Placenta Previa: My Story of a Rogue Placenta

I'm going to skip the usual niceties reserved for my first blogs back after months of being on hiatus, except to say that yes, it has been months. Frankly, I'm starting to go a little crazy, so I had to take some time to write what's on my heart and mind after what's been a rough 6 or so weeks.

So, before I start, I guess this particular post needs just a little introduction: I'm pregnant again! Like, really pregnant - 34 weeks, to be exact. Our second baby boy #2 is due on November 2, and we could not be more excited.

This pregnancy was kind of a planned surprise. We tried to get pregnant at the end of last year, but knowing we had a trip to the Dominican Republic coming in February 2017, we put things on pause o we could both go on the trip without worrying about Zika and with a plan start trying again a few months after we'd been to the Dominican. We went on the trip, had a fabulous time, and about a week after we'd been home, we found out we were expecting. Cue my first pregnancy freakout, since I had been exposed to Zika (and you know, drank ALL THE DRINKS in the Caribbean). I saw my doctor immediately, and she confirmed the pregnancy so as to start Zika testing. Thankfully, all tests came back negative and, there is no concern that this child has been affected. (In fact, his overall size and the size of his head are off the charts, so safe to say, he is A-OK.)

I'm not so naive to think pregnancy is easy, but Liam's pregnancy was pretty smooth sailing for me. I was never sick, I felt great most of the time. Even his labor was fast and relatively easy (except for post-delivery when we had all kinds of complications). This time around, I was super sick for about 16 weeks, I got bigger, faster; I've been more tired, my back is killing me, my boobs are bricks...basically all of the aches and pains of pregnancy arrived WAY earlier this time around. And of course now, I have Liam to chase after, and at 2.5, he is BUSY and SASSY. There is just not as much time to rest and take care of myself.

All that aside, aside from the sickness, I'd had no major issues and we were so looking forward to our 20-week ultrasound to find out baby's gender, and of course, make sure he's healthy. We found out it was a BOY (yay!) and he looked perfect. But of course, with the good news came the bad: they found that I had complete placenta previa and potential placenta accreta.

For those totally unfamiliar, placenta previa is where, instead of the placenta growing and attaching to the top or side of the uterus, it's low-laying. There are varying degrees of previa, but in my case, complete placenta means my placenta is completely covering my cervix. In other words, a vaginal birth is off the table because the placenta is blocking any way for the baby to get out. PP affects about 1 in 200 women, and the biggest symptom is painless bleeding. However, the bleeding poses big risks, as it can often be uncontrolled, result in preterm labor or hemorrhage. Placenta previa pretty much guarantees a C-section, usually at 37 weeks, because any contractions or dilation could cause the placenta to pull away from my uterus leading to severe bleeding.

In many cases—in fact, something like 95% of the time—the placenta moves before delivery, sometimes as late as 34 weeks. So, even though I was really upset and shaken at receiving this news, and I don't love the idea of a c-section, my doctor assured me that hope was not lost. She told me not to Google anything, call if I saw any bleeding, and we left the appointment hopeful that we had 20 full weeks for things to change.

In the meantime, I was put on "pelvic bed rest" (no sex or orgasms, as they cause uterine contractions), and given additional restrictions of no exercise, no heavy lifting, and to call if I experienced any bleeding, even if spotting.

We had another ultrasound at 28 weeks to see if anything had changed with the location of my placenta, and unfortunately, it was still solid across my cervix. But, baby looked great, measuring at 32 weeks (4 weeks ahead of his gestational age), super active and healthy. I carried on with our life and pregnancy, blissfully unaware of the real risks and symptoms of previa. Until...

29 Weeks: First Bleed

One week later, on August 19, we'd just gotten home from our regular Saturday routine of soccer, the park and lunch. Liam had just gone down for a nap, and I was laying down to do the same.

Disclaimer: Gory detail/TMI to follow. Read at your own discretion.

I suddenly felt a warm, unfamiliar, gush between my legs. I jumped out of bed to find blood pouring from between my legs. Pouring is not an understatement. I wish I could say I remained calm, but in fact, I had quite the opposite reaction. I freaked the fuck out.

Hysterical, I ran from our room upstairs, looking for Bryan. I couldn't find him, so back downstairs I went. I was moving as quickly as I could, completely hysterical, but also trying to be quiet so as not to wake up Liam. As blood continued to gush, I slipped in it, and fell down the second flight of stairs. No Bryan. To the first floor I went, and still no Bryan. (Our new home has 4 stories. Did I mention we also moved?)

