Andrea has twelve children, of whom seven were born at home. Her eleventh baby was born by caesarean, and her twelfth arrived at home. However, the third stage was complicated by a retained placenta, and Andrea lost a lot of blood. You may find this story distressing to read; Andrea has written Oscar's positive birth story separately from the Afterbirth story so that you can read one without the other, if you wish.
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.
Note: placenta accreta means that the placenta has grown too far into the walls of the uterus, so that it cannot detatch safely after the baby has been born. With the placenta still inside, the uterus cannot contract down. If the placenta partly detatches, but not enough to be delivered, then the mother can haemorrhage badly. This condition can be life-threatening and is a major reason for post-birth hysterectomy. It is most common in women who have a prior caesarean section, where the placenta grows over the scar on the uterus and grows deeply into the scar tissue and beyond.
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. Peter 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 Peter 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 Tessa (13) to call Sandra 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 Peter 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 'Peter 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 Peter and Tessa for the scissors out of the medical kit and some wool. 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.
Sandra 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 synto and a few 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 Tessa and midwife Sandra came with me in the ambulance. Tessa rode up front - she came to look after Oscar, as Peter needed to settle things at home before he could follow. He other midwife took her car and followed us.
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 Tessa up front and my new baby inside and begged them to slow down; it seemed so unsafe to me to be travelling so fast. I must have 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 Tessa 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. Sandra 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 Peter 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. Peter said at one stage "I don't know what drugs they gave you but I want some". 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 Peter 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 called in a second obstetrician, and they both worked on me until midnight. They finally got the blood to stop and gave me half an hour and if it started again they were out of options and were going to take my uterus. I lost around 3000mls all up, most of which was during the operation, and required 7 blood transfusions. I was told that the accreta may or may not have had anything to do with my pervious c/section; it wasn't near the scar and was mainly a fundal accreta, but I do wonder what scarring or damage was done during my c/section when my last anterior placenta was manually removed during the operation.
I spent the next day recovering and coming to terms with what had happened. I was pretty weak and groggy for a good 24 hours afterwards. The staff were brilliant at helping me care for Oscar who,, aside from the separation during the operation in which he stayed with my daughter and husband, was kept with me the whole time. They passed him to me when I wanted to cuddle and feed him, tucked him up beside so he could sleep with me. One lovely midwife helped me trim his cord which I'd left really long and was still bound with wool. It has started to seep and he lost a few mls of blood into his nappy from it so she brought a clamp and let me trim it up closer. When Sandra came to see me a few hours later we took it of as it had done its job by then. Everyone was very respectful of us and very caring, I had great postoperative care, but by day two I was itching to get home. I had my last IV line removed around dinner time on day 2 and I was out of there. I picked up my prescriptions (iron and antibiotics) and headed home.
A week on from the birth I have to say I am feeling great despite what I went through. My hb is back into the 90's (which is normal for me) I don't feel too tired, in fact I feel fairly energised and bouncy. Amazing what nearly losing your life will do for your appreciation of things you'd once find exhausting. My milk has been a little slow to come in, a fairly common occurrence after I large blood loss I've been told, but Oscar is a content little baby, sleeping well and feeding well. He's a complete delight and I'm feeling very blessed to still be around to appreciate and love him.
Oscar's birth story
Lydia's birth story
Seth's birth story
Grand Multiparas and home birth Home birth after caesarean
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