At a time when many women finish decorating their baby's nursery, mom-to-be Christy Carson was planning for the possibility that she might not survive childbirth. This is her account of being pregnant with placenta increta.
The first sign of trouble cropped up during my 20-week ultrasound. Hunched over her monitor, the radiology technician grew quiet and took an unusually large number of measurements and pictures of my unborn child. "I'll be right back," she promised as she walked out the door.
Ten minutes passed. Then a doctor walked in and, with little fanfare, told me I had placenta previa, a condition in which the birth organ covers the opening of the cervix. I'd need to have an ultrasound every two weeks, to assess any changes in its location, and stay on modified bedrest until the baby arrived.
Though I had heard of placenta previa, the diagnosis (and prescribed bedrest) wasn't easy to stomach. I had three children at home—two girls (2 and 7 years old) and a boy under 1. As much as I wanted to pick them up and be active with them, I knew I needed to follow the doctor's orders and be still. It helped that my own OB reassured me that my placenta would most likely move up before the delivery and that I'd make it to 39 weeks with no problem.
But after five weeks, my placenta hadn't budged, and subsequent imaging revealed what was really going on inside my body: My placenta was riddled with placental lakes, pools of blood that looked like Swiss cheese on scans. Worse, it had attached itself deeply into the muscles of my uterus. The condition, called placenta increta, is potentially life-threatening, and there was a distinct possibility I could hemorrhage and bleed to death before, during, or after delivery. Doctors said I'd need to deliver no later than 37 weeks.
What is placenta increta?
The placenta is an amazing organ, one our bodies produce during pregnancy to sustain new life. It develops in the upper portion of the uterus and, in most cases, stays put until it's expelled after childbirth. But occasionally, for reasons not entirely known, the organ continues growing and causes a condition called placenta accreta. The name is an umbrella term for three different levels of abnormal placental attachment. In the first and least severe level (though still potentially life-threatening), the placenta attaches firmly to the uterine wall (placenta accreta). In more severe cases, like mine, the placenta embeds into the uterine muscles (placenta increta). And in the most serious cases, the organ grows through the uterus and attaches to other organs, such as the bowels or bladder (placenta percreta).
Once rare, placenta accreta (which includes accreta, increta, and percreta cases) now occurs in 1 out of every 533 pregnancies, according to the American College of Obstetricians and Gynecologists (ACOG). Experts partially explain the rise to the increasing number of Cesarean deliveries. ACOG estimates that, if a woman has placenta previa, one prior C-section increases her odds of developing the condition by 3 percent; two boost them by 11 percent; three by 40 percent; four by 60 percent; and five by 67 percent. (I delivered my three older children by C-section, so I was especially at risk.)
Restrictions are placed on mothers during pregnancy, and childbirth is incredibly fraught: Blood transfusions are the norm—up to 90 percent of women require one, and 40 percent need more than 10 units. (To put that into perspective: The average adult has 10 pints of blood in her body, and one unit of blood is roughly equal to one pint.) And even in the most expert hands, maternal death is a possibility. Some 7 percent of women with placenta accreta have died during or immediately after giving birth. Those who do survive often require a hysterectomy.
Preparing for a Risky Childbirth
I learned all this and more as I lived, ate, and breathed the condition. My doctors didn't discourage my online research—in fact, they seemed to appreciate that I was educating myself.
I believed I could put off delivery until 37 weeks, but at 32 weeks, the specialist thought otherwise. He handed me a copy of my most recent scans and asked me to rush them to my OB (they're in the same office building). When my normally poker-faced OB saw them, he raised his eyebrows and asked, "When would you like to come in and deliver your baby? We should probably do it on a weekend, when we can assemble a team of people." We set a date for Saturday, January 25, at 9 a.m. Then he gave me a steroid shot to help my baby's lungs develop, took note of my blood type in case I needed a transfusion, and warned me that I may require a hysterectomy right after delivery. I was OK with that—by that point, I was sick of having a uterus anyway.
Over the next few days, while most women would be putting finishing touches on the nursery, I was planning for the possibility that I might not survive childbirth. My husband and I didn't have a living will, there were no directives in place. And then there was the job of preparing the kids, which was difficult because we weren't really sure what would happen. In the end, we explained that Mommy was going to have her tummy cut open and may be very sick for a while, and their baby sister would probably be sick for a while, too. Meanwhile, friends and family members were at the ready to donate blood in case I needed it.
The day of the surgery was nothing short of incredible. The operating room was three times the size of a typical surgical suite, and there were about 25 doctors and nurses on hand. Two anesthesiologists, three obstetricians, and a team of nurses tended to me, while the NICU team—two doctors and eight nurses—stood along the wall like the Queen's guard, waiting for my baby to arrive.
As the Cesarean got under way, I started feeling lightheaded and nauseated. I felt some tugging and pulling, and soon after heard someone say, "OK, she's out." Then I heard this little cry—her cry. A wave of relief washed over me. Sarah weighed just over 5 pounds. But she had trouble breathing and needed to be taken immediately to the NICU. As the nurses wheeled her out, I was able to kiss the tip of her nose and she pursed her lips in response, as if to kiss me back. I sent my husband with them and said, "Don't worry about me. Worry about the baby."
Fight for Life
Though Sarah was safe, my ordeal was far from over. From behind the blue screen, I could hear nonstop suctioning and smell my flesh being cauterized. When my husband came down to check on me, his face was as white as a ghost. I had lost 1,200 milliliters (about 2.5 pints) of blood, maybe more. Because the placenta had embedded itself into my uterine muscles, doctors had to carve out part of the uterus and sew it back together to stem the bleeding and avoid a hysterectomy. Afterward, in the recovery room, I was so weak I only had the strength to text a short message to my mother: "I'm OK. Baby's here. She has your nose."
Waves of the most intense, agonizing pain washed over me after I hit the "send" button—my spinal block was wearing off. Nurses rushed in, pulled back the sheets, and discovered I was hemorrhaging. After three Methergine injections in my thigh, the bleeding eventually stopped, and I was finally able to have some pain medicine. I was happy.
Moving On, with Hope
Postpartum recovery has had its ups and downs: Sarah was in the NICU for 11 days, mostly to develop and put on a little more weight. Because of my blood loss, I was only able to breastfeed for a couple of weeks. I relied on donated breast milk for the first six months of Sarah's life. (Now 2, she weighs an impressive 32 pounds.) The difficult delivery also had long-term implications. Ten months after my daughter was born, doctors removed my uterus. I'm taking hormone supplements and am basically going into menopause. But if going through all of that meant bringing my daughter into the world as healthy as possible, then it was all worthwhile.
I'm constantly inspired by how much my daughter fought to get where she is today. I'm also in awe of the amazing women I met in the NICU, who endured so much more than I did. No NICU stay is easy, but we didn't have the difficulties and heartache that some families had to endure. Some of the women posted pictures of their babies on their second birthday, while others posted photos of gravestones.
Through a connection on Facebook, I've also gotten involved with Hope for Accreta, a nonprofit whose goal is to raise awareness about the condition, mobilize blood drives around the country, and support women across the globe who have it. Once my kids get a little older, I plan to get them involved in helping out with blood drives. Considering the number of people who were so helpful to me, I want to find a way to give back.