Completely panicked, I ran back up stairs and found my phone in the kitchen. At this point, I was dizzy, nauseous and scared I was going to pass out. I called Bryan, who as it turns out, was upstairs on the deck the whole time. He heard my hysteria and came running. I heard him fall down the stairs, too, slipping in my blood, and the look on his face when he saw me was something I'll never forget. I mean, here I was, legs, hands, feet covered in blood, and the house looked like a crime scene. He told me to lay down and called 911. Shaking, hysterical and trying to stay conscious, I did as I was told.

This whole event, while it felt like an hour, was probably only 5 minutes. The ambulance was there within minutes, and I was taken to the nearest hospital, which, while not "my hospital" was just around the corner. They hooked me up immediately to monitors and to do an ultrasound, which were being finicky and not working, but soon, we could see that the baby's heart was beating—he was OK.

Meanwhile, I was watching in horror as the doctors pulled about 6 blood clots the size of golf balls from me. I lay there, trying not vomit, trying to breathe, trying to stay calm knowing that baby was fine, but not knowing if I was. Was I dying? Was I going to have to deliver the baby? I was being shoved paperwork to sign in case of an emergency c-section, while nurses and anesthesiologists jammed needles into my arms looking for veins and explaining in no uncertain terms that I may have to be put under general anesthesia if we did have an emergency c-section.

After a short while, they determined that I was not actively bleeding anymore; my cervix was still closed, and the clots were removed. As I stabilized, we learned that the hospital we were at was not a equipped to take babies younger than 32 weeks, and that, while they could do an emergency c-section if necessary, they were also not really considered a great obstetrics hospital. For reasons I couldn't understand, it was not logistically possible to be transferred to "my" hospital, so I was transferred to another hospital with a Level 3 NICU, and a very good group of Maternal Fetal Medicine Doctors.

Over the next 48 hours, I continued to stabilize and bleed, stabilize and bleed. The bleeds were much smaller and controlled than the first one I experienced, but each one was terrifying. I received a round of steroids for the baby's lung development and I was also given magnesium, which can help prevent things like cerebral palsy, in addition to slowing labor. Receiving the magnesium was one of the craziest things ever. They give it to you via IV and they start by giving you a LOT and then on a slow drip for 12 hours. The first 20 minutes, your body gets SUPER hot and you basically feel like you're severely tripping. It made me feel really yucky, but once I got through that first part, it wasn't terrible.

Finally, I had been stable for long enough that they moved me from Labor & Delivery up to the antepartum floor, which is where they keep women who are pregnant and need monitoring, like me; women who gave birth but have babies in the NICU, or women who may have lost a baby. I was ecstatic to move, as I could finally eat, drink and be in a more comfortable bed.

Over the next 4 days, I stayed in the hospital for monitoring. We talked to several teams of doctors - the high-risk doctors who would deliver the baby if necessary; neonatalogists, who explained what to expect delivering so early; perinatal counselors, who came to provide emotional support, and even a couple of oncology doctors, as they will be the team to do a hysterectomy, if necessary.

This is probably a good place to pause and explain that part. In addition to the previa, there is a chance I have placenta accreta, which is basically when the placenta is attached too deeply to the uterine wall. Since you have to deliver the placenta after the baby, obviously if it's deeply attached, it makes that task more difficult, and dangerous for mom because of risk of hemorrhage. It's hard to tell if you have it until are in there, but if you do have this condition, it's possible that instead of even trying to remove the placenta, it's safest to just take out the entire uterus, with the placenta attached.

They did say they don't think that will happen, but they're preparing for every scenario, so we met with that team and talked to them in the event that I do need a hysterectomy.

Needless to say, that period of 5 days in the hospital was a lot to digest. When it was time to go home, I was a complete mess.

Hop on board the emotional roller coaster

The worst part about this condition is the not knowing. You don't know when you're going to bleed, where you're going to bleed, IF you're going to bleed, or how much. For us, while my doctor talked to us about bleeding, it was always just "call if you bleed, even a little." There was no discussion of, 'Oh hey, by the way, if you start gushing blood from your vagina, don't freak out. It's 'normal!'" So when it happened, Bryan and I had no idea what was happening, or what to do, and we thought the worst.

Leaving the hospital, we were of course, much more educated. We made plans for every possible scenario. I was terrified, but tried my best to just take comfort in the fact that every day I stayed pregnant and didn't bleed was a win.

At home, I worked from home during the weeks, which has been a great distraction. I worked from bed and took it easy as best I could. We had a ton of people bring us meals so I didn't have to cook dinner. I did what I could with Liam, when he would let me. (This whole thing has brought on a whole new level of Daddy obsession, but that's another post). Physically, I was doing great. Mentally, has been a completely different story.

Every ache and pain brings panic. Every time I sit down to go to the bathroom, every time I feel anything down there, I panic. I have difficult sleeping, scared I'll wake up to another bleed. Everyone keeps telling me I'm doing a "great job," but honestly, I don't feel like I'm doing anything. All of this is completely out of my control.

