call was there to greet us. He gave me a reassuring
smile and I even mustered one back.
He began to examine me internally, thank goodness he was a small
Pakistani man with small hands, that was no fun let me tell you. He said
straight away lets get to theatre so I assumed by that the placenta
wasn’t coming out on its own. Around about then I started feeling really
bad. Sounds were fading, people seemed in the distance and I was
drifting off, I felt I was dying. I said before I lost consciousness
‘Please don’t let me die’. I wasn’t out for long and came to as they
were wheeling me out of the room. I could see my daughter and I told her
I loved her, I said look after Oscar, take care of him. I was passing
the role of his mother on to her. I wanted her to love him like I loved
him if I didn’t recover from this. I willed every last ounce of my love
into that baby, I knew he’d never remember me but I wanted to pass him
something unseen, a protection, a wish, a blessing, from mother to
child, something that would always be with him even when I wasn’t. He
was the last thing on my mind before I lost consciousness again.
Next time I came to I was in the receiving bay of the theatre. My
midwife was with me and gave me a hug, she told me they were going to
give me a general and it would be a quick operation and I’d be back out
here in 10 minutes and she’d be waiting for me, this was just before
8:30pm. I was wheeled into theatre and a female theatre staff member
started explaining what was happening, she told me just before I went
under they were going to pinch the tube down the front of my throat, I
may feel it or I may be asleep by then. I apologised for being so
grubby, I said I hadn’t had a chance to have a shower and they laughed
and said that was ok. Someone was stroking my head, it was very
soothing, then I had a warm blanket laid over me, toasty. The last thing
I remember was someone putting their fingers over my throat and saying
are you ready.
When I came too I was back up in the LDRP and my husband was there.
Another ob was explaining to him about the bleeding and that if it
started again he’d have to take the uterus. I groaned ‘no uterus’ and
they looked down at me and realised I was awake. I sort of drifted in
and out of semi sleep and said random things that kept everyone amused.
I asked if I’d had the baby yet, I couldn’t remember if I was at the
hospital to give birth or not, I couldn’t remember why I was there at
all. When I did remember why I was there I asked my husband if he’d fed
the baby and he said something like ‘yeah we offered him some toast but
he didn’t seem interested’ ha-ha so funny, not.
I found out later my 10 minute operation turned into a 3 hour operation.
I had a fairly established accreta and as the ob tried to remove it I
bled severely. When he couldn’t stop the bleeding he
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I think I’m trying Motrin tonight, and I hope for better results!