QuestionHi Elayne,
I've been browsing through your answers and I am sure many women appreciate your advice. I had posted a question before and would also like to thank you for your answer. (I am sorry, I have not had the chance to rate your service. Will do so soon).
Anyway, I am planning a VBA2C (but am not pregnant yet)but I have a few concerns about the placenta positioning.
I understand that women who have undergone c-sections like myself run a slightly higher risk of having a low lying placenta or one that is in-grown at the uterine scar.
Can you comment on that? Have you come across research that can debunk any fears there?
Do you know if there are ways to prevent such an occurence, or even, if they do occur, how would I deal with them best - and best means to avoid a C-section as much as possible.
Also, I noticed your VBACs were with midwives. Do you know of any herbal remedies / natural remedies that could curb the chances of haemmorhaging? Since I have never given birth vaginally before, I have no idea about the immediate bleeding after birth. It is a concern, but a small one and hope you can advise on how to deal with it - without considering drugs.
Thanks Elayne,
Maria
AnswerThe risk of placental problems increases after each c-section because a portion of your endometrium is now covered with scar tissue and unavailable for implantation. Also, because you have that incision in the uterus, if the placenta does implant nearby, it is more likely to grow through (placenta accreta or percreta). I am not sure of the exact numbers, but I do know that they increase after each c-section, making a VBAC that much more important to your future reproductive health if you can achieve it. There is nothing specific you can do to prevent it. If you are concerned, you can have ultrasound scans to check on the placenta position, but even if you can see a low-lying placenta, accreta or percreta are not diagnosed until delivery. There's just no way to see. But rest assured that, like rupture, these problems are very rare, and logically should not be more of a concern than other, typical birth complications like cord prolapse.
If you have a very low-lying placenta that is covering or bordering the cervix (placenta previa), you will not be able to avoid a c-section. This is one of the situations where a c-section is medically necessary. In an attempt at vaginal birth with placenta previa, the placenta would be delivered before the baby, cutting off the baby's oxygen supply and killing the baby. Again, this is not a common occurrence, and in fact many women diagnosed with previa early in pregnancy grow out of it as the uterus expands and pulls the placenta away from the cervix.
There is a surprising amount of blood postpartum that is actually normal with a vaginal birth. I am constantly amazed at how much blood is okay! If you do begin to bleed out, there are several remedies that midwives have available. First, there is eating your placenta. This may not seem palatable, but your body is hormonally geared for this immediately after birth and you may find it more appetizing than you think. The placenta contains hormones that help the uterus contract and seal off the bleeding at the implantation site, which is why all other mammals eat their placenta after birth. I have heard of some women eating theirs raw, but when I did this I had a few ounces cut up and stir-fried for me. Second, there is an herb called Shepherd's Purse which can also help stop hemorrhaging. If neither of these works, pitocin is the final step. Some midwives will carry this with them to home births or have it available in a birth center, but you will have to check with your midwife to see if this is the case. If all else fails, the midwives will assist you with transport to the hospital for treatment and transfusion if needed. This is something that is always discussed in advance with out of hospital births, so that if an emergency does arise everybody knows exactly what to do and what the fastest way to the hospital is. Again, though, you will be amazed at how much blood and chunks will come out of you in the first 12-24 hours, so trust in your midwives on this one; they will know how much is too much and what to do.