So, we watched and waited. I celebrated every day, and when I made it to 32 weeks with no issue, I was ecstatic. (You see, babies born after 32 weeks have a 98% survival rate.)

Second bleed: 33 weeks

33 weeks arrived for us, and again—it was a normal day. We went to the doctor's office, in fact, and spent about 3 hours for our prenatal visit, getting an ultrasound and non-stress test. The ultrasound and non-stress test showed our big, healthy boy. My placenta was still showing as completely covering my cervix, so we said we'd see the following week what it showed before scheduling anything. We were so happy to have made it to that point, and to see that our boy was already 6 lbs, 11oz at just 33 weeks (give or take a few pounds).

We got home with a little time to spare before we needed to pick up Liam. I went to the bathroom and had just started to go upstairs when I felt a familiar gush. Sure enough, I reached down and found blood on my fingers. I got to my knees and called for Bryan. I was so much more calm this time, and so was he. He called the doctor, while I made my way to the bathroom. I sat on the toilet while blood and clots exited my body. I remembered to breathe while we waited for the doctor to see what to do. After about 10 minutes of bleeding, and no call back from the doctor, we got in the car and headed to the hospital. Given that it was rush hour, and the amount of blood I had lost already, while the bleeding had slowed, it was still substantial enough that I felt the safest call was to go to the same hospital where I was taken last time, about 5 minutes from home. 

I got admitted and hooked up to monitors right away. Again, baby was fine, my bleeding had slowed with the exception of a few clots, and I was given another steroid shot for baby's lungs. We waited for a couple of hours to see what was happening, if anything, and once stable, I was transferred up to my hospital. I was super relieved to leave.

Labor & delivery was crowded that night, so Bryan and I had to hole up in a recovery room, while we watched women in labor cycle in and out. They were happy, excited. They had babies on the way! I resented every single one, as I lay there, crying through labor pains in my stomach and back, urinating in a bedpan and praying for an answer, one way or another.

They finally gave me something for the pain and to sleep, in hopes of slowing my contractions. I was finally able to relax and sleep, and as a result, my contractions stopped, and they felt comfortable moving me up to antepartum again.

To stay or to go?

Again, for the next four days. I was hooked up to fetal monitors, strapped into compression boots to prevent blood clots, and given steroids for baby's lungs. I had blood drawn frequently and IVs shoved into veins which kept collapsing, causing pain and discomfort. I had no more bleeding and baby continued to look perfect. As the doctor's talked about letting me go home, I was a complete basket case. They told me they saw no reason I couldn't go home and ride out the rest of my pregnancy, but they said if I really, really wanted to, I could stay in the hospital until delivery.

I agonized over the decision. My fear was not of bleeding again, or even of the baby coming early. My fear was—is—not that would I bleed again, but that I would hemorrhage and there would be no time to get to my hospital and doctors. Instead, an emergency situation would bring me to the same place I'd been taken two times already, where I did not feel I or my baby was a priority, or that they were a reliable resource to care for us in an emergent situation. So, did I go home and hope for the best? Or stay put where I knew I would be in a safe place with providers who knew us and our situation, with an amazing NICU to care for what would definitely be a premature baby?

My gut was telling me that I should stay in the hospital, but I really, really, didn't want to listen. Who would want to stay in the hospital for 3 weeks voluntarily? How could I leave Liam and not see him every day? Could Bryan handle it? Who would come help? What would happen to work? How would all the things get done if I wasn't there? Of course, in my heart I knew that everyone would be fine, and everything would get done. Friends and family would rally, Bryan and Liam would visit. It would all be OK.

After a long conversation with my doctors, they came together and decided that based on my lack of bleeding since I'd arrived at the hospital, and the size of the two bleeds I'd had, my risk of having an unmanageable bleed before our scheduled C-section was low. Not completely out of the realm of possibility, of course, but low. And further, the doctors recognized my strong desire not to deliver at the hospital around the corner, but said that if push came to shove, they had faith that me and baby would be just fine. So,  I decided to come home.

Now what?

Now that I've rambled for pages and pages about WHAT I've dealing with, let's get to HOW I've been dealing. Because I'll tell you, the physical challenges of have been minuscule compared to the mental challenges.

The worst part about placenta previa is the not knowing.

You don't know when you're going to bleed, or if you're going to bleed. Some women bleed once, then never again. Some have multiple bleeds and are hospitalized for majority of their pregnancy.
You don't know where you're going to bleed. You could be at a public restaurant, or sleeping in bed.
You don't know how much you're going to bleed. Some women go through their whole pregnancy with zero issue. Some women spot throughout their pregnancy. Some women have multiple, huge bleeds.
There are no signs that you're going to bleed. As cruel luck would have it, they happen when you're inactive most of the time. For one of my bleeds, I felt a cramping before it happened. The other time, it was while I was sleeping. Literally doing nothing.
There is nothing you can do to prevent bleeding. Sure, doctors put you on pelvic rest. Some put you on bed rest. But, the reality is, there is actually no research that bed rest has any benefit, and there is even more research that says it has the opposite effect. So, you just "take it easy." You have restrictions. No exercise. Sit more than you stand. Don't bend. Don't lift. Don't walk far. You can leave the house, but only if you drive, and and only if you are sitting where you drive to.
I'm scared, anxious and paranoid... all of the time. Any ache or pain makes my mind whirl. If I feel any fluid of any sort "down there," I panic. Every time I sit on the toilet, I hold my breath until I see what's on the toilet paper. I hate being alone. I hate leaving the house. Every moment, I am thinking about my "plan" if I were to start bleeding right then and there.
I can't sleep. Any time my mind has a quiet moment, my mind is racing. I imagine worst-case scenarios, like hemorrhaging during my c-section, and dying. If I manage to sleep, I inevitably wake to go to the bathroom and if my mind is awake for more than 1 minute, I'm doomed.
I feel like I'm being a baby. Everyone tells me I'm "so strong" and I'm doing "so great". I feel like I'm not doing anything.
I feel guilty about everything. I'm a part of support groups of other women going through this and reading some of their experiences, I know I'm lucky. I think of friends who, while they didn't have previa, have had other unimaginable outcomes, like losing their babies. I know things could be so much worse. I feel guilty for wishing this pregnancy away at the beginning (in a "hurry up, I'm over being pregnant" sense), and feel like the universe is getting me back now that all I need is to stay pregnant. I feel guilty for wanting this all to be over. I feel guilty I can't do things 100 percent. I feel guilty I can't be a better mom or wife or friend right now. I feel guilty for getting annoyed when people ask me how I am, or tell me I'm strong.
I'm grieving for this pregnancy...and future pregnancies. This is not how things were supposed to go. This is not how I wanted or planned to spend our last weeks and months as a family of three. I have been so consumed by anxiety and worry, I have not been able to enjoy this pregnancy, I've just wanted it to be over. And not only that, this might be my last pregnancy. The chance of a hysterectomy is small, but given my complications the past two pregnancies, I honestly don't know if I can go through it again. That makes me sad, too.

I could go on, but half of the reason I wrote this post is to try and close the door on these feelings. I am trying to shift perspective as best as I can as we near the end of all of this.

First and foremost - our baby is doing so great. He has been unaffected by everything going on, and for that, we are thankful. I know he will be OK, no matter what.
Second, what will be will be. Yes, I can do my part to try and prevent another bleed, but the reality is, if it's going to happen, it's going to happen. I can't control that. This story is already written.
I need to give myself grace and allow myself to feel.
I need to be kind to myself, and rest.
I need to lean on my husband and family and friends to HELP me, instead of being stubborn and resisting.
And to that end, the amount of support we've received from people these past couple of months has been so humbling. Family has traveled to and from Iowa, and back again, to help us with Liam and Addy, and just to be here for us. Friends and strangers have brought us food. People I haven't spoken to in ages have reached out to let me know they are praying for us, or to share a similar experience with a positive outcome.
I need to leave my "support" group of women who are also experiencing this, because I get lost in their posts and stories, and that doesn't help my mindset. Their stories and experiences are not mine.
I will count my blessings, of which there are many.

We had our 34 week appointment last week, and my placenta is still in place over my cervix. (This puts me in the lucky 5 percent of women who don't have a resolved previa). Not only that, but it's also in front, along with the umbilical cord. {insert eyeroll} That basically means that baby needs to get out ASAP because they will have to cut through both the placenta and umbilical cord to get him out. In other words, there will probably be a lot of blood and baby will need oxygen immediately.

We scheduled our c-section for 36 weeks, 0 days, on October 5, 2017. 10 days from today. TEN DAYS. Although it feels like a lifetime and like anything could happen between now and then, 10 days is ideally all that separates us from this nightmare of a third trimester being over, and meeting our baby boy.

I'm terrified about the c-section, but know it's the best (and only) option to get our babe here quickly, and I'm thankful the docs know what they're walking into. They will have all teams in place to get the baby out safely and quickly, and to get me put back together in the same manner.

I know all too well that this next phase of life will bring its own challenges. Not only with having a new baby, but all of us adjusting to life as a family of four. I will be able to soon look back on this period of time and think of all it taught me. I'm sure I will even long for the opportunity to rest without judgment.

Does anyone else have experience with placenta previa?

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